Modelling propofol pharmacodynamics using BIS-guided anaesthesia

Martín-Mateos, Isabel; Pérez, José Andrés Moreno; Reboso, José Antonio; Leon, Ana M.

doi:10.1111/anae.12384

Cited by 27 publications

(16 citation statements)

References 22 publications

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“…25 In 2013, Martín-Mateos and colleagues showed that BIS values fluctuate around an index of 50 and that this fluctuation varies among patients. 26 In our study, approximately 50% of patients demonstrated low BIS values, and in five of these patients, the EEG showed a burst suppression pattern, which signifies overly deep anaesthesia.…”

Section: Discussionsupporting

confidence: 46%

Determination of loss of consciousness

Zetterlund

Gréen

Oscarsson

et al. 2016

European Journal of Anaesthesiology

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Section: Discussionsupporting

confidence: 46%

Determination of loss of consciousness

Zetterlund

Gréen

Oscarsson

et al. 2016

European Journal of Anaesthesiology

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“…Where, EC 50 represents the value of the brain concentration in ug/ml to achieve loss of consciousness after bolus dose. λ is the steepness of brain concentration versus response curve [23,26]. If these parameters are known, the dose required to achieve the target BIS signal can be calculating.…”

Section: Drug Sensitivity Parameters Estimationmentioning

confidence: 99%

Adaptive smith predictor controller for total intravenous anesthesia automation

Patel

Vachhrajani

et al. 2018

Biomed. Eng. Lett.

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Anesthetic agent propofol needs to be administered at an appropriate rate to prevent hypotension and postoperative adverse reactions. To comprehend more suitable anesthetic drug rate during surgery is a crucial aspect. The main objective of this proposal is to design robust automated control system that work efficiently in most of the patients with smooth BIS and minimum variations of propofol during surgery to avoid adverse post reactions and instability of anesthetic parameters. And also, to design advanced computer control system that improves the health of patient with short recovery time and less clinical expenditures. Unlike existing research work, this system administrates propofol as a hypnotic drug to regulate BIS, with fast bolus infusion in induction phase and slow continuous infusion in maintenance phase of anesthesia. The novelty of the paper lies in possibility to simplify the drug sensitivity-based adaption with infusion delay approach to achieve closedloop control of hypnosis during surgery. Proposed work uses a brain concentration as a feedback signal in place of the BIS signal. Regression model based estimated sensitivity parameters are used for adaption to avoid BIS signal based frequent adaption procedure and large offset error. Adaptive smith predictor with lead-lag filter approach is applied on 22 different patients' model identified by actual clinical data. The actual BIS and propofol infusion signals recorded during clinical trials were used to estimate patient's sensitivity parameters EC 50 and λ. Simulation results indicate that patient's drug sensitivity parameters based adaptive strategy facilitates optimal controller performance in most of the patients. Results are obtained with proposed scheme having less settling time, BIS oscillations and small offset error leads to adequate depth of anesthesia. A comparison with manual control mode and previously reported system shows that proposed system achieves reduction in the total variations of the propofol dose. Proposed adaptive scheme provides better performance with less oscillation in spite of computation delay, surgical stimulations and patient variability. Proposed scheme also provides improvement in robustness and may be suitable for clinical practices.

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“…For instance, a linear relation is found between age and EC 50 [70]. Cardiac output (CO) [3,108] and administration mode (bolus or infusion) [91] were also found to influence the time and dose required for propofol anaesthesia.…”

Section: Model Uncertaintymentioning

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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Modelling propofol pharmacodynamics using BIS-guided anaesthesia

Cited by 27 publications

References 22 publications

Determination of loss of consciousness

Determination of loss of consciousness

Adaptive smith predictor controller for total intravenous anesthesia automation

Automation of anaesthesia: a review on multivariable control

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