Model-based drug administration: current status of target-controlled infusion and closed-loop control

Area of Science:

• Anesthesiology
• Pharmacokinetics and Pharmacodynamics
• Control Engineering

Background:

• Optimizing drug administration in anesthesia is crucial for patient safety and outcomes.
• Pharmacokinetic-dynamic (PK/PD) principles and control engineering offer advanced approaches to drug delivery.
• Target-controlled infusion (TCI) and closed-loop systems represent key innovations in this field.

Purpose of the Study:

• To provide an updated review of target-controlled infusion (TCI) and closed-loop computer-controlled drug administration.
• To discuss the current status and ongoing research in automated drug administration.
• To highlight the integration of PK/PD principles and control engineering in anesthesia.

Main Methods:

• Literature review of TCI and closed-loop drug administration systems.
• Analysis of current clinical applications and research findings.
• Evaluation of PK/PD model development and integration into drug delivery systems.

Main Results:

• TCI is a mature, safe technology with increasing clinical use, but requires adaptable PK/PD models for diverse populations.
• New PK/PD models are being developed for broader TCI application.
• Closed-loop hypnotic drug administration using EEG shows superiority over manual methods.
• Feasibility of closed-loop systems for multiple anesthetic components is demonstrated, but further research on safety and efficiency is needed.

Conclusions:

• Increasing evidence supports TCI and closed-loop systems as valuable tools for anesthesiologists.
• These technologies can assist in optimizing drug administration during anesthesia.
• Further research is required to fully establish the clinical safety and efficiency of advanced closed-loop systems.