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The accuracy and clinical feasibility of a new Bayesian-based closed-loop control system for propofol administration using the bispectral index as a controlled variable

Tom De Smet, Michel Struys UGent, MARTINE NECKEBROEK UGent, KRISTOF VAN DEN HAUWE UGent, SJOERT BONTE UGent and Eric Mortier UGent (2008) ANESTHESIA AND ANALGESIA. 107(4). p.1200-1210
abstract
BACKGROUND: Closed-loop control of the hypnotic component of anesthesia has been proposed in an attempt to optimize drug delivery. Here, we introduce a newly developed Bayesian-based, patient-individualized, model-based, adaptive control method for bispectral index (BIS) guided propofol infusion into clinical practice and compare its accuracy and clinical feasibility under direct observation of all anesthesiologist versus BIS guided, effect compartment controlled propofol administration titrated by the anesthesiologist during ambulatory gynecological procedures. METHODS: Forty ASA patients were randomly allocated to the closed-loop or manual control group. All patients received miclazolam 1 mg IV and alfentanil 0.5 mg IV before induction. In the closed-loop control group, propofol was administered using the previously described closed-loop control system to reach and maintain a target BIS of 50. In the manual control group, the propofol effect-site concentration was adapted at the discretion of the anesthesiologist to reach and maintain a BIS as close as possible to 50. Induction characteristics, performance, and robustness during maintenance and recovery times were compared. Hemodynamic and respiratory stability were calculated as clinical feasibility parameters. RESULTS: The closed-loop control system titrated propofol administration accurately resulting in BIS values close to the set point. The closed-loop control system was able to induce the patients within clinically accepted time limits and with less overshoot than the manual control group. Automated control resulted in beneficial recovery times. Our closed-loop control group showed similar acceptable clinical performance specified by similar hemodynamic, respiratory stability, comparable movement rates, and quality scores than the manual control group. CONCLUSIONS: The Bayesian-based closed-loop control system for propofol administration using the BIS as a controlled variable performed accurate during anesthesia for ambulatory gynecological procedures. This control system is clinical feasibility and can be further validated in clinical practice.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
REMIFENTANIL, ISOFLURANE, PHARMACODYNAMICS, PHARMACOKINETICS, PERFORMANCE ASSESSMENT, ANESTHESIA, SIMULATION, HYPNOSIS
journal title
ANESTHESIA AND ANALGESIA
Anesth. Analg.
volume
107
issue
4
pages
1200 - 1210
publisher
LIPPINCOTT WILLIAMS & WILKINS
place of publication
530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA
Web of Science type
Article
Web of Science id
000259522100022
JCR category
ANESTHESIOLOGY
JCR impact factor
2.59 (2008)
JCR rank
6/22 (2008)
JCR quartile
2 (2008)
ISSN
0003-2999
DOI
10.1213/ane.0b013e31817bd1a6
language
English
UGent publication?
yes
classification
A1
copyright statement
I don't know the status of the copyright for this publication
id
528917
handle
http://hdl.handle.net/1854/LU-528917
date created
2009-03-24 09:59:39
date last changed
2009-03-26 09:53:01
@article{528917,
  abstract     = {BACKGROUND: Closed-loop control of the hypnotic component of anesthesia has been proposed in an attempt to optimize drug delivery. Here, we introduce a newly developed Bayesian-based, patient-individualized, model-based, adaptive control method for bispectral index (BIS) guided propofol infusion into clinical practice and compare its accuracy and clinical feasibility under direct observation of all anesthesiologist versus BIS guided, effect compartment controlled propofol administration titrated by the anesthesiologist during ambulatory gynecological procedures.
METHODS: Forty ASA patients were randomly allocated to the closed-loop or manual control group. All patients received miclazolam 1 mg IV and alfentanil 0.5 mg IV before induction. In the closed-loop control group, propofol was administered using the previously described closed-loop control system to reach and maintain a target BIS of 50. In the manual control group, the propofol effect-site concentration was adapted at the discretion of the anesthesiologist to reach and maintain a BIS as close as possible to 50. Induction characteristics, performance, and robustness during maintenance and recovery times were compared. Hemodynamic and respiratory stability were calculated as clinical feasibility parameters.

RESULTS: The closed-loop control system titrated propofol administration accurately resulting in BIS values close to the set point. The closed-loop control system was able to induce the patients within clinically accepted time limits and with less overshoot than the manual control group. Automated control resulted in beneficial recovery times. Our closed-loop control group showed similar acceptable clinical performance specified by similar hemodynamic, respiratory stability, comparable movement rates, and quality scores than the manual control group.

CONCLUSIONS: The Bayesian-based closed-loop control system for propofol administration using the BIS as a controlled variable performed accurate during anesthesia for ambulatory gynecological procedures. This control system is clinical feasibility and can be further validated in clinical practice.},
  author       = {De Smet, Tom and Struys, Michel and NECKEBROEK, MARTINE and VAN DEN HAUWE, KRISTOF and BONTE, SJOERT and Mortier, Eric},
  issn         = {0003-2999},
  journal      = {ANESTHESIA AND ANALGESIA},
  keyword      = {REMIFENTANIL,ISOFLURANE,PHARMACODYNAMICS,PHARMACOKINETICS,PERFORMANCE ASSESSMENT,ANESTHESIA,SIMULATION,HYPNOSIS},
  language     = {eng},
  number       = {4},
  pages        = {1200--1210},
  publisher    = {LIPPINCOTT WILLIAMS \& WILKINS},
  title        = {The accuracy and clinical feasibility of a new Bayesian-based closed-loop control system for propofol administration using the bispectral index as a controlled variable},
  url          = {http://dx.doi.org/10.1213/ane.0b013e31817bd1a6},
  volume       = {107},
  year         = {2008},
}

Chicago
De Smet, Tom, Michel Struys, MARTINE NECKEBROEK, KRISTOF VAN DEN HAUWE, SJOERT BONTE, and Eric Mortier. 2008. “The Accuracy and Clinical Feasibility of a New Bayesian-based Closed-loop Control System for Propofol Administration Using the Bispectral Index as a Controlled Variable.” Anesthesia and Analgesia 107 (4): 1200–1210.
APA
De Smet, T., Struys, M., NECKEBROEK, M., VAN DEN HAUWE, K., BONTE, S., & Mortier, E. (2008). The accuracy and clinical feasibility of a new Bayesian-based closed-loop control system for propofol administration using the bispectral index as a controlled variable. ANESTHESIA AND ANALGESIA, 107(4), 1200–1210.
Vancouver
1.
De Smet T, Struys M, NECKEBROEK M, VAN DEN HAUWE K, BONTE S, Mortier E. The accuracy and clinical feasibility of a new Bayesian-based closed-loop control system for propofol administration using the bispectral index as a controlled variable. ANESTHESIA AND ANALGESIA. 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA: LIPPINCOTT WILLIAMS & WILKINS; 2008;107(4):1200–10.
MLA
De Smet, Tom, Michel Struys, MARTINE NECKEBROEK, et al. “The Accuracy and Clinical Feasibility of a New Bayesian-based Closed-loop Control System for Propofol Administration Using the Bispectral Index as a Controlled Variable.” ANESTHESIA AND ANALGESIA 107.4 (2008): 1200–1210. Print.