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Model-based control of neuromuscular block using mivacurium: design and clinical verification

Published online by Cambridge University Press:  04 April 2006

P. M. Schumacher ,
K. S. Stadler ,
R. Wirz ,
D. Leibundgut ,
C. A. Pfister  and
A. M. Zbinden
P. M. Schumacher
Affiliation:
University Hospital, Department of Anesthesiology, Bern
K. S. Stadler
Affiliation:
Swiss Federal Institute of Technology (ETH), Automatic Control Laboratory, Zurich
R. Wirz
Affiliation:
University Hospital, Department of Anesthesiology, Bern
D. Leibundgut
Affiliation:
University Hospital, Department of Anesthesiology, Bern
C. A. Pfister
Affiliation:
University Hospital, Department of Anesthesiology, Bern
A. M. Zbinden
Affiliation:
University Hospital, Department of Anesthesiology, Bern
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Summary

Background: Short-acting agents for neuromuscular block (NMB) require frequent dosing adjustments for individual patient's needs. In this study, we verified a new closed-loop controller for mivacurium dosing in clinical trials. Methods: Fifteen patients were studied. T1% measured with electromyography was used as input signal for the model-based controller. After induction of propofol/opiate anaesthesia, stabilization of baseline electromyography signal was awaited and a bolus of 0.3 mg kg−1 mivacurium was then administered to facilitate endotracheal intubation. Closed-loop infusion was started thereafter, targeting a neuromuscular block of 90%. Setpoint deviation, the number of manual interventions and surgeon's complaints were recorded. Drug use and its variability between and within patients were evaluated. Results: Median time of closed-loop control for the 11 patients included in the data processing was 135 [89–336] min (median [range]). Four patients had to be excluded because of sensor problems. Mean absolute deviation from setpoint was 1.8 ± 0.9 T1%. Neither manual interventions nor complaints from the surgeons were recorded. Mean necessary mivacurium infusion rate was 7.0 ± 2.2 μg kg−1 min−1. Intrapatient variability of mean infusion rates over 30-min interval showed high differences up to a factor of 1.8 between highest and lowest requirement in the same patient. Conclusions: Neuromuscular block can precisely be controlled with mivacurium using our model-based controller. The amount of mivacurium needed to maintain T1% at defined constant levels differed largely between and within patients. Closed-loop control seems therefore advantageous to automatically maintain neuromuscular block at constant levels.

Keywords

ANAESTHESIA GENERALNEUROMUSCULAR BLOCKADE, monitoring, automation, closed-loop controlNEUROMUSCULAR BLOCKING AGENTS, mivacuriumELECTROMYOGRAPHYCOMPUTER SIMULATION
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 8 , August 2006 , pp. 691 - 699
Copyright
© 2006 European Society of Anaesthesiology

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