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Closed loop administration of propofol based on a Smith predictor: a randomized controlled trial.

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A new PI+Smith controller effectively manages propofol administration delays in total intravenous anesthesia (TIVA), outperforming manual control for better hypnosis regulation and patient safety.

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Area of Science:

  • Anesthesiology
  • Biomedical Engineering
  • Control Systems

Background:

  • Propofol pharmacodynamics exhibit common delays in total intravenous anesthesia (TIVA).
  • Hypnosis control during TIVA is challenging due to these delayed effects.
  • A proportional-integral (PI) controller with a Smith predictor (PI+Smith) was developed to address this challenge.

Purpose of the Study:

  • To evaluate the feasibility of a closed-loop PI+Smith controller for propofol administration.
  • To compare the performance of the PI+Smith controller against manual control (MC) guided by Bispectral Index (BIS).

Main Methods:

  • Fifty-seven adult patients undergoing TIVA with propofol and remifentanil were randomized into PI+Smith and MC groups.
  • The target Bispectral Index (BIS) was set to 50.
  • Performance was assessed using global score (GS), median performance error (MDPE), median absolute performance error (MDAPE), offset, and Wobble.

Main Results:

  • The PI+Smith group (25 patients) demonstrated significantly better performance than the MC group (29 patients).
  • Key metrics like GS, MDPE, MDAPE, and offset were significantly improved in the PI+Smith group (P<0.001).
  • The percentage of time BIS remained within the 40-60 range was higher in the PI+Smith group (80.8%) compared to MC (59.1%) (P<0.001).

Conclusions:

  • The PI controller with a Smith predictor effectively managed propofol administration delays.
  • This automated system outperformed manual practice in maintaining BIS within the target range.
  • The controller successfully regulated propofol, maintained desired BIS levels, and managed oscillations during TIVA.