Closed-loop systems for drug delivery

Fields, Aaron M.; Fields, Kevin M; Cannon, Jeremy W.

doi:10.1097/aco.0b013e3283007ecc

Cited by 13 publications

(5 citation statements)

References 29 publications

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“…With the advancement of accurate non-invasive continuous blood pressure and cardiac output monitors, the creation of a closed loop system able to deliver anesthetics and vasoactive medications based upon optimization of hemodynamics may be on the horizon. The goal is to create multiple-input multiple-output controllers able to integrate input from several sources in order to maintain adequate anesthesia and cardiovascular stability [38] ultimately improving patient safety, morbidity and mortality.…”

Section: Discussionmentioning

confidence: 99%

Impact of non invasive and beat-to-beat arterial pressure monitoring on intraoperative hemodynamic management

Chen

Chung

Meng

et al. 2012

J Clin Monit Comput

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The Nexfin device allows for non-invasive beat-to-beat blood pressure monitoring (BP(NXF)). Perioperative hypotension and hypertension have been shown to be associated with poor clinical outcomes. The goal of the present study was to assess the ability of this device to decrease the duration of significant intraoperative hypo- or hypertension compared to standard BP monitoring by cuff (BP(CUFF)). We studied25 patients (ASA I-III) undergoing either abdominal or orthopedic surgery. BP(CUFF) was monitored every 5 min from the introduction of anesthesia, while BP(NXF) was monitored continuously on the opposite arm. When systolic BP(NXF) (SBP(NXF)) decreased or increased more than 20% relative to baseline SBP(NXF), a standard BP(CUFF) measurement was taken to compare values. In addition, the time interval between the 20% change in SBP(NXF) and the next scheduled standard SBP(CUFF) measurement was recorded for each event. The mean length of surgery was 3.0 ± 0.3 h. Patients presented with 11 ± 4 episodes of hypotension and 12 ± 4 episodes of hypertension during the surgery. If BP(CUFF) had been used, this would have resulted in 21 ± 7 min of hypotension and 20 ± 10 min of hypertension. If hemodynamic changes seen by SBP(NXF) were appropriately treated, an average of 7 ± 1 min/h of hypotension time, 7 ± 2 min/h of hypertension time and 14 ± 3 min per hour of hypo- or hypertension time may have been identified. The Nexfin BP has the potential to decrease the time of hypotension and hypertension compared to conventional intermittent BP(CUFF) monitoring. Therefore, this device has the potential to positively impact clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

Impact of non invasive and beat-to-beat arterial pressure monitoring on intraoperative hemodynamic management

Chen

Chung

Meng

et al. 2012

J Clin Monit Comput

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“…Closedloop systems will automate anesthesia care in the near future [52]. Paper [53] presents an interesting perspective from a clinical point of view of automated systems in anaesthesia. It suggests that the future anesthesiologist may devote less time to easily delegated tasks when in the operating room, using the ability of computers to maintain variables in a set range allows some tasks to be automated.…”

Section: Discussionmentioning

confidence: 99%

Towards automation in anaesthesia: A review

Nunes

2014

2014 IEEE International Symposium on Medical Measurements and Applications (MeMeA)

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Surgeries represent a risk for patients and a big cost for the hospital. Anaesthesia represents a complex part of surgery also carries risks for patients. The most known are awareness (with deep psychological consequences); increased risk of morbidity and mortality; adverse reactions and long post-op recovery. The complexity of anaesthesia management can be reduced by studying the patients' responses and developing indicators of the patient state. To assess the level of depth of anaesthesia, the anaesthetist needs to be aware of the patient physiological responses to the drugs and to surgical stimuli. A system that could advise on the patient state considering all clinical signs being measured, the patient individual response and the amount of drugs, will have a big impact on patient overall safety and future health, post-op recovery and hospital resources. This paper does a review of different systems and methods applied to several aspects of the anaesthesia field. All with the goal of working towards automation in this very complex area, that involves high risks for patients. This paper covers advisor systems; signal processing; new monitors and devices; mathematical modelling; and control algorithms; all focused on practical clinical implementation. The objective is to have an overview of the work done so far and the steps taken towards automation in anaesthesia.

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“…As the haemodynamic side effects of propofol are crucial in daily clinical practice, a pharmacodynamic model for these effects may be helpful not only for procedural sedation with propofol but also for the design of drug delivery systems with multiple inputs and multiple outputs. 31…”

Section: Pharmacokineticsmentioning

confidence: 99%