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

Schumacher, P M; Stadler, K S; Wirz, R; Leibundgut, D; Pfister, C A; Zbinden, A M (2006). Model-based control of neuromuscular block using mivacurium: design and clinical verification. European journal of anaesthesiology, 23(8), pp. 691-9. Philadelphia, Pa.: Lippincott Williams & Wilkins 10.1017/S0265021506000524

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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 11 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 microg 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.

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:	Schumacher, Peter, Leibundgut, Daniel
ISSN:	0265-0215
ISBN:	16805935
Publisher:	Lippincott Williams & Wilkins
Language:	English
Submitter:	Jeannie Wurz
Date Deposited:	04 Oct 2013 14:49
Last Modified:	05 Dec 2022 14:15
Publisher DOI:	10.1017/S0265021506000524
PubMed ID:	16805935
Web of Science ID:	000239400900011
URI:	https://boris.unibe.ch/id/eprint/20437 (FactScience: 3734)