Simultaneous regulation of hemodynamic and anesthetic states: a simulation study

A model predictive control strategy to simultaneously regulate hemodynamic and anesthetic variables in critical care patients is presented. A nonlinear canine circulatory model, which has been used to study the effect of inotropic and vasoactive drugs on hemodynamic variables, has been extended to include propofol pharmacokinetics and pharmacodynamics. Propofol blood concentration is used as a measure for depth of anesthesia. The simulation model is used to design and test the control strategy. The optimization-based model predictive control strategy assures that constraints imposed on the drug infusion rates are met. The physician always remains "in the loop" and serves as the "primary controller" by making propofol blood concentration setpoint changes based on observations about anesthetic depth. Results are shown for three simulated cases: (i) congestive heart failure, (ii) postcoronary artery bypass, and (iii) acute changes in hemodynamic variables.