Closed-Loop Control of General Anesthesia: “My Clinical - Scata

44 Pages·2007·6.18 MB·English

Closed-Loop Control of General Anesthesia:
“My Clinical Experience”
LIU, M.D.
Ngai
[email protected]
33(1)-46-25-27-67
Service d’Anesthésie
Hôpital Foch Suresnes
France
JAMA 1950, 144 (13)
50 patients, ETHER
“Major Surgical procedures
varying age, both sexes
Without untoward effect “
Feasibility of Feedback control
of Propofol
-Mortier/Struys: Anaesthesia 1998 “Closed-loop controlled administration of propofol using BIS”
-Morley: Anaesthesia 2000 “Closed-loop control of anaesthesia: An assessment of the BIS…”
During GA Maintenance
-Struys: Anesthesiology 2001 “Comparison of closed-loop controlled administration of propofol..”
-Leslie/Absalom: Anaesthesia 2002 “Closed-loop … colonoscopy using the BIS”
-Absalom: AnesthesioUlogy 2s002i “nClosged-lo otp hconterol… unBder cIomSbine d mgeneraol annd reigitonoal anresthesia”
-Absalom : BJA 2003 “Closed-loop control of propofol using the BIS …minor surgery”
-Ihmsen/ Naguib: BJA 2007 “Teletherapeutic drug administration by long distance closed-loop control of propofol”
-Puri: Anaesth. Intensive Care 2007 “Closed-loop anaesthesia delivery system using bispectral index”
-Haddad : IEEE Neural Network 2007 “Neural Network Adaptive Output Feedback …for Intraoperative Anesthesia
Proportional-Differential + TCI propofol (Schnider) + Feed-forward
June 2006, pp 470-475
Prospective randomized study
20 patients/group
Manual vs Automated induction
We wanted to compare our closed-loop controller to the manual TCI
Titration in varying conditions of routine clinical anesthesia.
Including minor and major surgery.
The titration of remifentanil TCI during the surgical procedure was
decided by the physician in charge of the patient in both groups.
End point : 40 < BIS < 60 during maintenance.
Percentage BIS 40-60
50 50
Manual (n=81) Closed-loop (n=83) 46
40 40
30 30
20 20
21
18
17
16
10 10 12
11
6
5 5
0 0 3
10 20 30 40 50 60 70 80 90 100
10 20 30 40 50 60 70 80 90 100
– –
70 21 vs 89 9,
p = 0.0001
Adequate anesthesia was more frequent in the Closed-loop group
Gray Br Med J 1952
Hypnotic
Hypnosis
?
Opioid
Dynamic
Balance
Surgery
Analgesia Paralysis
HR, MAP, Pupillometry

NMBA
Case report
Male 72 years
History of coronary disease (CABG and Angioplasty)
Beta-blocker
Tympanoplasty
General Anesthesia
Closed-loop
Propofol
Manual TCI of Remifentanil
Bolus of Atracurium
TI draping Incision Arousal
Instability !
Oscillation !
Propofol Target
Remi (ng/ml) 6 4 8 12 14 16 20