Adaptive Multi-Drug Infusion Control System for General Anesthesia in Major Surgery

Introduction

A major challenge in anesthesia is to adapt the drug infusion rates from observed patient response to surgical stimuli. The patient models are based on nominal population characteristic responses and lack specific surgical effects. In major surgery (e.g., cardiac, transplant, obese patients), modeling uncertainty stems from significant blood losses, anomalous drug diffusion, drug effect synergy/antagonism, anesthetic-hemodynamic interactions, etc. This complex optimization problem requires superhuman abilities of the anesthesiologist.

Computer Controlled Anesthesia

Computer controlled anesthesia holds the answer to be the game changer for best surgery outcomes. Although few clinical studies report that computer-based anesthesia for one or two drugs outperforms manual management, in reality, clinical practice mitigates a multi-drug optimization problem while accommodating large patient model uncertainty.

The anesthesiologist makes decisions based on future surgeon actions and expected patient response. This is a predictive control strategy, a mature methodology in systems and control engineering with potential to achieve:

1. Faster recovery times
2. Lower risk of complications

Proposal Goals

The goal of this proposal is to advance the scope and clinical use of computer-based constrained optimization of multi-drug infusion rates for anesthesia with strong effects on hemodynamics.

Methodology

I plan to identify multivariable models and minimize the large uncertainties in patient response. With adaptation mechanisms from nominal to individual patient models, we will design multivariable optimal predictive control methodologies to manage strongly coupled dynamics.

To maximize the performance of the closed loop, we will model the surgical stimulus as a known disturbance signal and additional bolus infusions from the anesthesiologist as known inputs.

Conclusion

I am convinced that the integration of human expertise with computer optimization is a successful solution for breakthrough into clinical practice.