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Model based closed-loop control of propofol sedation using transcutaneous CO2 as target variable


A. Caruso

ASA - American Society of Anesthesiologists Annual Meeting, New Orleans, LA

The ability of anesthetic agents to provide adequate analgesia and sedation is limited by the ventilatory depression associated with overdosing in spontaneously breathing patients. Propofol, increasingly used to deliver sedation, causes profound respiratory depression. Additionally, light sedation is difficult to quantify. This is not the case for the partial pressure of CO2 (PCO2), the preferred marker of ventilation. Combined pulse oximetry/transcutaneous PCO2 (PtcCO2) sensors are commercially available. Therefore, targeting the pharmacologic side effect rather than the desired effect might be preferable during sedation. We tested in a model of human metabolism and ventilation whether a model based feedback controller targeting PtcCO2 levels between 45 and 60 mmHg and propofol effect site concentrations (Ce) below 4 micro g/ml would yield acceptable performance and safety. The physiological model allowed us to investigate efficiently the use of a model based controller to deliver propofol sedation. The MPC controller personalizes drug delivery and achieves the target PtcCO2 and Ce setpoints despite significant PKPD variability. The performance of the model based controller is superior to previously considered non-model based designs. The proposed dosing paradigm is currently being investigated in gastroenterology patients at the Bern University Hospital, Switzerland. Clinical results of the proof-of-concept study will be included in the presentation of this work at the conference.


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M. Morari

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