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Control strategy with multivariable fault tolerance module for automatic intravenous anesthesia

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Abstract

In the anesthesia automation, an automatic propofol infusion system uses Bi-spectral Index Signal (BIS) as a primary feedback signal to manipulate propofol dose. However, the BIS signal may be suspended for some time due to poor EEG signal quality, noise, and many other factors. Therefore, BIS signal failure may be the main cause of inadequate propofol infusion. This fact motivates the need for integration of multivariable fault tolerance module (MFTM) and fractional-order Smith predictor controller to avoid adverse reactions of inadequate propofol dosing during BIS failure. Smith Predictor control strategy is sufficiently robust to predict feedback BIS during BIS failure via patient pharmacological modeled BIS. However, modeled BIS may not provide a guarantee of adequate propofol infusion during BIS failure and especially in the presence of hypotension and hypertension. Thus, the proposed control strategy is designed with MFTM to detect BIS sensor fault and to estimate feedback BIS during BIS failure. Further, the proposed control strategy is designed with a multivariable pharmacological patient model to analyze the cross effect of propofol infusion on BIS and hemodynamic variables. The robustness of the proposed control strategy is tested in the presence of noxious surgical stimulation, BIS sensor fault and heavy hemodynamic disturbance. The pharmacological parameters and recorded signals of 30 patients during various surgeries have been used to validate simulated results. The performance of the proposed control strategy assures optimization and smooth propofol infusion during BIS failure. The proposed system provides stability for a wide range of physiological parameters range. The proposed scheme maintains smooth BIS and MAP signal despite the delay, BIS sensor fault, and surgical disturbances.

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Acknowledgements

The authors would like to thank to anesthesia department team of the SMIMER hospital, Surat for providing the clinical environment facility and drug dose combination as per proposed scheme. The authors are grateful to anonymous reviewers for their useful suggestions to improve the manuscript.

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Authors and Affiliations

  1. Department of Electrical Engineering, Sardar Vallabhbhai National Institute of Technology, Surat, India

    Bhavina Patel & Hirenkumar Patel

  2. Surat Municipal Institute of Medical Education and Research (SMIMER), Surat, India

    Divyang Shah

  3. U. N. Mehta Institute of Cardiology and Research, Ahmedabad, India

    Alpesh Sarvaia

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  1. Bhavina Patel
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  2. Hirenkumar Patel
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Correspondence to Bhavina Patel.

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All procedures performed in study involving human participants were in accordance with the ethical standards of the Surat Municipal Institute of Medical Education and Research (SMIMER), India and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards or comparable ethical standards. Informed consent: Informed consent was obtained from all individual participants included in the study.

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Appendix

Appendix

See Tables 8, 9, 10, 11, 12 and Figs. 10 and 11.

Table 8 3rd order PK model parameters calculation equations for bolus and continuous
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Table 9 Propofol sensitivity parameters for BIS, SBP and DBP signals
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Table 10 Nomenclature
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Table 11 Clinical study environment with premedication drugs and anesthetics drugs dosing in operation theater
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Table 12 Patients pharmacokinetic and their estimated PD parameters from recorded signals [n = number of patients (30)]
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Fig. 10
figure 10

Combined infusion-based multivariable PK–PD model with infusion delay

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Fig. 11
figure 11

Propofol dose response curve and pseudo code

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Patel, B., Patel, H., Shah, D. et al. Control strategy with multivariable fault tolerance module for automatic intravenous anesthesia. Biomed. Eng. Lett. 10, 555–578 (2020). https://doi.org/10.1007/s13534-020-00169-2

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  • DOI: https://doi.org/10.1007/s13534-020-00169-2

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