Self-tuning, microprocessor-based closed-loop control of atracurium-induced neuromuscular blockade

A self-tuning, closed-loop computerized system was used to maintain atracurium-induced neuromuscular blockade in patients undergoing routine lower abdominal gynaecological surgery. The controller is based on a unique algorithm which utilizes a bi-exponential model wherein two of the variables are estimated on-line. This enables the system to optimize the sizes of subsequent bolus doses according to patient sensitivity. In this study an initial bolus of 0.3 mg kg-1 was given in a trade-off aimed at achieving earlier intubating conditions rather than taking control of relaxation ab initio and obtaining the pre-programmed setpoint of 15% single twitch response (STR) without overshoot. This was successful in all of the 11 patients studied, the mean time from injecting the bolus to intubation being 2.47 (SD 0.95) min and the drug maintenance requirement being 0.34 (0.07) mg kg-1 h-1. This provided a mean value of 10.26% STR with minimal oscillation about the setpoint (average standard deviation = 4.31 (2.53)) for up to 147 min.