Event-Based control of depth of hypnosis in anesthesia

BACKGROUND AND OBJECTIVE In this paper, we propose the use of an event-based control strategy for the closed-loop control of the depth of hypnosis in anesthesia by using propofol administration and the bispectral index as a controlled variable. METHODS A new event generator with high noise-filtering properties is employed in addition to a PIDPlus controller. The tuning of the parameters is performed off-line by using genetic algorithms by considering a given data set of patients. RESULTS The effectiveness and robustness of the method is verified in simulation by implementing a Monte Carlo method to address the intra-patient and inter-patient variability. A comparison with a standard PID control structure shows that the event-based control system achieves a reduction of the total variation of the manipulated variable of 93% in the induction phase and of 95% in the maintenance phase. CONCLUSIONS The use of event based automatic control in anesthesia yields a fast induction phase with bounded overshoot and an acceptable disturbance rejection. A comparison with a standard PID control structure shows that the technique effectively mimics the behavior of the anesthesiologist by providing a significant decrement of the total variation of the manipulated variable.

[1]  Efstratios N. Pistikopoulos,et al.  A framework for Simultaneous State Estimation and Robust Hybrid Model Predictive Control in Intravenous Anaesthesia , 2016 .

[2]  Teresa Mendonça,et al.  Controlling the depth of anesthesia by a novel positive control strategy , 2014, Comput. Methods Programs Biomed..

[3]  Marek Miskowicz,et al.  Send-On-Delta Concept: An Event-Based Data Reporting Strategy , 2006, Sensors (Basel, Switzerland).

[4]  Gade Pandu Rangaiah,et al.  Advanced Control Strategies for the Regulation of Hypnosis with Propofol , 2009 .

[5]  W. Haddad,et al.  Drug dosing control in clinical pharmacology , 2005, IEEE Control Systems.

[6]  Naira Hovakimyan,et al.  Neural Network Adaptive Output Feedback Control for Intensive Care Unit Sedation and Intraoperative Anesthesia , 2007, IEEE Transactions on Neural Networks.

[7]  Efstratios N. Pistikopoulos,et al.  Modeling, estimation and control of the anaesthesia process , 2017, Comput. Chem. Eng..

[8]  Robin De Keyser,et al.  Closed loop anesthesia: are we getting close to finding the holy grail? , 2011, Anesthesia and analgesia.

[9]  G N Kenny,et al.  Closed-loop control of propofol anaesthesia. , 1999, British journal of anaesthesia.

[10]  José Sánchez,et al.  On the Application of Different Event-Based Sampling Strategies to the Control of a Simple Industrial Process , 2009, Sensors.

[11]  Antonio Visioli,et al.  Inversion-based propofol dosing for intravenous induction of hypnosis , 2016, Commun. Nonlinear Sci. Numer. Simul..

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

[13]  K. Leslie,et al.  Low Bispectral Index Values and Death: The Unresolved Causality Dilemma , 2011, Anesthesia and analgesia.

[14]  Michel M R F Struys,et al.  Performance Evaluation of Two Published Closed-loop Control Systems Using Bispectral Index Monitoring: A Simulation Study , 2004, Anesthesiology.

[15]  Hugo Vereecke,et al.  Spectral Entropy as an Electroencephalographic Measure of Anesthetic Drug Effect: A Comparison with Bispectral Index and Processed Midlatency Auditory Evoked Response , 2004, Anesthesiology.

[16]  I. Constant,et al.  Which model for propofol TCI in children , 2010, Paediatric anaesthesia.

[17]  Xiaoming Hu,et al.  Analysis and Design of Nonlinear Control Systems , 2011 .

[18]  M. Omizo,et al.  Modeling , 1983, Encyclopedic Dictionary of Archaeology.

[19]  Teresa Mendonça,et al.  Positive state observer for the automatic control of the depth of anesthesia - Clinical results , 2016, Comput. Methods Programs Biomed..

[20]  A. Absalom,et al.  Closed-loop Control of Anesthesia Using Bispectral Index: Performance Assessment in Patients Undergoing Major Orthopedic Surgery under Combined General and Regional Anesthesia , 2002, Anesthesiology.

[21]  G D Puri,et al.  Closed-Loop Anaesthesia Delivery System (CLADSTM) using Bispectral Index: A Performance Assessment Study , 2007, Anaesthesia and intensive care.

[22]  S L Shafer,et al.  The influence of age on propofol pharmacodynamics. , 1999, Anesthesiology.

[23]  Ramon Vilanova,et al.  PID Control in the Third Millennium , 2012 .

[24]  Arturo Martínez.  Robust control : PID vs. fractional control design, a case study , 2006 .

[25]  Marek Miskowicz,et al.  Event-Based Control and Signal Processing , 2015 .

[26]  Guy Albert Dumont,et al.  Robust closed-loop control of hypnosis with propofol using WAVCNS index as the controlled variable , 2012, Biomed. Signal Process. Control..

[27]  Willy Wojsznis,et al.  PID control using wireless measurements , 2014, 2014 American Control Conference.

[28]  Clara M. Ionescu,et al.  Advanced Model-Based Control Studies for the Induction and Maintenance of Intravenous Anaesthesia , 2015, IEEE Transactions on Biomedical Engineering.

[29]  C. Rosow,et al.  Bispectral index monitoring , 2001 .

[30]  N. Morton,et al.  Overview of total intravenous anesthesia in children , 2010, Paediatric anaesthesia.

[31]  Chuang Liu,et al.  Design of Type-1 and Interval Type-2 Fuzzy PID Control for Anesthesia Using Genetic Algorithms , 2014 .

[32]  Antonio Visioli.  Event-based PID control , 2018, 2018 IEEE 16th World Symposium on Applied Machine Intelligence and Informatics (SAMI).

[33]  Guy Albert Dumont,et al.  Quantifying cortical activity during general anesthesia using wavelet analysis , 2006, IEEE Transactions on Biomedical Engineering.

[34]  Dorothea Heiss-Czedik,et al.  An Introduction to Genetic Algorithms. , 1997, Artificial Life.

[35]  Antonio Visioli,et al.  Digital Control Engineering: Analysis and Design , 2009 .

[36]  Ngai Liu,et al.  Closed-loop control of consciousness during lung transplantation: an observational study. , 2008, Journal of cardiothoracic and vascular anesthesia.

[37]  Julio E. Normey-Rico,et al.  Robust Predictive Control Strategy Applied for Propofol Dosing Using BIS as a Controlled Variable During Anesthesia , 2008, IEEE Transactions on Biomedical Engineering.

[38]  Hugo Vereecke,et al.  Ability of the Bispectral Index, Autoregressive Modelling with Exogenous Input-derived Auditory Evoked Potentials, and Predicted Propofol Concentrations to Measure Patient Responsiveness during Anesthesia with Propofol and Remifentanil , 2003, Anesthesiology.

[39]  P. Wen,et al.  The design and investigation of model based internal model control for the regulation of hypnosis , 2010, 2010 IEEE International Conference on Nano/Molecular Medicine and Engineering.

[40]  A. Absalom,et al.  Closed-loop control of propofol anaesthesia using bispectral index: performance assessment in patients receiving computer-controlled propofol and manually controlled remifentanil infusions for minor surgery. , 2003, British journal of anaesthesia.

[41]  Tore Hägglund,et al.  Individualized closed-loop control of propofol anesthesia: A preliminary study , 2013, Biomed. Signal Process. Control..

[42]  Ngai Liu,et al.  Closed-Loop Anesthesia Based on Neuromonitoring , 2014 .

[43]  Clara M. Ionescu,et al.  Optimized PID control of depth of hypnosis in anesthesia , 2017, Comput. Methods Programs Biomed..

[44]  Kristian Soltesz,et al.  On Automation in Anesthesia , 2013 .

[45]  Fredrik Granath,et al.  Mortality Within 2 Years After Surgery in Relation to Low Intraoperative Bispectral Index Values and Preexisting Malignant Disease , 2009, Anesthesia and analgesia.

[46]  Donald E. Grierson,et al.  Comparison among five evolutionary-based optimization algorithms , 2005, Adv. Eng. Informatics.

[47]  Terrence L. Blevins.  PID Advances in Industrial Control , 2012 .

[48]  Jesse M. Ehrenfeld,et al.  Monitoring technologies in acute care environments , 2014 .

[49]  C. Minto,et al.  Contributions of PK/PD Modeling to Intravenous Anesthesia , 2008, Clinical pharmacology and therapeutics.

[50]  Loren A. Hemachandra.  Target-Controlled Infusions , 2014 .

[51]  S. Shafer,et al.  The Influence of Method of Administration and Covariates on the Pharmacokinetics of Propofol in Adult Volunteers , 1998, Anesthesiology.

[52]  Aloysius K. Mok,et al.  Improving PID Control with Unreliable Communications , 2006 .

[53]  G. G. Stokes.  "J." , 1890, The New Yale Book of Quotations.

[54]  Manfred Morari,et al.  Challenges and opportunities in process control: Biomedical processes , 2001 .

[55]  Efstratios N. Pistikopoulos,et al.  Explicit hybrid model predictive control strategies for intravenous anaesthesia , 2017, Comput. Chem. Eng..

[56]  M. Struys,et al.  Comparison of Closed-loop Controlled Administration of Propofol Using Bispectral Index as the Controlled Variable versus “Standard Practice” Controlled Administration , 2001, Anesthesiology.

[57]  Laurent Beydon,et al.  Closed-Loop Coadministration of Propofol and Remifentanil Guided by Bispectral Index: A Randomized Multicenter Study , 2011, Anesthesia and analgesia.

[58]  Tore Hägglund,et al.  Advanced PID Control , 2005 .

[59]  Tony Gin,et al.  BIS-guided Anesthesia Decreases Postoperative Delirium and Cognitive Decline , 2013, Journal of neurosurgical anesthesiology.

[60]  Luc Barvais,et al.  Titration of Propofol for Anesthetic Induction and Maintenance Guided by the Bispectral Index: Closed-loop versus Manual Control: A Prospective, Randomized, Multicenter Study , 2006, Anesthesiology.

[61]  M. Janda,et al.  Clinical evaluation of a simultaneous closed‐loop anaesthesia control system for depth of anaesthesia and neuromuscular blockade * , 2011, Anaesthesia.

[62]  J. E. Gibson,et al.  ANALYSIS AND DESIGN OF NONLINEAR CONTROL SYSTEMS. , 1965 .