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

Stadler, Konrad S; Schumacher, Peter M; Hirter, Sibylle; Leibundgut, Daniel; Bouillon, Thomas W; Glattfelder, Adolf H; Zbinden, Alex M (2006). Control of muscle relaxation during anesthesia: a novel approach for clinical routine. IEEE transactions on biomedical engineering, 53(3), pp. 387-98. New York, N.Y.: Institute of Electrical and Electronics Engineers IEEE 10.1109/TBME.2005.869649

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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.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy
UniBE Contributor:	Bouillon, Thomas Winfried
ISSN:	0018-9294
ISBN:	16532765
Publisher:	Institute of Electrical and Electronics Engineers IEEE
Language:	English
Submitter:	Jeannie Wurz
Date Deposited:	04 Oct 2013 14:46
Last Modified:	05 Dec 2022 14:14
Publisher DOI:	10.1109/TBME.2005.869649
PubMed ID:	16532765
Web of Science ID:	000235560400004
URI:	https://boris.unibe.ch/id/eprint/19143 (FactScience: 1532)