Model-based control of neuromuscular block using mivacurium: design and clinical verification

被引:10
作者
Schumacher, P. M. [1 ]
Stadler, K. S.
Wirz, R.
Leibundgut, D.
Pfister, C. A.
Zbinden, A. M.
机构
[1] Univ Hosp Bern, Dept Anesthesiol, CH-3010 Bern, Switzerland
[2] Swiss Fed Inst Technol, Automat Control Lab, Zurich, Switzerland
关键词
anaesthesia general; neuromuscular blockade; monitoring; automation; closed-loop; control; neuromuscular blocking agents; mivacurium; electromyography; computer simulation;
D O I
10.1017/S0265021506000524
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Background. Short-acting agents for neuromuscular block (NMB) require frequent dosing adjustments for individual patient's needs. In this study, we verified a new closed-loop controller for mivacurium dosing in clinical trials. Methods: Fifteen patients were studied. T1% measured with electromyography was used as input signal for the model-based controller. After induction of propofol/opiate anaesthesia, stabilization of baseline electromyography signal was awaited and a bolus of 0.3 mg kg(-1) mivacurium was then administered to facilitate endotracheal intubation. Closed-loop infusion was started thereafter, targeting a neuromuscular block of 90%. Setpoint deviation, the number of manual interventions and surgeon's complaints were recorded. Drug use and its variability between and within patients were evaluated. Results: Median time of closed-loop control for the I 1 patients included in the data processing was 135 [89-336] min (median [range]). Four patients had to be excluded because of sensor problems. Mean absolute deviation from setpoint was 1.8 +/- 0.9 T1%. Neither manual interventions nor complaints from the surgeons were recorded. Mean necessary mivacurium infusion rate was 7.0 +/- 2.2 mu g kg(-1) min(-1). Intrapatient variability of mean infusion rates over 30-min interval showed high differences up to a factor of 1.8 between highest and lowest requirement in the same patient. Conclusions: Neuromuscular block can precisely be controlled with mivacurium using our model-based controller. The amount of mivacurium needed to maintain T1% at defined constant levels differed largely between and within patients. Closed-loop control seems therefore advantageous to automatically maintain neuromuscular block at constant levels.
引用
收藏
页码:691 / 699
页数:9
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