Patel Bhavina, Patel Hiren, Vachhrajani Pragna, Shah Divyang, Sarvaia Alpesh
1Department of Electrical Engineering, Sardar Vallabhbhai National Institute of Technology, Surat, India.
Surat Municipal Institute of Medical Education and Research (SMIMER), Surat, India.
Biomed Eng Lett. 2018 Dec 11;9(1):127-144. doi: 10.1007/s13534-018-0090-3. eCollection 2019 Feb.
Anesthetic agent propofol needs to be administered at an appropriate rate to prevent hypotension and postoperative adverse reactions. To comprehend more suitable anesthetic drug rate during surgery is a crucial aspect. The main objective of this proposal is to design robust automated control system that work efficiently in most of the patients with smooth BIS and minimum variations of propofol during surgery to avoid adverse post reactions and instability of anesthetic parameters. And also, to design advanced computer control system that improves the health of patient with short recovery time and less clinical expenditures. Unlike existing research work, this system administrates propofol as a hypnotic drug to regulate BIS, with fast bolus infusion in induction phase and slow continuous infusion in maintenance phase of anesthesia. The novelty of the paper lies in possibility to simplify the drug sensitivity-based adaption with infusion delay approach to achieve closed-loop control of hypnosis during surgery. Proposed work uses a brain concentration as a feedback signal in place of the BIS signal. Regression model based estimated sensitivity parameters are used for adaption to avoid BIS signal based frequent adaption procedure and large offset error. Adaptive smith predictor with lead-lag filter approach is applied on 22 different patients' model identified by actual clinical data. The actual BIS and propofol infusion signals recorded during clinical trials were used to estimate patient's sensitivity parameters and . Simulation results indicate that patient's drug sensitivity parameters based adaptive strategy facilitates optimal controller performance in most of the patients. Results are obtained with proposed scheme having less settling time, BIS oscillations and small offset error leads to adequate depth of anesthesia. A comparison with manual control mode and previously reported system shows that proposed system achieves reduction in the total variations of the propofol dose. Proposed adaptive scheme provides better performance with less oscillation in spite of computation delay, surgical stimulations and patient variability. Proposed scheme also provides improvement in robustness and may be suitable for clinical practices.
麻醉剂丙泊酚需要以适当的速率给药,以防止低血压和术后不良反应。了解手术期间更合适的麻醉药物速率是一个关键方面。本提议的主要目标是设计强大的自动控制系统,该系统能在大多数患者中高效运行,使脑电双频指数(BIS)平稳,手术期间丙泊酚变化最小,以避免术后不良反应和麻醉参数不稳定。此外,设计先进的计算机控制系统,以缩短恢复时间并减少临床费用,从而改善患者健康状况。与现有研究工作不同,该系统将丙泊酚作为催眠药物来调节BIS,在麻醉诱导期快速推注给药,在维持期缓慢持续输注给药。本文的新颖之处在于有可能通过输液延迟方法简化基于药物敏感性的适应过程,以实现手术期间催眠的闭环控制。所提出的工作使用脑内浓度作为反馈信号,取代BIS信号。基于回归模型估计的敏感性参数用于适应过程,以避免基于BIS信号的频繁适应过程和较大的偏移误差。采用带有超前滞后滤波器方法的自适应史密斯预估器应用于通过实际临床数据识别的22个不同患者模型。临床试验期间记录的实际BIS和丙泊酚输注信号用于估计患者的敏感性参数。仿真结果表明,基于患者药物敏感性参数的自适应策略在大多数患者中有助于实现最优控制器性能。所提出的方案具有更短的调节时间、BIS振荡更小且偏移误差小,从而能实现足够的麻醉深度。与手动控制模式和先前报道的系统相比,结果表明所提出的系统实现了丙泊酚剂量总变化的减少。尽管存在计算延迟、手术刺激和患者个体差异,所提出的自适应方案仍能提供更好的性能且振荡更小。所提出的方案还提高了鲁棒性,可能适用于临床实践。