Control of Drug Administration During Monitored Anesthesia Care

Caruso, Antonello; Bouillon, Thomas; Schumacher, Peter; Zanderigo, Eleonora; Morari, Manfred

doi:10.1109/tase.2008.2009088

Cited by 19 publications

(7 citation statements)

References 44 publications

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“…Caruso et al [4] modelled the effect of remifentanil on breathing and showed that their controller maintains CO 2 set point in the presence of disturbances. Gentilini et al [11] proposed a model for the regulation of mean arterial pressure (MAP) and hypnosis with isoflurane-it was observed that controlling both MAP and hypnosis simultaneously with isoflurane was difficult.…”

Section: Introductionmentioning

confidence: 99%

Modelling and multi-parametric control for delivery of anaesthetic agents

Dua

Pistikopoulos

2010

Med Biol Eng Comput

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This article presents model predictive controllers (MPCs) and multi-parametric model-based controllers for delivery of anaesthetic agents. The MPC can take into account constraints on drug delivery rates and state of the patient but requires solving an optimization problem at regular time intervals. The multi-parametric controller has all the advantages of the MPC and does not require repetitive solution of optimization problem for its implementation. This is achieved by obtaining the optimal drug delivery rates as a set of explicit functions of the state of the patient. The derivation of the controllers relies on using detailed models of the system. A compartmental model for the delivery of three drugs for anaesthesia is developed. The key feature of this model is that mean arterial pressure, cardiac output and unconsciousness of the patient can be simultaneously regulated. This is achieved by using three drugs: dopamine (DP), sodium nitroprusside (SNP) and isoflurane. A number of dynamic simulation experiments are carried out for the validation of the model. The model is then used for the design of model predictive and multi-parametric controllers, and the performance of the controllers is analyzed.

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Section: Introductionmentioning

confidence: 99%

Modelling and multi-parametric control for delivery of anaesthetic agents

Dua

Pistikopoulos

2010

Med Biol Eng Comput

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“…Simulations demonstrated that Remifentanil concentrations well tolerated in the steady state will cause a clinically significant hypoventilation following bolus administration, confirming the acute risk of bolus administration of fast-acting opioids in spontaneously breathing patients (Caruso et al, 2009;Pattinson et al, 2009). Haemodynamic Effects: Remifentanil induces a dosedependent decrease in heart rate, arterial blood pressure and cardiac output consistent with µ-opioid agonism (Caruso et al, 2009;Mahfouf et al, 2005). Central Nervous System: Remifentanil induces dosedependent changes in relative cerebral blood flow in areas involved in pain processing.…”

Section: Respiratory Effectmentioning

confidence: 77%

“…A fuzzy analgesia control system for induction, maintenance and recovery has been reported in (Schubert et al, 2008), using three variables: heart rate, mean arterial pressure and an index derived from a (modified) standard deviation of the RR-intervals in the electrocardiogram format. Furthermore, a control system, which minimizes the risks associated with delivery of respiratory depressants to spontaneously breathing patients during medical procedures, has been proposed in (Caruso et al, 2009). This has been based on modelling the respiratory depressant effects of Remifentanil by means of pharmacokinetic (PK)-pharmacodynamic (PD) models in (Caruso et al, 2009) provided the transcutaneous monitoring of partial pressure of carbon dioxide in tidal breathing.…”

Section: The Multivariable Paradigm Of Automated Doamentioning

confidence: 99%

“…Furthermore, a control system, which minimizes the risks associated with delivery of respiratory depressants to spontaneously breathing patients during medical procedures, has been proposed in (Caruso et al, 2009). This has been based on modelling the respiratory depressant effects of Remifentanil by means of pharmacokinetic (PK)-pharmacodynamic (PD) models in (Caruso et al, 2009) provided the transcutaneous monitoring of partial pressure of carbon dioxide in tidal breathing. However, this strategy may fail in the event of mechanical ventilation, which alters the nominal depressant effect.…”

Section: The Multivariable Paradigm Of Automated Doamentioning

confidence: 99%

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Towards a Multivariable Model for Controlling the Depth of Anaesthesia using Propofol and Remifentanil

Ionescu

Nașcu

Keyser

2012

IFAC Proceedings Volumes

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In this paper is presented a brief state of art regarding the multivariable formulation for controlling the depth of anaesthesia by means of two intravenously administrated drugs, i.e. Propofol and Remifentanil. In a feasibility study of determining a suitable variable to quantify analgesia levels in patients undergoing cardiac surgery, the Bispectral index and an electromyogram-based surrogate variable are proposed as the controlled variables. The study is carried on in the context of implementing a multivariable predictive control algorithm. The simulation results show that such a paradigm is feasible, although it does not guarantee perfect knowledge of the analgesia level -in other words, the variable is not validated against typical evaluations of the pain levels (eg. clinical scores).

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“…Automation can benefit a variety of medical applications: surgical robotics [14], remote diagnosis [15], radiation biodosimetry [16],health analytics [17] and monitored anesthesia control [18]. Okamura et al [19] provides a detailed description of recent advances in medical and healthcare robotics.…”

Section: Background and Related Workmentioning

confidence: 99%

Robot-Guided Open-Loop Insertion of Skew-Line Needle Arrangements for High Dose Rate Brachytherapy

Garg

Siauw

Berenson

et al. 2013

IEEE Trans. Automat. Sci. Eng.

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Abstract-We present a study in human-centered automation that has potential to reduce patient side effects from high dose rate brachytherapy (HDR-BT). To efficiently deliver radiation to the prostate while minimizing trauma to sensitive structures such as the penile bulb, we modified the Acubot-RND 7-axis robot to guide insertion of diamond-tip needles into desired skew-line geometric arrangements. We extend and integrate two algorithms: Needle Planning with Integer Programming (NPIP) and Inverse Planning with Integer Programming (IPIP) to compute skew-line needle and dose plans. We performed three physical experiments with anatomically-correct phantom models to study performance: two with the robot and one control experiment with an expert human physician (co-author Hsu) without the robot. All were able to achieve needle arrangements that meet the RTOG-0321 clinical dose objectives with zero trauma to the penile bulb. We analyze systematic and random errors in needle placement; total RMS error for the robot system operating without feedback ranged from 2.6 mm to 4.3 mm, which is comparable to the RMS error of 2.7 mm obtained in an earlier study for PPI-BT treatment using a robot with 3D ultrasound feedback.Note to Practitioners Brachytherapy treats cancer by delivering radioactive sources proximal to cancer sites via needles. Current methods use standardized fixed mechanical templates that force needles into parallel arrangements that may prevent needles from reaching prostate volumes blocked by the pubic arch and often require needles to puncture sensitive organs. Skew-line (non-parallel) arrangements of needles can reach targets under the pubic arch and avoid sensitive organs. However these arrangements cannot be achieved with standard templates, motivating the use of automation. We present a human-centered automation system that integrates state-of-the- Left: The current clinical approach to prostate high dose rate brachytherapy (HDR-BT) uses parallel needles guided by a mechanical template. This approach may prevent needles from reaching prostate volumes blocked by the pubic arch and often require needles to puncture sensitive organs (which can produce long-term side-effects). Right: Skew-line needle arrangements facilitated by robot guidance can avoid puncture by reaching under the pubic arch and can minimize trauma to sensitive organs such as the penile bulb which can produce side effects such as incontinence and impotence.art needle and dose planning algorithms with a modified needle insertion robot. Results suggest that the robot can achieve precision and accuracy comparable to that of expert human physician. This approach has applications to brachytherapy treatment for other organs and to other needle procedures such as biopsy and anesthetic injection.

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Control of Drug Administration During Monitored Anesthesia Care

Cited by 19 publications

References 44 publications

Modelling and multi-parametric control for delivery of anaesthetic agents

Modelling and multi-parametric control for delivery of anaesthetic agents

Towards a Multivariable Model for Controlling the Depth of Anaesthesia using Propofol and Remifentanil

Robot-Guided Open-Loop Insertion of Skew-Line Needle Arrangements for High Dose Rate Brachytherapy

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