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Control of Muscle Relaxation During Anesthesia: A Novel Approach for Clinical Routine


K.S. Stadler, T. Bouillon, Sibylle Hirter, D. Leibundgut, P.M. Schumacher, A.H. Glattfelder, A.M. Zbinden

IEEE Transactions on Biomedical Engineering, vol. 53, no. 3, pp. 387-398

During general anesthesia drugs are administered to provide hypnosis, ensure analgesia, and skeletal muscle relaxation. In this paper, the main components of a newly developed controller for skeletal muscle relaxation are described. Muscle relaxation is controlled by administration of neuromuscular blocking agents. The degree of relaxation is assessed by supramaximal train-of-four stimulation of the ulnar nerve and measuring the electromyogram response of the adductor pollicis muscle. For closed-loop control purposes, a physiologically based pharmacokinetic and pharmacodynamic model of the neuromuscular blocking agent mivacurium is derived. The model is used to design an observer-based state feedback controller. Contrary to similar automatic systems described in the literature this controller makes use of two different measures obtained in the train-of-four measurement to maintain the desired level of relaxation. The controller is validated in a clinical study comparing the performance of the controller to the performance of the anesthesiologist. As presented, the controller was able to maintain a preselected degree of muscle relaxation with excellent precision while minimizing drug administration. The controller performed at least equally well as the anesthesiologist.


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% Autogenerated BibTeX entry
@Article { StaEtal:2006:IFA_2932,
    author={K.S. Stadler and T. Bouillon and Sibylle Hirter and D. Leibundgut and P.M. Schumacher and A.H. Glattfelder and A.M. Zbinden},
    title={{Control of Muscle Relaxation During Anesthesia: A Novel
	  Approach for Clinical Routine}},
    journal={IEEE Transactions on Biomedical Engineering},
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