Model-based automatic feedback control versus human control of end-tidal isoflurane concentration using low-flow anaesthesia

Sieber, T.; Frei, C.W.; Derighetti, M.; Feigenwinter, P; Leibundgut, D.; Zbinden, A. M.

doi:10.1093/bja/85.6.818

Cited by 31 publications

(16 citation statements)

References 18 publications

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“…[5] The ET concentration of an inhalational anesthetic closely represents the brain concentration and thus is an indirect measure of depth of anesthesia. [6]…”

Section: Discussionmentioning

confidence: 99%

Cost efficiency of target-controlled inhalational anesthesia

Potdar¹,

Kamat²,

Save³

2014

J Anaesthesiol Clin Pharmacol

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Background:Cost and environmental pollution are two prime concerns with general anesthesia. We hypothesized that target-controlled (TC) anesthesia drug delivery system also called as end-tidal (ET) control is an effective and safe system that would reduce the cost and also environmental pollution.Materials and Methods:We studied 200 patients undergoing laparoscopic abdominal and pelvic surgeries and randomly distributed those in 2 groups of 100 each, TC and manual-controlled (MC) group. We reviewed the two groups in term of consumption of gases, time required to achieve the ET concentration of sevoflurane of 1.5%, maximum inspired concentration of sevoflurane achieved, and number of adjustments required to maintain the depth of anesthesia.Results:We found that the consumption of nitrous oxide and sevoflurane was significantly less in TC group than MC group (P < 0.05), oxygen consumption was also less in TC group but not statistically significant. The time required to achieve the desired levels, maximum inspired sevoflurane concentration achieved, and the number of drug delivery adjustments required were statistically significant in TC group (P < 0.05). As the consumption reduced in TC group, the cost of the inhalational anesthesia reduced by approximately Rs. 64/h ($1.12) and thus the environmental pollution.Conclusion:We concluded from our study that ET control is a good system for conserving the consumption of gases and thus is efficient as it reduces both the cost and the environmental pollution.

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“…[5] The ET concentration of an inhalational anesthetic closely represents the brain concentration and thus is an indirect measure of depth of anesthesia. [6]…”

Section: Discussionmentioning

confidence: 99%

Cost efficiency of target-controlled inhalational anesthesia

Potdar¹,

Kamat²,

Save³

2014

J Anaesthesiol Clin Pharmacol

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“…There is an increasing interest in computerized closed-loop control of medication infusion for critically ill patients by virtue of its potential for delivery and continuous monitoring of high-quality treatment [1][2][3] and alleviation of caregivers' workload. 4,5 Indeed, closed-loop control of anesthesia, [6][7][8] vasopressor infusion, 9 and fluid resuscitation [10][11][12] has been an active area of research for a few decades.…”

Section: Introductionmentioning

confidence: 99%

Coordinated semi‐adaptive closed‐loop control for infusion of two interacting medications

Jin

Kim

Shipley

et al. 2017

Adaptive Control & Signal

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SummaryThis paper presents a coordinated and semi-adaptive closed-loop control approach to the infusion of 2 interacting medications. The proposed approach consists of an upper-level coordination controller and a lower-level semiadaptive controller. The coordination controller recursively adjusts the reference targets based on the estimated dose-response relationship of a patient to ensure that they can be achieved by the patient. The semi-adaptive controller drives the patient outputs to the reference targets while estimating the patient's dose-response relationship online. In this way, the controller is resilient to unachievable caregiver-specified reference targets and responsive to the medication needs of individual patients. To establish the proposed approach, we developed the following: (1) a linear two-input-two-output dose-response model; (2) a two-input-two-output semi-adaptive controller to regulate the patient outputs while adapting high-sensitivity parameters in the patient model; and (3) a coordination controller to adjust the reference targets that reconcile caregiver inputs and medication use. The proposed approach was applied to an example scenario in which cardiac output and respiratory rate are regulated via infusion of propofol and remifentanil in an in silico simulation setting. The results show that the coordinated semi-adaptive control could (1) track achievable reference targets with consistent transient and steady-state performance and (2) resiliently adjust the unachievable reference targets to achievable ones.

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“…Studies investigating the efficacy of closed-loop medication infusion relative to manual medication infusion suggest that the former performs as well as, or sometimes even outperforms, the latter in sticking to the specified target clinical endpoint in anesthesia care [1][2][3], vasopressor therapy [4], and fluid resuscitation [5][6][7]. Studies investigating the efficacy of closed-loop medication infusion relative to manual medication infusion suggest that the former performs as well as, or sometimes even outperforms, the latter in sticking to the specified target clinical endpoint in anesthesia care [1][2][3], vasopressor therapy [4], and fluid resuscitation [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

A semi‐adaptive control approach to closed‐loop medication infusion

Jin

Kim

Dumont

et al. 2016

Adaptive Control & Signal

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This paper presents a semi-adaptive control approach to closed-loop medication infusion problems. The rationale underlying this approach is to design a controller that can adapt model parameters with a large impact on the model's fidelity while fixing the remaining parameters at nominal values. In this paper, a control-oriented model for this purpose is derived via system identification and sensitivity analysis of a loworder model capturing the direct dose-response relationship Using the model thus derived, a model-reference adaptive controller and a composite adaptive controller are designed and compared with each other. In-silico simulation results using remifentanil's effect on respiratory rate as an example indicate that both controllers can regulate the output at commanded set points.

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Model-based automatic feedback control versus human control of end-tidal isoflurane concentration using low-flow anaesthesia

Cited by 31 publications

References 18 publications

Cost efficiency of target-controlled inhalational anesthesia

Cost efficiency of target-controlled inhalational anesthesia

Coordinated semi‐adaptive closed‐loop control for infusion of two interacting medications

A semi‐adaptive control approach to closed‐loop medication infusion

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