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Model-based feedback control of propofol administration for monitored anesthesia care


A. Caruso

Second World Congress of Total Intravenous Anaesthesia - TIVA TCI, Berlin, Germany

The ability of anesthetic agents to provide adequate analgesia and sedation is limited by the ventilatory depression associated with overdosing in spontaneously breathing patients. Respiratory events are indeed the most common complications of monitored anesthesia care (MAC). Opioids and propofol, frequently used in this setting, cause profound respiratory depression. Additionally, light sedation is difficult to quantify. This is not the case for the partial pressure of CO2, the preferred marker of ventilation. Combined pulse oximetry/transcutaneous CO2 partial pressure (PtcCO2) sensors are commercially available. Therefore, targeting the pharmacologic side effect might be preferable to targeting the desired effect during MAC. We tested in a comprehensive model of human metabolism and ventilation, whether a model-based feedback controller targeting PtcCO2 values between 45 and 60 mmHg administering propofol would yield acceptable performance and safety. The physiologic model enabled us to safely and efficiently investigate a model-based controller of propofol administration for MAC. The MPC controller personalizes drug administration and achieves the target PtcCO2 despite significant inter-patient PK/PD variability. The dosing paradigm appears to be promising and will undergo clinical testing. A physical prototype of the device has been developed using MATLAB xPC real-time technology. We shall test the proposed novel dosing paradigm in the clinical environment with a prospective study to be performed at the University Hospital, Bern (Switzerland).


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M. Morari

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