Closed-Loop Control of General Anesthesia: “My Clinical Experience” LIU, M.D. Ngai [email protected] 33(1)-46-25-27-67 Service d’Anesthésie Hôpital Foch Suresnes France JAMA 1950, 144 (13) 50 patients, ETHER “Major Surgical procedures varying age, both sexes Without untoward effect “ Feasibility of Feedback control of Propofol -Mortier/Struys: Anaesthesia 1998 “Closed-loop controlled administration of propofol using BIS” -Morley: Anaesthesia 2000 “Closed-loop control of anaesthesia: An assessment of the BIS…” During GA Maintenance -Struys: Anesthesiology 2001 “Comparison of closed-loop controlled administration of propofol..” -Leslie/Absalom: Anaesthesia 2002 “Closed-loop … colonoscopy using the BIS” -Absalom: AnesthesioUlogy 2s002i “nClosged-lo otp hconterol… unBder cIomSbine d mgeneraol annd reigitonoal anresthesia” -Absalom : BJA 2003 “Closed-loop control of propofol using the BIS …minor surgery” -Ihmsen/ Naguib: BJA 2007 “Teletherapeutic drug administration by long distance closed-loop control of propofol” -Puri: Anaesth. Intensive Care 2007 “Closed-loop anaesthesia delivery system using bispectral index” -Haddad : IEEE Neural Network 2007 “Neural Network Adaptive Output Feedback …for Intraoperative Anesthesia Proportional-Differential + TCI propofol (Schnider) + Feed-forward June 2006, pp 470-475 Prospective randomized study 20 patients/group Manual vs Automated induction We wanted to compare our closed-loop controller to the manual TCI Titration in varying conditions of routine clinical anesthesia. Including minor and major surgery. The titration of remifentanil TCI during the surgical procedure was decided by the physician in charge of the patient in both groups. End point : 40 < BIS < 60 during maintenance. Percentage BIS 40-60 50 50 Manual (n=81) Closed-loop (n=83) 46 40 40 30 30 20 20 21 18 17 16 10 10 12 11 6 5 5 0 0 3 10 20 30 40 50 60 70 80 90 100 10 20 30 40 50 60 70 80 90 100 – – 70 21 vs 89 9, p = 0.0001 Adequate anesthesia was more frequent in the Closed-loop group Gray Br Med J 1952 Hypnotic Hypnosis ? Opioid Dynamic Balance Surgery Analgesia Paralysis HR, MAP, Pupillometry NMBA Case report Male 72 years History of coronary disease (CABG and Angioplasty) Beta-blocker Tympanoplasty General Anesthesia Closed-loop Propofol Manual TCI of Remifentanil Bolus of Atracurium TI draping Incision Arousal Instability ! Oscillation ! Propofol Target Remi (ng/ml) 6 4 8 12 14 16 20