Evaluation of a novel closed-loop total intravenous anaesthesia drug delivery system: a randomized controlled trial

Hemmerling, Thomas M.; Arbeid, Erik; Wehbe, Mohamad; Cyr, Stéphane; Taddei, Riccardo; Zaouter, Cédrick

doi:10.1093/bja/aet001

Cited by 104 publications

(59 citation statements)

References 20 publications

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“…Two devices have already been validated: EasyTIVA ® (Medsteer ® , Suresnes, France) [8,9] and McSleepy ® (McGill university, Québec, Canada) [44]. The analgesic targets differ between these two devices: EasyTIVA ® targets specific changes in a EEG-derived signal that has been related to nociception during surgery under propofol anaesthesia [39], and hence infers therapeutic changes implemented by an automated syringe pump administering a short acting opioid: remifentanil [51].…”

Section: Closed-loop Opioid Administrationmentioning

confidence: 99%

Closed-loop Administration of General Anaesthesia: From Sensor to Medical Device

Jeanne

Tavernier

Logier

et al. 2017

Pharmaceutical Technology in Hospital Pharmacy

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AbstractClosed-loop administration devices for general anaesthesia have become a common subject of clinical research over the last decade and appear more and more acceptable in clinical practice. They encompass various therapeutic needs of the anesthetized patient, e. g. fluid administration, hypnotic and analgesic drug administration, myorelaxation. Multiple clinical trials involving closed-loop devices have underscored their safety, but data concerning their clinical benefit to the patient are still lacking. As the marketing of various devices increases, clinicians need to understand how comparisons between these devices can be made: the measure of performance error and wobble are technical but have also a clinical meaning, to which clinical outcomes can be added, such as drug consumption and maintenance of hemodynamic parameters (e. g. heart rate and blood pressure) within predefined ranges. Clinicians using closed-loop devices need especially to understand how various physiological signals lead to specific drug adaptations, which means that they switch from decision making to supervision of general anaesthesia.

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Section: Closed-loop Opioid Administrationmentioning

confidence: 99%

Closed-loop Administration of General Anaesthesia: From Sensor to Medical Device

Jeanne

Tavernier

Logier

et al. 2017

Pharmaceutical Technology in Hospital Pharmacy

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“…Two components of spectral entropy are calculated: response entropy (RE) and state entropy (SE). RE is computed from EEG and electromyography (EMG) frequencies in the range of 0.8- 47 Hz. An increase in the EMG frequency is an indicator of patient arousal, for example, in response to nociception stimulation.…”

Section: Eeg-based Monitors Of Depth Of Anesthesiamentioning

confidence: 99%

Current Status of EEG-Based Depth-of-Consciousness Monitoring During General Anesthesia

Musialowicz

Lahtinen

2014

Curr Anesthesiol Rep

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Monitoring the level of consciousness during general anesthesia with processed electroencephalogram (EEG) monitors has become an almost routine practice in the operating room, despite ambiguous research results regarding its potential benefits. For the patient as well as the anesthesiologist, the primary concern with respect to general anesthesia is that there will be a lack of awareness and recall during surgery. Using EEG signals to monitor the depth of anesthesia should reduce the incidence of intraoperative awareness, lead to a reduction in drug consumption, prevent anesthesia-related adverse events, and enable faster recovery. These benefits have been associated with depth-of-anesthesia monitoring in small clinical trials, but larger studies of EEG-based monitoring have failed to confirm the results of the smaller studies. The results of recent studies that investigated the emergence of consciousness after general anesthesia and the mechanism of action of anesthetic drugs on the central nervous system may help us to understand the limitations of EEG-based monitors and why they do not perform better in large clinical trials. In this article, we review the current status of monitoring the hypnotic component of general anesthesia and discuss the results of recent studies and guidelines that pertain to depth-of-anesthesia monitoring.

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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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Evaluation of a novel closed-loop total intravenous anaesthesia drug delivery system: a randomized controlled trial

Abstract: The closed-loop system was better at maintaining BIS and Analgoscore than manual administration.

Cited by 104 publications

References 20 publications

Closed-loop Administration of General Anaesthesia: From Sensor to Medical Device

Closed-loop Administration of General Anaesthesia: From Sensor to Medical Device

Current Status of EEG-Based Depth-of-Consciousness Monitoring During General Anesthesia

Automation of anaesthesia: a review on multivariable control

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