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A microcomputer based controller for neuromuscular block during surgery.

G Ritchie, J P Ebert, T C Jannett

    Annals of Biomedical Engineering
    |January 1, 1985
    PubMed
    Summary
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    A new computer system automatically controls muscle relaxant infusion during surgery using electromyogram feedback. It effectively induced and maintained neuromuscular block in most patients, enabling rapid recovery.

    Area of Science:

    • Anesthesia and Perioperative Medicine
    • Biomedical Engineering
    • Control Systems

    Background:

    • Maintaining precise neuromuscular block is critical for surgical safety and efficiency.
    • Current methods for administering muscle relaxants may lack real-time, automated adjustments.
    • Electromyography (EMG) provides objective feedback on neuromuscular function.

    Purpose of the Study:

    • To develop and evaluate a microcomputer-based control system for automated induction and maintenance of neuromuscular block.
    • To assess the system's ability to adjust muscle relaxant infusion rates based on real-time EMG data.
    • To determine the efficacy and safety of the system in a surgical patient cohort.

    Main Methods:

    • A closed-loop microcomputer system was designed to control succinylcholine infusion.

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  • The system utilized evoked, rectified, and integrated electromyogram (EMG) from the thenar muscle.
  • The control system aimed for an 80% depression of baseline EMG in 12 surgical patients over a 30-minute infusion period.

    • Main Results:

    • The system achieved the target neuromuscular block setpoint in 10 out of 12 patients within an average of 5.5 minutes.
    • Average recovery to 95% of baseline EMG after infusion cessation was 5.4 minutes.
    • The system demonstrated minimal overshoot (9.9%) and maintained the setpoint for an average of 22.1 minutes, with a mean succinylcholine dose of 1.92 mg/kg.

    Conclusions:

    • The microcomputer-based control system effectively induces and maintains neuromuscular block using EMG feedback.
    • The system shows potential for precise and automated anesthetic drug delivery, improving patient safety.
    • Further investigation is needed for patients with atypical drug sensitivity.