A Scheme-Based Closed-Loop Anesthesia System

Many aspects of modern medicine, including the administration of anesthetic agents during general surgery, remain unautomated and reliant on the vigilance of the attending clinicians. In other fields where failures can have catastrophic consequences, such as the aviation and nuclear power industry, automated control regimens have been adopted to reduce the risks and improve performance. In this paper we discuss many aspects of the implementation of a complete automated system for intravenous anesthetic drug infusion based on feedback from electroencephalography (EEG) readings. The system software in its entirety consists of approximately 22K lines of Scheme code and features a client-server implementation interfacing medical devices with a portable graphical user interface. The user interface runs on both mobile devices and dedicated medical flat panel displays. The strengths of the Scheme functional language have been leveraged to build a robust maintainable modular system with extensive testing facilities to mitigate the inherent safety hazards associated with the application.

[1]  E. Gat,et al.  Lisp as an Alternative to Java , 2000 .

[2]  Matthias Görges,et al.  Improving Alarm Performance in the Medical Intensive Care Unit Using Delays and Clinical Context , 2009, Anesthesia and analgesia.

[3]  Subbarao Kambhampati,et al.  Planning and Scheduling , 1997, The Computer Science and Engineering Handbook.

[4]  Microcomputer Standards Subcommittee.  IEEE standard for the Scheme programming language , 1991 .

[5]  Richard J. Fateman,et al.  Software Fault Prevention by Language Choice: Why C is Not My Favorite Language , 2002, Adv. Comput..

[6]  Jonathan Kendler,et al.  Usability Testing of Medical Devices , 2010 .

[7]  Erann Gat.  Point of view: Lisp as an alternative to Java , 2000, INTL.

[8]  Kristian Soltesz,et al.  Robust closed‐loop control of induction and maintenance of propofol anesthesia in children , 2013, Paediatric anaesthesia.

[9]  R S G M Perez,et al.  Dosage scheme for propofol in children under 3 years of age , 2004, Paediatric anaesthesia.

[10]  H. Wulf,et al.  [Postoperative nausea and vomiting following stabismus surgery in children. Inhalation anesthesia with sevoflurane-nitrous oxide in comparison with intravenous anesthesia with propofol-remifentanil]. , 1999 .

[11]  Ian M. Mitchell,et al.  The continual reachability set and its computation using maximal reachability techniques , 2011, IEEE Conference on Decision and Control and European Control Conference.

[12]  R. Hawkins,et al.  The Planning and Scheduling Working Group Report on Programming Languages , 2022 .

[13]  R. Eyres.  Update on TIVA , 2004, Paediatric anaesthesia.

[14]  G. Dumont,et al.  The effect of a target controlled infusion of propofol on predictability of recovery from anesthesia in children , 2010, Paediatric anaesthesia.

[15]  Guy Albert Dumont,et al.  Experience report: functional programming of mHealth applications , 2013, ICFP.

[16]  Guy A. Dumont,et al.  Robust control of depth of anesthesia , 2008 .

[17]  James R. Lewis,et al.  IBM computer usability satisfaction questionnaires: Psychometric evaluation and instructions for use , 1995, Int. J. Hum. Comput. Interact..

[18]  P J Manberg,et al.  Regulatory Challenges Facing Closed‐Loop Anesthetic Drug Infusion Devices , 2008, Clinical pharmacology and therapeutics.

[19]  T. Short,et al.  The use of propofol infusions in paediatric anaesthesia: a practical guide , 1999, Paediatric anaesthesia.

[20]  Edward A. Lee.  The problem with threads , 2006, Computer.

[21]  Ulf T. Wiger.  Four-fold Increase in Productivity and Quality , 2001 .

[22]  Target controlled infusion for Kids: Trials and simulations , 2008, 2008 30th Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[23]  R. Larsen,et al.  Total intravenous anaesthesia with propofol and remifentanil in paediatric patients: a comparison with a desflurane‐nitrous oxide inhalation anaesthesia , 1998, Acta anaesthesiologica Scandinavica.

[24]  Ian M. Mitchell,et al.  Computing the viability kernel using maximal reachable sets , 2012, HSCC '12.

[25]  Kristian Soltesz,et al.  Design and Clinical Evaluation of Robust PID Control of Propofol Anesthesia in Children , 2014, IEEE Transactions on Control Systems Technology.

[26]  M. Sury,et al.  Recovery After Anesthesia for Short Pediatric Oncology Procedures: Propofol and Remifentanil Compared with Propofol, Nitrous Oxide, and Sevoflurane , 2005, Anesthesia and analgesia.

[27]  Alexandre M. Bayen,et al.  Aircraft Autolander Safety Analysis Through Optimal Control-Based Reach Set Computation , 2007 .

[28]  Lawrence M Knuckey,et al.  EPSM 2005 Workshop - IEC 60601-1: Medical Electrical Equipment - Part 1: General Requirements for Basic Safety and Essential Performance - 3rd Edition 2005 , 2006 .