COMPUTINO IN ANESTHESIA AND INTENSIVE CARE DEVELOPMENTS IN CRITICAL CARE MEDIClNE AND ANESTHESIOLOGY Other volumes in this series: Prakash, Omar (ed.): Applied Physiology in Clinical Respiratory Care. 1982. ISBN 9O-247-2662-X. McGeown, Mary G.: Clinical Management of Electrolyte Disorders. 1983. ISBN 0-89838-559-8. Scheck, P.A., Sjöstrand, V.H., and Smith, R.B. (eds.): Perspectives in High Frequency Ventilation. 1983. ISBN 0-89838-571-7. Stanley, Tb.H. and Petty, W.C. (eds.): New Anesthetic Agents, Devices and Mo nitoring Techniques. 1983. ISBN 0-89838-566-0. COMPUTING IN ANESTHESIA AND INTENSIVE CARE edited by OMAR PRAKASH, MD Thoraxeentrum. Academic Hospital Dijkzigt. Erasmus University. Rotterdam associate editors SIMON H. MEY M.Sc and RICHARD W. PATTERSON MD Thoraxeentrum. University 01 California Medical Center. Rotterdam Los Angeles 1983 MARTINUS NIJHOFF PUBLISHERS a member of the KLUWER ACADEMIC PUBLISHERS GROUP BOSTON / THE HAGUE / DORDRECHT / LANCASTER DIstrlbuton for the United States and Canada: IOuwer Boston. Inc •• 190 Old Derby Street. Hinaham. MA 02043. USA for all other collntries: IOuwer Academic Publishers OrouP. Distribution Center. P .O.Box 322. 3300 AU Dordrecht. The Netherlands Library or Congress Catalog Card Number 83·17301 ISBN-13:978-94-009-6749-6 e-ISBN-13:978-94-009-6747-2 DOI: 10.10071978-94-009-6747-2 Copyright © 1983 by Martinus Nijhoff Publishers. Boston. Reprint ofthe original edition 1983 All rights reserved. No part of this publication may be reproduced. stored in a retrieval system. or transmitted in any form or by any means. mechanical. photocopying. recording. or otherwise. without the prior written permission of the publishers. Martinus Nijhoff Publishers. 190 Old Derby Street. Hingham. MA 02043. USA. P R E F ACE This volume represents selected topics in Computing in Anesthesia and Intensive Care and contains the proceedings of the Second International Symposium, held in Rotterdam, September 6-10, 1983. This monograph provides the role of Computing in Anes thesia and Intensive Care, covering a wide range of topics: Education, Monitoring, Innovative Techniques, Computer Assisted Intravenous Anesthesia, Data Management and Closed Loop Systems. At tre outset, I must thank the keynote speakers and others for submitting their manuscripts promptly. I express my gratitude to R.W. Patterson, Simon Heij and Bas van der Borden for helping me to edit this volume. Finally, thanks are due to E.N.R. Rulf, Norma van Toornburg and Claudia Dijkstra for their help and cooperation. July, 1983 Omar Prakash, rl.D. CONTENTS Preface V Contributors XI computer operating systems for patient monitoring 1 A.K. Ream On the use of computers in the practice of anaesthesia ..•..•..•.....•........•••............... 11 •• D. Daub and K.A. Lehmann Computerized data acquisition and display in anesthesia ...•....•.............•...••...•.......... 25 J.E.W. Beneken, J.A. BIom, A.P. Meijler, P. Cluitmans, Joh. Spierdijk, A. Nandorff, R. Nijhuis, H.M. van Kessel Microcomputer based automatie capture of signals from non-invasive instruments •....•..•••••.•.••.•... 44 N.H. Naqvi Physiologie monitoring of critically ill patients: computerized da ta acquisition, outcome prediction, organisation of therapy and prospective clinical trials.............................................. 61 W.C. Shoemaker Set up and results ICU database .•...............•... 78 J.A. Leusink and R. van Staden An interactive information system for anaesthesia 86 G.L. Olsson Automated analysis of the esophageal accelerogram as a minimally invasive monitor of manifest contractile state ............•.......•.............. 96 R.S. Wiley, L.S. Shepard, L.B. Wolfenson Information transfer from operating room to ICU ..... 107 R.M. Peters Energy metabolism ..........•......•..•.......••..... 116 S. Bursztein and Z. Bshouty Gas distribution and ventilation-perfusion relationships during anaesthesia and in acute respiratory failure ........ - •.•...•........•..•..... 121 G. Hedenstierna and S. Baehrendtz Continuous monitoring of intrathoraeie fluid .•...... 141 H.H.M. Karsten, J.H. Meijer, S.J. Hengeveld, J.B.V.M. Delemarre, J.A. Leusink, G.A. Schurink, H. Schneider The potential of computer modelling techniques in intensive care medicine ...•.•..•••...•..•.......• 153 C.J. Hinds and C.J. Dickinsan VIII An interaetive program for intravenous drug infusion management •••••••.••••••••.••••••.•.••••••• 170 M.N. Skaredoff and P.J. Poppers Computer assisted learning in anaesthesiology •.••••• 184 J.W.R. Melntyre Teaehing with "ATTENDING": Tutorial use of an expert system •••••••••••••••••••••••.••••••••••••••• 193 P.L. Miller, D. Angers, J.R. Keefer, N. Sudan, G. Tanner Introductory courses in eomputing for anaesthetists • 202 J.H. Kerr, B.J. Harrison, W.L. Davies The use of computer-genera ted numbers in interpret ing the EEG •••••.••.•••••..•••••••••••••••. 2 14 N. Ty Smith and I.J. Rampil Automatie EEG monitoring during anesthesia •.••.••••• 227 A.J.R. Simons and R.A.F. Pronk Computerized EMG and EEG correlates of consciousness ••.•••••••.••..•••••••••••••••••••.•••• 258 H.L. Edmonds Jr., Y.K. Yoon, S.I. Sjogren, H.T. Maguire, C.P. McGraw Computer control of anesthesia delivery ••...••••••.. 269 D.R. Westenskow, W.S. Jordan, J.K. Hayes, T.D. East Computer controlled anaesthesia ••..••.••••••.••••••• 279 J.M. Evans, A. Fraser, C.C. Wise, W.L. Davies Computer regulated sonium nitroprusside infusion for blood pressure control .••••••.•••.••.•• 292 N.L. Pace and D.R. Westenskow Computer controlled infusion of drugs during anesthesia: methods of muscle relaxant and narcotic administration .••••.••••••.•••••••.•••••••• 302 G. Ritchie, J. Spain, J.G. Reves Oxygen requirements during anesthesia •••••••..•••••. 316 S.F. Sullivan Real time oximetry ••.•••.••.•••••••••.••••••.•.•..•• 328 M. Yelderman and J. Corenmen Graphic presentation of blood gas data •••••••••••.•• 342 P.M. Osswald, J. Bernauer, H.J. Bender, H.J. Hartung Teaching the interpretation of acid-base and blood gas parameters by computer application •••.•••. 354 E. Voigt Vis~al evo~ed po~entials during cardiac surgery, bas1c cons1dera t10ns •••••••••••.••••.•••••.••.•••••• 366 w. Russ, D. Kling, B. von Bormann, G. Hempelmann Phosphorus nuclear magnetic resonance (31 P NMR) : a computer based instrument for studying brain hypoxia •.••••••.•••••••••••••••••••.•••••••••.•••••• 386 M. Hilberman, V.H. Subramanian, L. Gyulai, B. Chance Measuring pulmonary blood flow with an 8085 •••.•.••. 402 J.M. Bellville, L. Arena, o. Brovko, D.M. Wiberg IX A microcomputer-based charting system for documentation of heamodynamic, respiratory parameters and drug administration during cardiac anaesthesia ••.••.••••..•.•.•.•.•.•..•.••••.. 416 S.G. van der Borden, O. Prakash, S.H. Meij Computer control of Intravenous anesthesia •••••••••• 423 T.H. Stanley Contributors Angers, D. Department of Anesthesiology, Yale University School of Medicine, New Haven, CT 06510, USA. Arena, L. Department of Anesthesiology, UCLA School of Medicine, Los Angeles, USA. Baehrendtz, S. Department of Medicine I, South Hospital, Stock holm, Sweden Bellville, J.W. Department of Anesthesiology, UCLA School of Medicine, Los Angeles, USA. Bender, H.J. Department of Anaesthesiology, University of Heidelberg, Mannheim, West Germany. Beneken, J.E.W. Division of Medical Electrical Engineering, University of Technology, Eindhoven, The Netherlands. Bernauer, J. Department of Anaesthesiology, University of Heidelberg, Mannheim, West Germany. BIom, J.A. Division of Medical Electrical Engineering, University of Technology, Eindhoven, The Netherlands. Borden, S.G., van der. Thorax Centrum, Erasmus University, Universlty Hospital Dijkzigt, PO Box 1738, 3000 DR Rotterdam, The Netherlands. Bormann, B., von. Department of Anaesthesiology and Intensive Care, Justus Liebig University, Giessen, West Germany. Brovko, o. Department of Anesthesiology, UCLA School of Medicine, Los Angeles, USA. Bshouty, Z. Intensive Care Department, Rambam, Medical Center and Technion School of Medicine, Haifa, Israel. Bursztein, S. Intensive Care Department, Rambam, Medical Center and Technion School of Medicine, Haifa, Israel. Chance, B. Department of Biophysics, University of pennsylvania, Philadelphia, PA 19104, USA. Cluitmans, P. Division of Medical Electrical Engineering, University of Technology, Eindhoven, The Netherlands. Corenmen, J. Department of Anesthesia, Stanford University School of Medicine, Stanford, CA 94305, USA. Davies, W.L. Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford OX3 9DU, Uni ted Kingdom. . Daub, D. Department of Anaesthesiology, University of Technology, Aachen, West Germany. Delemarre, J.B.V.M. Department of Cardiovascular Surgery, St. Antonius Hospital, Utrecht, The Netherlands. Dickinson, C.J. Anaesthetics Laboratory, St. Bartholomew's Hospital, West Smithfield, London EC1A 1BE, United Kingdom. East, T.D. Department of Anesthesiology, University of Utah, Salt Lake City, UT 84132, USA. Edmonds, H.L.,Jr. Department of Anesthesiology, University of Louisville, Louisville, Kentucky 40292, USA. Evans, J.M. Nuffield Department of Anaesthetics, The Radcliffe Infirmary, Oxford OX2 6HE, United Kingdom. Fraser, A. Nuffield Department of Anaesthetics, The Radcliffe Infirmary, Oxford OX2 6HE, United Kingdom. xrr Gyulai, L. Department of Biophysics, University of Pennsylvania, Philadelphia, PA 19104, USA. Harrison, B.J. Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom. Hartung, H.J. Department of Anaesthesiology, University of Heidelberg, Mannheim, West Germany. Hayes, J.K. Department of Anesthesiology, University of Utah, Salt Lake City, UT 84132, USA. Hedenstierna, G. Department of Clinical Physiology, Huddinge Hospital, Stockholm, Sweden. Hempelmann, G. Department of Anaesthesiology and Intensive Care, Justus Liebig University, Giessen, West Germany. Hengeveld, S.J. Department of Instrumentation and Automation, St. Antonius Hospital, Utrecht, The Netherlands. Hilberman, M. Department of Anesthesia, University of Pennsylvania Philadelphia, PA 19104, USA. Hinds, C.J. Anaesthetics Laboratory, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, Uni ted Kingdom. Jordan, W.S. Department of Anesthesiology, University of Utah, Salt Lake City, UT 84132, USA. Keefer, J.R. Department of Anesthesiology, Yale University School of Medicine, New Haven, CT 06510, USA. Kerr, J.H. Nuffield Departrnent of Anaesthetics, John Radcliffe Hospital, Oxford, OX3 9DU, united Kingdom. Kessel, H.M. van. Department of Anesthesiology, Leyden University Hospital, Leiden, The Netherlands. Kling, D. Department of Anaesthesiology and Intensive Care, Justus Liebiq University, Giessen, West Germany. Korsten, H.H.M. Department of Anaesthesiology, St. Antonius Hospital, Utrecht, The Netherlands. Lehmann, K.A. Department of Anaesthestology, University of Technology, Aachen, West Germany. Leusink, J.A. Department of Anaesthesiology, St. Antonius Hospital Utrecht, The Netherlands. Maguire, H.T. Department of Anesthesiology, University of Louisville, Louisville, Kentucky, 40292, USA. McGraw, C.P. Department of Surgery, University of Louisville, Louisville, Kentucky, 40292, USA. McIntyre, J.W.R. Department of Artaesthesia, University Hospital, Edmonton, Alberta, Canada. Meij, S.H. Thorax Centrum Erasmus University, University Hospital Dijkzigt, PO Box 1738, 3000 DR Rotterdarn, The Netherlands. Meijer, J.H. Department of Medical Physics, Free University, Amsterdam, The Netherlands. Meijler, A.P. Division of Medical Electrical Engineering, University of Technology, Eindhoven, The Netherlands. Miller, P.L. Department of Anesthesiology,Yale University, School of Medicine, New Haven, CT 06510, USA. Nandorff, A. Department of Anesthesiology, Leyden University Hospital, Leiden, The Netherlands. Naqvi, N.H. Department of Anaesthetics, Bolton Royal Infirmary, Bolton, Lancashire, United Kingdom. Nijhuis, R. Department of Anesthesiology, Leyden University Hospital. Leiden, The Netherlands.