Bi-spectral index guided closed-loop anaesthesia delivery system (CLADS™) in pheochromocytoma

Hegde, Harihar V; Puri, Goverdhan D; Kumar, Bhupesh; Behera, Arunanshu

doi:10.1007/s10877-009-9181-0

Cited by 19 publications

(9 citation statements)

References 17 publications

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“…37 The most frequently used control signal has been the Bispectral Index (BIS). 7-9,11,13,14,17,18,21-23,38-40 Other control signals have included a wavelet-based index, 12 entropy measures, 16 an auditory evoked potential index 15 and the spectrogram median frequency. 24-26 These systems have been constructed with standard and nonstandard control paradigms 15,16,23,24,40 and used principally to control unconsciousness.…”

Section: Discussionmentioning

confidence: 99%

“…24 In contrast, several of the studies that used BIS as the control signal defined successful control as a BIS value between 40 to 60, and reported BIS time courses averaged across subjects. 7-9,11,13,14,17,18,21-23,38-40 Control using BIS as a control signal is achieved with a 20- to 30-s delay required to compute the BIS updates. 41 Those CLAD systems that have been developed to study burst suppression have also only shown results for time courses averaged across subjects.…”

Section: Discussionmentioning

confidence: 99%

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Real-time Closed-loop Control in a Rodent Model of Medically Induced Coma Using Burst Suppression

et al. 2013

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Background A medically-induced coma is an anesthetic state of profound brain inactivation created to treat status epilepticus and to provide cerebral protection following traumatic brain injuries. We hypothesized that a closed-loop anesthetic delivery system could automatically and precisely control the electroencephalogram state of burst suppression and efficiently maintain a medically-induced coma. Methods In six rats, we implemented a closed-loop anesthetic delivery system for propofol consisting of: a computer-controlled pump infusion, a two-compartment pharmacokinetics model defining propofol’s electroencephalogram effects, the burst suppression probability algorithm to compute in real time from the electroencephalogram the brain’s burst suppression state, an on-line parameter estimation procedure and a proportional-integral controller. In the control experiment each rat was randomly assigned to one of the six burst suppression probability target trajectories constructed by permuting the burst suppression probability levels of 0.4, 0.65 and 0.9 with linear transitions between levels. Results In each animal the controller maintained approximately 60 min of tight, real-time control of burst suppression by tracking each burst suppression probability target level for 15 min and two between-level transitions for 5 to 10 min. The posterior probability that the closed-loop anesthetic delivery system was reliable across all levels was 0.94 [95% confidence interval; (0.77 to 1.00) n = 18] and that the system was accurate was 1.00 [95% confidence interval; (0.84 to 1.00) n = 18]. Conclusion Our findings establish the feasibility of using a closed-loop anesthetic delivery systems to achieve in real-time reliable and accurate control of burst suppression in rodents and suggest a paradigm to precisely control medically-induced coma in patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Real-time Closed-loop Control in a Rodent Model of Medically Induced Coma Using Burst Suppression

et al. 2013

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“…In recent years, a few clinical studies of closed-loop control have been done and have shown to outperform manual administration of drugs [33,36,39,58]. However, these controllers were designed based on subjective clinical experience rather than optimization of the process.…”

Section: Closed-loop Applicationmentioning

confidence: 99%

Automation of anaesthesia: a review on multivariable control

Chang

Syafiie

Kamil

et al. 2014

J Clin Monit Comput

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Anaesthesia is a multivariable problem where a combination of drugs are used to induce desired hypnotic, analgesia and immobility states. The automation of anaesthesia may improve the safety and cost-effectiveness of anaesthesia. However, the realization of a safe and reliable multivariable closed-loop control of anaesthesia is yet to be achieved due to a manifold of challenges. In this paper, several significant challenges in automation of anaesthesia are discussed, namely model uncertainty, controlled variables, closed-loop application and dependability. The increasingly reliable measurement device, robust and adaptive controller, and better fault tolerance strategy are paving the way for automation of anaesthesia.

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“…Recently, they compared the accuracy of their system with manual control during cardiac surgery and concluded that automated control was safe, efficient and performed better than manual control [61 ]. Additionally, they proved the feasibility of their system during pheochromocytoma surgery [62].…”

Section: Closing the Loopsmentioning

confidence: 99%

Administration and monitoring of intravenous anesthetics

Sahinovic

Absalom

Struys

2010

Current Opinion in Anaesthesiology

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Bi-spectral index guided closed-loop anaesthesia delivery system (CLADS™) in pheochromocytoma

Abstract: CLADS performed well in patients undergoing pheochromocytoma surgeries which represent one of the few clinically extreme situations.

Cited by 19 publications

References 17 publications

Real-time Closed-loop Control in a Rodent Model of Medically Induced Coma Using Burst Suppression

Real-time Closed-loop Control in a Rodent Model of Medically Induced Coma Using Burst Suppression

Automation of anaesthesia: a review on multivariable control

Administration and monitoring of intravenous anesthetics

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