Control of muscle relaxation during anesthesia: a novel approach for clinical routine

During general anesthesia drugs are administered to provide hypnosis, ensure analgesia, and skeletal muscle relaxation. In this paper, the main components of a newly developed controller for skeletal muscle relaxation are described. Muscle relaxation is controlled by administration of neuromuscular...

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Bibliographic Details
Published in:IEEE transactions on biomedical engineering 2006-03, Vol.53 (3), p.387-398
Main Authors: Stadler, K.S., Schumacher, P.M., Hirter, S., Leibundgut, D., Bouillon, T.W., Glattfelder, A.H., Zbinden, A.M.
Format: Article
Language:English
Subjects:
Anesthesia
Anesthetics, General - administration & dosage
Associate members
Automatic control
Biomedical measurements
clinical validation
Computer Simulation
Control systems
Drug Combinations
Drug Therapy, Computer-Assisted - methods
Drugs
Humans
Models, Biological
Muscle Contraction - drug effects
Muscle Contraction - physiology
muscle relaxation
Muscle Relaxation - drug effects
Muscle Relaxation - physiology
Muscle, Skeletal - drug effects
Muscle, Skeletal - physiology
Muscles
Neuromuscular
Neuromuscular Agents - administration & dosage
Safety
State feedback
Stress
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Summary:During general anesthesia drugs are administered to provide hypnosis, ensure analgesia, and skeletal muscle relaxation. In this paper, the main components of a newly developed controller for skeletal muscle relaxation are described. Muscle relaxation is controlled by administration of neuromuscular blocking agents. The degree of relaxation is assessed by supramaximal train-of-four stimulation of the ulnar nerve and measuring the electromyogram response of the adductor pollicis muscle. For closed-loop control purposes, a physiologically based pharmacokinetic and pharmacodynamic model of the neuromuscular blocking agent mivacurium is derived. The model is used to design an observer-based state feedback controller. Contrary to similar automatic systems described in the literature this controller makes use of two different measures obtained in the train-of-four measurement to maintain the desired level of relaxation. The controller is validated in a clinical study comparing the performance of the controller to the performance of the anesthesiologist. As presented, the controller was able to maintain a preselected degree of muscle relaxation with excellent precision while minimizing drug administration. The controller performed at least equally well as the anesthesiologist.
ISSN:0018-9294
1558-2531
DOI:10.1109/TBME.2005.869649