Model‐based adaptive closed‐loop feedback control of atracurium‐induced neuromuscular blockade

Closed‐loop control of atracurium‐induced neuromuscular blockade by a model‐based adaptive feedback algorithm is described. Mean offsets (± s.d.) from setpoints at 50, 70 and 90% neuromuscular blocks using the Relaxograph® were 1.1 ± 1.3, 0.2 ± 0.7 and 0.1 ± 0.4%, respectively. Correspondingly, the mean steady‐state rates of infusion of atracurium were 0.20 ± 0.06, 0.25 ± 0.03 and 0.39 ± 0.10 mg ‐ kg‐1 ‐ h‐1. The described controller provides reasonable control of atracurium dosing at different degrees of neuromuscular blockade. It gives a solution to the problem of adapting pharmacokinetic and pharmacodynamic data to individuals when using population mean data as starting values for drug therapy.

[1]  P C Uys,et al.  Self-tuning, microprocessor-based closed-loop control of atracurium-induced neuromuscular blockade. , 1988, British journal of anaesthesia.

[2]  Weatherley Bc,et al.  Pharmacokinetics, pharmacodynamics and dose-response relationships of atracurium administered i.v. , 1983 .

[3]  M. keeri-Szanto.  DRUG CONSUMPTION DURING THIOPENTONE-NITROUS OXIDE-RELAXANT ANAESTHESIA: THE PREPARATION AND INTERPRETATION OF TIME/DOSE CURVES , 1960 .

[4]  C E Blogg,et al.  Feedback control of neuromuscular blockade , 1987, Anaesthesia.

[5]  H. H. Ali,et al.  Monitoring of Neuromuscular Function , 1976, Anesthesiology.

[6]  L. Sheiner,et al.  Understanding the Dose-Effect Relationship , 1981, Clinical pharmacokinetics.

[7]  N R Webster,et al.  Closed‐loop administration of atracurium , 1987, Anaesthesia.

[8]  Lewis B. Sheiner,et al.  Simultaneous modeling of pharmacokinetics and pharmacodynamics: Application to d‐tubocurarine , 1979 .

[9]  L. B. Rametti,et al.  On-line control of atracurium induced muscle relaxation. , 1986, Journal of biomedical engineering.

[10]  D A Linkens,et al.  Automatic control of neuromuscular block with atracurium. , 1989, British journal of anaesthesia.

[11]  A Sibbald,et al.  A pharmacodynamic model for pancuronium. , 1978, British journal of anaesthesia.

[12]  J. Wagner,et al.  Kinetics of pharmacologic response. I. Proposed relationships between response and drug concentration in the intact animal and man. , 1968, Journal of theoretical biology.