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Closed loop anaesthesia

Sebastian Heiderich, Christian Thoben, Nils Dennhardt, Wolfgang Koppert, Terence Krauß, Robert Sümpelmann, Stefan Zimmermann, Werner Klingler
BACKGROUND: Volatile anaesthetics are a potential hazard during occupational exposure, pregnancy or in individuals with existing disposition to malignant hyperthermia. Anaesthetic waste gas concentration in postanaesthesia care units (PACU) has rarely been investigated. OBJECTIVE(S): The current study aims to assess concentrations of volatile anaesthetics in relation to room size, number of patients and ventilator settings in different PACUs. DESIGN: A prospective observational study...
February 9, 2018: European Journal of Anaesthesiology
Aurélien Bataille, Avit Guirimand, Barbara Szekely, Mireille Michel-Cherqui, Virginie Dumans, Ngai Liu, Thierry Chazot, Marc Fischler, Morgan Le Guen
BACKGROUND: Hypnosis has a positive effect on peri-operative anxiety and pain. OBJECTIVE: The objective of this study was to assess the impact of a formal deep hypnosis session on the consumption of propofol for anaesthetic induction using automated administration of propofol guided by the bispectral index (BIS) in a closed loop. DESIGN: A 1 : 1 randomised, usual-care-controlled, single-centre trial. SETTING: Tertiary care centre in France from April 2014 to December 2015...
November 27, 2017: European Journal of Anaesthesiology
V Mahajan, T Samra, G D Puri
OBJECTIVES: To compare the efficacy of anaesthetic depth control using Closed Loop Anaesthesia Delivery System (CLADS) and Target Controlled Infusion (TCI) in patients with moderate to severe left ventricular dysfunction (LVSD). DESIGN: Randomized control trial. PATIENTS: Forty ASA III/IV adult patients with moderate to severe LVSD scheduled for open heart surgery. INTERVENTIONS: Propofol was administered using CLADS or TCI for maintaining BIS of 50...
November 2017: Journal of Clinical Anesthesia
A Ramos-Luengo, F Asensio-Merino
OBJECTIVE: Determine the influence of general anaesthesia with closed-loop systems in the results of outpatient varicose vein surgery. PATIENTS AND METHODS: Retrospective observational study including data from 270 outpatients between 2014 and 2015. The patients were divided into 2 groups according to the type of general anaesthesia used. The CL Group included patients who received propofol in closed-loop guided by BIS and remifentanil using TCI, and the C Group received non-closed-loop anaesthesia...
June 2017: Revista Española de Anestesiología y Reanimación
A Restoux, S Grassin-Delyle, N Liu, C Paugam-Burtz, J Mantz, M Le Guen
BACKGROUND: Automated titration of propofol and remifentanil guided by the bispectral index (BIS) has been used for numerous surgical procedures. Orthotopic liver transplantation (OLT) uniquely combines major changes in circulating volume, an anhepatic phase, and ischaemia-reperfusion syndrome. We assessed the behaviour of this automated controller during OLT. METHODS: Adult patients undergoing OLT were included in this pilot study. Consumption of propofol and remifentanil was calculated for each surgery period (dissection, anhepatic, and liver reperfusion phases)...
September 2016: British Journal of Anaesthesia
Merel H Kuizenga, Hugo E M Vereecke, Michel M R F Struys
PURPOSE OF REVIEW: Drug administration might be optimized by incorporating pharmacokinetic-dynamic (PK/PD) principles and control engineering theories. This review gives an update of the actual status of target-controlled infusion (TCI) and closed-loop computer-controlled drug administration and the ongoing research in the field. RECENT FINDINGS: TCI is becoming mature technology clinically used in many countries nowadays with proven safety. Nevertheless, changing populations might require adapting the established PK/PD models...
August 2016: Current Opinion in Anaesthesiology
Warwick D Ngan Kee, Kim S Khaw, Yuk-Ho Tam, Floria F Ng, Shara W Lee
Closed-loop feedback computer-controlled vasopressor infusion has been previously described for maintaining blood pressure during spinal anaesthesia for caesarean section but there are limited data available comparing the relative performance of different vasopressors. The aim of this study was to compare the performance of norepinephrine versus phenylephrine in this system. Data from a randomized, two-arm parallel group, double-blinded controlled trial were reanalyzed. 104 patients scheduled for elective caesarean section under spinal anaesthesia were randomized to receive computer-controlled closed-loop infusion of either norepinephrine 5 µg ml-1 or phenylephrine 100 µg ml-1 ...
June 2017: Journal of Clinical Monitoring and Computing
Aurélien Bataille, Jacques-Florian Letourneulx, Alain Charmeau, Pascale Lemedioni, Philippe Léger, Thierry Chazot, Morgan Le Guen, Pierre Diemunsch, Marc Fischler, Ngai Liu
BACKGROUND: In obese patients, the incidence of postoperative nausea and vomiting (PONV) following sleeve gastrectomy under titration of total intravenous anaesthesia (TIVA) and the relevance of risk factors to indicate prophylaxis is unknown. OBJECTIVES: The hypothesis was that after automated TIVA, prophylaxis reduces PONV following laparoscopic sleeve gastrectomy. Our objective was to determine the incidence of PONV and evaluate the efficacy of dexamethasone and ondansetron as prophylaxis when automated intravenous anaesthesia is employed...
December 2016: European Journal of Anaesthesiology
A Joosten, T Huynh, K Suehiro, C Canales, M Cannesson, J Rinehart
BACKGROUND: Goal directed fluid therapy (GDFT) has been shown to improve outcomes in moderate to high-risk surgery. However, most of the present GDFT protocols based on cardiac output optimization use invasive devices and the protocols may require significant practitioner attention and intervention to apply them accurately. The aim of this prospective pilot study was to evaluate the clinical feasibility of GDFT using a closed-loop fluid administration system with a non-invasive cardiac output monitoring device (Nexfin™, BMEYE, Amsterdam, Netherlands)...
June 2015: British Journal of Anaesthesia
N Liu, C Lory, V Assenzo, V Cocard, T Chazot, M Le Guen, D I Sessler, D Journois, M Fischler
BACKGROUND: We used an automated bispectral index (BIS)-guided dual-loop controller to determine propofol and remifentanil requirements during general anaesthesia in obese and lean surgical patients. METHODS: Obese patients, BMI>35 kg m(-2), and lean patients (<25 kg m(-2)) having laparoscopic procedures were prospectively evaluated in this multicentre single-blind study. The automated controller targeted BIS between 40 and 60 by adjusting propofol and remifentanil administration...
April 2015: British Journal of Anaesthesia
Jingtian Tang, Yang Cao, Jiaying Xiao, Qulian Guo
Due to individual differences of the depth of anaesthesia (DOA) controlled objects, the drawbacks of monitoring index, the traditional PID controller of anesthesia depth could not meet the demands of nonlinear control. However, the adjustments of the rules of DOA fuzzy control often rely on personal experience and, therefore, it could not achieve the satisfactory control effects. The present research established a fuzzy closed-loop control system which takes the cerebral state index (CSI) value as a feedback controlled variable, and it also adopts the particle swarm optimization (PSO) to optimize the fuzzy control rule and membership functions between the change of CSI and propofol infusion rate...
June 2014: Sheng Wu Yi Xue Gong Cheng Xue za Zhi, Journal of Biomedical Engineering, Shengwu Yixue Gongchengxue Zazhi
Jing Jing Chang, S Syafiie, Raja Kamil, Thiam Aun Lim
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...
April 2015: Journal of Clinical Monitoring and Computing
Shehzaad Joomye, Donglai Yan, Haiyun Wang, Guoqiang Zhou, Guolin Wang
BACKGROUND: We devised this study to quantify the effect of age on the consumption of cisatracurium under general anaesthesia, using a computer controlled closed loop infusion system. We further investigated this effect on, sufentanil and propofol consumption. METHODS: 74 patients of physical status I and II, requiring general anaesthesia for elective abdominal surgery, were assigned to three groups. Patients in group 1 were aged from 20 to 45, group 2 were from 46 to 64, and group 3 above 65 years old...
2014: BMC Anesthesiology
N Liu, M Le Guen, N Boichut, A Genty, T Hérail, D Schmartz, G Khefif, A Landais, J J Bussac, A Charmeau, J Baars, B Rehberg, S Tricoche, T Chazot, D I Sessler, M Fischler
BACKGROUND: Nitrous oxide (N2O) offers both hypnotic and analgesic characteristics. We therefore tested the hypothesis that N2O administration decreases the amount of propofol and remifentanil given by a closed-loop automated controller to maintain a similar bispectral index (BIS). METHODS: In a randomized multicentre double-blind study, patients undergoing elective surgery were randomly assigned to breathe 60% inspired N2O (N2O group) or 40% oxygen (AIR group)...
May 2014: British Journal of Anaesthesia
Clara M Ionescu, Ioana Nascu, Robin De Keyser
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...
December 2014: Journal of Clinical Monitoring and Computing
B L Sng, H S Tan, A T H Sia
Hypotension necessitating vasopressor administration occurs commonly during caesarean section under spinal anaesthesia. We developed a novel vasopressor delivery system that automatically administers phenylephrine or ephedrine based on continuous non-invasive arterial pressure monitoring. A phenylephrine bolus of 50 μg was given at 30-s intervals when systolic blood pressure fell < 90% of baseline; an ephedrine bolus of 4 mg was given instead if systolic pressure fell < 90% of baseline together with a heart rate < 60 beats...
January 2014: Anaesthesia
Vijaya P Patil, Madhavi G Shetmahajan, Jigeeshu V Divatia
Over the years, the conventional anaesthesia machine has evolved into an advanced carestation. The new machines use advanced electronics, software and technology to offer extensive capabilities for ventilation, monitoring, inhaled agent delivery, low-flow anaesthesia and closed-loop anaesthesia. They offer integrated monitoring and recording facilities and seamless integration with anaesthesia information systems. It is possible to deliver tidal volumes accurately and eliminate several hazards associated with the low pressure system and oxygen flush...
September 2013: Indian Journal of Anaesthesia
A T Sia, B L Sng, H S Tan
Perioperative care often involves treating rapid changes in a patient's physiological profile that requires timely intervention by anaesthetists. Interactive technology and closed-loop systems are currently developed in obstetric anaesthesia and analgesia for maintaining parameters during caesarean section and epidural analgesia. This review discusses the principles of interactive systems and the use of patient feedback to integrate these interactive systems. The components of an interactive system such as the input sensor or device, microprocessor-based control unit and the effector are introduced...
November 2013: International Journal of Obstetric Anesthesia
W D Ngan Kee, S W Y Lee, K S Khaw, F F Ng
BACKGROUND: Phenylephrine given during spinal anaesthesia for caesarean delivery often induces a decrease in heart rate which may decrease cardiac output. Anticholinergic drugs may be given to attenuate this effect but may also cause more labile blood pressure. This study evaluated the effects of glycopyrrolate pre-treatment on non-invasively measured cardiac output and accuracy of blood pressure control. METHODS: At induction of spinal anaesthesia for caesarean delivery, 104 patients randomly received intravenous glycopyrrolate 4μg/kg or saline placebo...
July 2013: International Journal of Obstetric Anesthesia
T M Hemmerling, E Arbeid, M Wehbe, S Cyr, R Taddei, C Zaouter
BACKGROUND: We have developed an automatic anaesthesia system for closed-loop administration of anaesthesia drugs. The control variables used were bispectral index (BIS) and Analgoscore for hypnosis and antinociception, respectively. METHODS: One hundred and eighty-six patients were randomly enrolled in two groups. Propofol, remifentanil, and rocuronium were administered using closed-loop feedback control (closed-loop, n = 93) or manually (control group, n = 93)...
June 2013: British Journal of Anaesthesia
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