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Introduction to automated drug delivery in clinical anesthesia. (English) Zbl 1293.93236

Summary: Control technology has been applied to a wide variety of industrial and domestic applications to improve performance, safety and efficiency. Anesthesia, a critical aspect of clinical and emergency medicine, has not yet benefited from such technological advances. The lack of dedicated feedback sensors, and the large inter- and intra-patient variability in terms of patients’ response to drug administration, have seriously limited the effectiveness and reliability of closed-loop controllers in clinical settings. However, recent advances in sensing devices, along with robust nonlinear control theories, have generated new hopes that the gap between manual and automated control of anesthesia can finally be bridged. This paper addresses the pharmacological principles of clinical anesthesia in a context appropriate for control engineers. Concepts and terminology, monitoring issues, as well as drug dose vs. response relationships, are covered.

MSC:

93B35 Sensitivity (robustness)
92C50 Medical applications (general)
93C10 Nonlinear systems in control theory
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[1] Allan, B. T.W.; Smith, I., Cost considerations in the use of anaesthetic drugs, Curr Opin Anaesthesiol, 15, 227-232 (2002)
[2] Angel, A.; Linkens, D. A.; Ting, C. H., Estimation of latency changes and relative amplitudes in somatosensory evoked potentials using wavelets and regression, Comput Biomed Res, 32, 209-251 (1999)
[3] Bibian S. Automation in clinical anesthesia. PhD thesis, University of British Columbia,Department of Electrical and Computer Engineering, 2006; Bibian S. Automation in clinical anesthesia. PhD thesis, University of British Columbia,Department of Electrical and Computer Engineering, 2006
[4] Bibian, S.; Dumont, G. A.; Huzmezan, M.; Ries, C. R., Quantifying uncertainty bounds in anesthetic PKPD models, (Proceedings of the 26th annual international conference of the IEEE engineering in medicine and biology Society. Proceedings of the 26th annual international conference of the IEEE engineering in medicine and biology Society, San Francisco,USA (2004))
[5] Bibian, S.; Ries, C. R.; Huzmezan, M.; Dumont, G. A., Clinical anesthesia and control engineering: Terminology, concepts and issues, (Proceedings of the European control conference. Proceedings of the European control conference, Cambridge, UK (2003))
[6] Bibian S, Zikov T, Dumont GA, Ries CR, Puil E, Ahmadi HC, Huzmezan M, Macleod BA. Method and apparatus for the estimation of the anesthetic depthusing wavelet analysis of the electroencephalogram. U.S. Patent #10/616,997 (pending), 2004; Bibian S, Zikov T, Dumont GA, Ries CR, Puil E, Ahmadi HC, Huzmezan M, Macleod BA. Method and apparatus for the estimation of the anesthetic depthusing wavelet analysis of the electroencephalogram. U.S. Patent #10/616,997 (pending), 2004
[7] Bibian, S.; Zikov, T.; Ries, C. R.; Dumont, G. A.; Huzmezan, M., The wavelet-based anesthetic value (WAV): A novel alternative to the bispectral index (BIS), (Proceedings of the American Society of Anesthesiologists (2004)), pp A-342
[8] Bibian, S.; Zikov, T.; Ries, C. R.; Voltz, D. M.; Dumont, G. A.; Huzmezan, M., Pharmacodynamic intra- and interpatient variability of processed electroencephalography variable during thiopental induction for ECT, (Proceedings of the 58th post graduate assembly of the New York state society of anesthesiologists (2004)), pp P-9145
[9] Billard, V.; Gambus, P. L.; Chamoun, N.; Stanski, D. R.; Shafer, S. L., A comparison of spectral edge,delta power, and bispectral index as EEG measures of alfentanil, propofol,and midazolam drug effect, Clin Pharm Ther, 61, 1, 45-58 (1997)
[10] Bovill, J. G., Opioid Anesthesia, vol 21 of monographs in anaesthesiology Ch 4, 81-102 (1991), Elsevier Science Publisher Amsterdam: Elsevier Science Publisher Amsterdam The Netherlands
[11] Bowles, S. M.; Sebel, P. S.; Saini, V.; Chamoun, N., Effects of anesthesia on the EEG-bispectral analysis correlates with movement, 249-254 (1993), Prentice Hall: Prentice Hall Englewood Cliffs,NJ
[12] Camu, F.; Kay, B., Why total intravenous anesthesia (TIVA),vol 21 of monographs in anaesthesiology, Ch 1, 1-14 (1991), Elsevier Science Publisher Amsterdam: Elsevier Science Publisher Amsterdam The Netherlands
[13] Capitanio, L.; Jensen, E. W.; Filligoi, G. C.; Makovec, B.; Gagliardi, M.; Henneberg, S. W., On-line analysis of AEP and EEG for monitoring the depth of anaesthesia, Method Informatics Med, 36, 311-314 (1997)
[14] Egan, T. D.; Lemmens, H. J.M.; Fiset, P.; Hermann, D. J.; Muir, K. T.; Stanski, D. R.; Shafer, S. L., The pharmacokinetics of the new short-acting opioid Remifentanil (GI87084B) in healthy adult male volunteers, Anesthesiology, 79, 5, 881-892 (1993)
[15] Egan, T. D.; Minto, C. F.; Hermann, D. J.; Barr, J.; Muir, K. T.; Shafer, S. L., Remifentanil versus alfentanil: comparative pharmacokinetics and pharmacodynamics in healthy adult male volunteers, Anesthesiology, 84, 821-833 (1996)
[16] Gan, T. J.; Glass, P. S.; Windsor, A., bispectral index monitoring allows faster emergence and improved recovery from propofol, alfentanil, and nitrous oxide anesthesia, Anesthesiology, 87, 808-815 (1997)
[17] Gentilini A, Frei C, Glattfelder AH, Morari M, Sieber TJ, Wymann R, Schnider TW, Zbinden AM. Closed-loop control in anesthesia. Technical report, ETH, Zürich, Switzerland, July 2000; Gentilini A, Frei C, Glattfelder AH, Morari M, Sieber TJ, Wymann R, Schnider TW, Zbinden AM. Closed-loop control in anesthesia. Technical report, ETH, Zürich, Switzerland, July 2000
[18] Gepts, E.; Camu, F.; Cockshott, I. D.; Douglas, E. J., Disposition of propofol administered as constant rate intravenous infusion in humans, Anesth Analg, 66, 1256-1263 (1987)
[19] Glass, P. S.A., Why and how we will monitor the state of anesthesia in 2010?, Acta Anaesthesiol Belg, 50, 1, 35-44 (1999)
[20] Glass, P. S.A.; Rampil, I. J., Automated anesthesia: Fact or fantasy?, Anesthesiology, 95, 1-2 (2001)
[21] Gray, T. C.; Rees, G. J., The role of apnoea in anaesthesia for major surgery, Br Med J, 2, 891-892 (2000)
[22] Hagihira, S.; Takashina, M.; Mori, T.; Mashimo, T.; Yoshiya, I., Practical issues in bispectral analysis of electroencephalographic signals, Anesth Analg, 93, 966-970 (2001)
[23] Jensen, E. W.; Lindholm, P.; Henneberg, S. W., Autoregressive modeling with exogenous input of middle-latency auditory-evoked potentials to measure rapid changes in depth of anesthesia, Method Informatics Med, 35, 256-260 (1996)
[24] Kazama, T.; Ikeda, K.; Morita, K.; Kikura, M.; Doi, M.; Ikeda, T.; Kurita, T.; Nakajima, Y., Comparison of the effect-site ke0s of propofol for blood pressure and EEG bispectral index in elderly and younger patients, Anesthesiology, 90, 1517-1527 (1999)
[25] Kearse, L.; Saini, V.; deBros, F.; Chamoun, N., Bispectral analysis of EEG may predict anesthetic depth using narcotic induction, Anesthesiology (1990), 3A: A175
[26] Kissin, I., Depth of anesthesia and bispectral index monitoring, Anesth Analg, 90, 5, 1114-1117 (2000)
[27] Kreuer, S.; Biedler, A.; Larsen, R.; Altmann, S.; Wilhelm, W., Narcotrend monitoring allows faster emergence and a reduction off drug consumption in propofolremifentanil anesthesia, Anesthesiology, 99, 34-41 (2003)
[28] Kuizenga, K.; Proost, J. H.; Wierda, J. M.; Kalkman, C. J., Predictability of processed electroencephalography effects on the basis on pharmacokineticpharmacodynamic modeling during repeated propofol infusions in patients with extradural analgesia, Anesthesiology, 95, 607-615 (2001)
[29] Lang, E.; Kapila, A.; Shlugman, D., Reduction of isoflurane minimum alveolar concentration by remifentanil, Anesthesiology, 85, 721-728 (1996)
[30] Lennmarken, C.; Bildfors, K.; Enlund, G.; Samuelsson, P.; Sandin, R., Victims of awareness, Acta Anaesthesiol Scand, 43, 3, 229-231 (2002)
[31] Liu, N.; Genty, A.; Landais, A.; Chazot, T.; Fischler, M., Titration of propofol guided by the bispectral index (BIS): Closed-loop versus manual target controlled infusion, (Proceedings of the 2005 American anesthesiology society conference. Proceedings of the 2005 American anesthesiology society conference, Atlanta, USA (2005)), October 22-26
[32] Locher, S.; Stadler, K. S.; Boehlen, T.; Bouillon, T.; Leibundgut, D.; Schumacher, P. M.; Wymann, R.; Zbinden, A. M., A new closed-loop control system for isoflurane using bispectral index outperforms manual control, Anesthesiology, 101, 591-602 (2004)
[33] Luginbühl, M.; Wüthrich, S.; Petersen-Felix, S.; Zbinden, A. M.; Schnider, T. W., Different benefit of bispectral index \((BIS^{tm})\) in desflurane and propofol anesthesia, Acta Anaesthesiol Scand, 47, 165-173 (2003)
[34] Lundqvist, K. L.; Bibian, S.; Ries, C. R.; Yu, P. Y.H., Can the wavelet-based anesthetic value (WAV) predict airway motor response to LMA insertion?, (Proceedings of the American Society of anesthesiologists (2004)), pp A-A606
[35] Marsh, B.; White, W.; Morton, N.; Kenny, G. N.C., Pharmacokinetic model driven infusion of propofol in children, Br J Anaesth, 67, 41-48 (1991)
[36] Mayfield, J. B.; Quigley, J. D., BIS monitoring reduces phase I PACU admissions in an ambulatory surgical unit, Anesthesiology, 91, 3A (1999), pp A-28
[37] Minto, C. F.; Schnider, T. W.; Egan, T. D.; Youngs, E.; Lemmens, H. J.M.; Gambus, P. L.; Billard, V.; Hoke, J. F.; Moore, K. H.P.; Hermann, D. J.; Muir, K. T.; Mandema, J. W.; Shafer, S. L., Influence of age and gender on the pharmacokinetics and pharmacodynamics of remifentanil, Anesthesiology, 86, 1, 10-23 (1997)
[38] Minto, C. F.; Schnider, T. W.; Gregg, K. M.; Henthorn, T. K.; Shafer, S. L., Using the time of maximum effect site concentration to combine pharmacokinetics and pharmacodynamics, Anesthesiology, 99, 2, 324-333 (2003)
[39] Minto, C. F.; Schnider, T. W.; Short, T. G.; Gregg, K. M.; Gentilini, A.; Shafer, S. L., Response surface model for anesthetic drug interactions, Anesthesiology, 92, 1603-1616 (2000)
[40] Monk, T. G.; Saini, V.; Weldon, B. C.; Sigl, J. C., Anesthetic management and one-year mortality after noncardiac surgery, Anesth Analg, 100, 1, 4-10 (2005)
[41] Morgan, M., Total intravenous anaesthesia, Anaesthesia, 38, 1-9 (1983)
[42] Myles, P. S.; Leslie, K.; McNeil, J.; Forbes, A.; Chan, M. T.V., Bispectral index monitoring to prevent awareness during anaesthesia: the B-AWARE randomised controlled trial, Lancet, 363, 1757-1763 (2004)
[43] Newton, D. E.F.; Thornton, C.; Jordan, C., The auditory evoked response as a monitor of anesthetic depth, 274-280 (1993), Prentice Hall: Prentice Hall Englewood Cliffs,NJ
[44] Ning, T.; Bronzino, J. D., Bispectral analysis of the rat EEG during various vigilance states, IEEE Trans Biomed Eng, 36, 4, 497-499 (1989)
[45] Osterman, J. E.; Hopper, J.; Heran, W. J.; Keane, T. M.; Van Der Kolk, B. A., Awareness under anesthesia and the development of posttraumatic stress disorder, Gen Hosp Psychiatry, 23, 4, 198-204 (2001)
[46] Peñnuelas-Acuñna, J.; Oriol-Lopez, S. A.; Castelazo-Arredondo, J. A.; Hernandez-Bernal, C. E., Usefulness of bispectral index in pharmaceutical cost reduction for anesthesia, Cirugía y Cirujanos, 71, 300-303 (2003)
[47] Plourde, G.; Boylan, J. F., The auditory steady state response during sufentanil anaesthesia, Br J Anaesth, 66, 683-691 (1991)
[48] Pomfrett, C. J.D., Heart rate variability BIS and ‘depth of anaesthesia’, Br J Anaesth, 82, 5, 659-662 (1999)
[49] Pomfrett, C. J.D., Monitoring depth of anesthesia, R Coll of Anaesth, 4, 155-157 (2000)
[50] Prys-Roberts, C., Anaesthesia: a practical or impractical construct?, Br J Anaesth, 59, 1341 (1987)
[51] Quasha, A. L.; Eger, E. I.; Tinker, J. H., Determination and application of MAC, Anesthesiology, 53, 315-334 (1980)
[52] Rampil, I. J., A primer for EEG signal processing in anesthesia, Anesthesiology, 89, 4, 980-1002 (1998)
[53] Rampil, I. J.; Sasse, F. J.; Smith, N. T.; Hoff, B. H.; Flemming, D. C., Spectral edge frequency - a new correlate of anesthetic depth, Anesthesiology, 53 (1980), 3: S12
[54] Rosow, C.; Manberg, P. J., Bispectral index monitoring, Anesthesiol Clin North America, 19, 4, 947-966 (2001)
[55] Ross, P. E., Holy grail: Customized medecine, IEEE Spectrum (January 2004)
[56] Schnider, T. W.; Minto, C. F.; Gambus, P. L.; Andresen, C.; Goodale, D. B.; Shafer, S. L.; Youngs, E. J., The influence of method of administration and covariates on the pharmacokinetics of propofol in adult volunteers, Anesthesiology, 88, 5, 1170-1182 (1998)
[57] Schüttler, J.; Ihmsen, H., Population pharmacokinetics of propofol: a multicenter study, Anesthesiology, 92, 3, 727-738 (2000)
[58] Schüttler, J.; Schwilden, H., Feedback control of intravenous anaesthetics by quantitative EEG, 194-207 (1995), Springer- Verlag: Springer- Verlag Berlin
[59] Schwender, D.; Madler, C.; Keller, I.; Klasing, S.; Peter, K.; Pöoppel, E., Midlatency auditory evoked potentials indicate wakefulness during cesarean section, 333-342 (1993), Prentice Hall: Prentice Hall Englewood Cliffs,NJ
[60] Schwilden, H.; Stoeckel, H.; Quantitative EEG, analysis during anaesthesia with isoflurane in nitrous oxide at 1.3 and 1.5 MAC, Br J Anaesth, 59, 6, 738-745 (1987)
[61] Schwilden, H.; Stoeckel, H.; Schüttler, J., Closed-loop feedback control of propofol anesthesia by quantitative EEG analysis in humans, Br J Anaesth, 62, 3, 290-296 (1989)
[62] Scott, J. C.; Cooke, J. E.; Stanski, D. R., Electroencephalographic quantitation of opioid effect: Comparative pharmacodynamics of fentanyl and sufentanil, Anesthesiology, 74, 1, 34-42 (1991)
[63] Sebel, P. S.; Bowles, S.; Saini, V.; Chamoun, N., Accuracy of EEG in predicting movement at incision during isoflurane anesthesia, Anesthesiology (1990), 3A: A446
[64] Sheiner, L. B.; Stanski, D. R.; Vozeh, S.; Miller, R. D.; Ham, J., Simultaneously modeling of pharmacokinetics and pharmacodynamics: application to d-tubocurarine, Clin Pharmacol Ther, 25, 358-371 (1979)
[65] Smith, C.; McEwan, A. I.; Jhaveri, R., Reduction of propofol \(C_{p50}\) by fentanyl, Anesthesiology (1992), 77: A340
[66] Smith, N. T.; Dec-Silver, H.; Sanford, T. J.; Westover, C. J.; Quinn, M. L.; Klein, F.; Davis, D. A., EEGs during high-dose fentanyl-,sufentanil-, or morphine-oxygen anesthesia, Anesth Analg, 63, 4, 386-393 (1984)
[67] Struys, M. M.R. F.; De Smet, T.; Versichelen, L. F.M.; Van de Velde, S.; Van den Broecke, R.; Mortier, E. P., Comparison of closed-loop controlled administration of propofol using BIS as the controlled variable versus “standard practice” controlled administration, Anesthesiology, 95, 6-17 (2001)
[68] Suttner, S.; Boldt, J.; Schmidt, C.; Piper, S.; Kumle, B., Cost analysis of target-controlled infusion-based anesthesia compared with standard anesthesia regimen, Anesth Analg, 88, 77-82 (1998)
[69] Vakkuri, A.; Yli-Hankala, A.; Talja, P.; Mustola, S.; Tolvanen-Laakso, H.; Sampson, T.; Viertiö-Oja, H., Time-frequency balanced spectral entropy as a measure of anesthetic drug effect in central nervous system during sevoflurane,propofol,and thiopental anesthesia, Acta Anaesthesiol Scand, 48, 145-153 (2004)
[70] Vernon, J.; Bowles, S.; Sebel, P. S.; Chamoun, N., EEG bispectrum predicts movement at incision during isoflurane or propofol anesthesia, Anesthesiology, 77 (1992), (3A) A502
[71] Viertio-Oja, H.; Maja, V.; Sarkela, M.; Talja, P.; Tenkanen, N.; Tolvanen-Laakso, H.; Paloheimo, M.; Vakkuri, A.; Yli-Hankala, A.; Merilainen, P., Description of the entropy algorithm as applied in the Datex-Ohmeda S/5 entropy module, Acta Anaesthesiol Scand, 48, 154-161 (2004)
[72] Villemure, C.; Plourde, G.; Lussier, I.; Normandin, N., Auditory processing during isoflurane anesthesia: A study with an implicit memory task and auditory evoked potentials, 99-106 (1993), Prentice Hall: Prentice Hall Englewood Cliffs NJ
[73] Vuyk, J., Clinical interpretation of pharmacokinetic and pharmacodynamic propofol-opioid interactions, Acta Anaesthesiol Belg, 52, 445-451 (2001)
[74] Vuyk, J.; Mertens, M. J.; Olofsen, E.; Burm, A. G.; Bovill, J. G., Propofol anesthesia and rational opioid selection: determination of optimal \(EC_{50}-EC_{95}\) propofol-opioid concentrations that assure adequate anesthesia and a rapid return of consciousness, Anesthesiology, 87, 1549-1562 (1997)
[75] Vuyk, J.; Schnider, T.; Engbers, F., Population pharmacokinetics of propofol for target-controlled infusion (TCI) in the elderly, Anesthesiology, 93, 6, 1557-15560 (2000)
[76] Weldon, B. C.; Mahla, M. E.; Van Der Aa, M. T.; Monk, T. G., Advancing age and deeper intraoperative anesthetic levels are associated with higher first year death rates, ASA Meeting Abstract (2002), pp A-1097
[77] Zikov T Monitoring the anesthetic-induced unconsciousness (hypnosis) using wavelet analysis of the electroencephalogram. Master’s thesis,The University of British Columbia,Canada, 2002; Zikov T Monitoring the anesthetic-induced unconsciousness (hypnosis) using wavelet analysis of the electroencephalogram. Master’s thesis,The University of British Columbia,Canada, 2002
[78] Zikov T,Bibian S,Dumont GA,Huzmezan M, Ries CR. Quantifying decrease in cortical activity during general anesthesia using wavelet analysis. IEEE Trans Biomed Eng (accepted for publication) in press.; Zikov T,Bibian S,Dumont GA,Huzmezan M, Ries CR. Quantifying decrease in cortical activity during general anesthesia using wavelet analysis. IEEE Trans Biomed Eng (accepted for publication) in press.
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