Control and Automation in Anaesthesia

This book records the presentations given at a workshop held in Bonn in May 1994. The aim of the meeting was to bring together scientists from various disciplines and clinicians to discuss within a group of experts the theoretical, medical, engineering, and regulatory aspects of automated control of therapeutic interventions in. anaesthesiology. The meeting was considered a continuation of a preceding work shop on "Quantitation, Modelling and Control in Anaesthesia" [1], which was held also in Bonn 10 years ago in May 1984. That workshop dealt with problems of how to quantitate concepts like anaesthetic depth, how to model anaesthetic drug disposition, how to link phar macokinetics and pharmacodynamics, and how to use such concepts for the control of anaesthetic drug delivery. With respect to these topics the current proceedings have simultaneously both a broadened and a narrowed perspective. It is broadened in so far as the topics of the workshop did not focus exclusively on anaesthetic drugs and the control of their delivery, but did also discuss anaesthesia machine monitoring and patients therapeutic monitoring as well as control of blood pressure and artificial ventilation. The proceedings have nar rowed the perspective insofar as they do not intensively discuss the processes of quantitation and modelling but presuppose them and give more room to control, especially automated control. During the past 10 years informatics has tremendously expanded its knowledge and methods applicable to control problems.

Klappentext

This book represents the proceedings of an international workshop. It gives an up-to-date survey on methods applicable to the control and automation of therapeutic interventions in anaesthesiology, existing systems for the automated control of artificial ventilation, blood pressure, delivery of volatile and intravenous anaesthetics, and delivery of neuromuscular blocking agents. The last chapter discusses the legal requirements and liability aspects for automated systems in medicine, especially in view of the recently established regulations and guidelines (e.g. law for medical products). The contributions come from various specialties, including medicine and anaesthesiology, but also mathematics and operations research, neuroinformatics, engineering, regulatory authorities, and industry.

Inhalt
I General Methods of Control and Automation.- Decision Support via Fuzzy Technology.- Principles of Adaptive Neural Networks for Control.- Artificial Intelligence and Expert Systems.- II Assessment and Evaluation of Signals and Measurements.- a) Anaesthesia Machine Monitoring.- Which Monitoring Qualities Ensure Proper Machine Function?.- Reliability, Testability, Alarms, and the Fail-Safe Concept.- The Differences Between Closed-circuit, Low-flow, and High-flow Breathing Systems: Controllability, Monitoring, and Engineering Aspects.- b) Therapeutic Monitoring of Patients.- Does the EEG Measure Therapeutic Opioid Drug Effect?.- Somatosensory Evoked Potentials: Objective Measures of Antinöciception in the Anaesthetized Patient?.- Do Auditory Evoked Potentials Assess Awareness?.- Should Neuromuscular Transmission Be Monitored Routinely During Anaesthesia?.- III Control and Automation of Artificial Ventilation.- Pulmonary Function and Ventilatory Patterns During Anaesthesia.- What Can and What Should Be Controlled During Artificial Ventilation?.- Closed-Loop Control of Artificial Ventilation.- IV Control and Automation of Drug Delivery.- a) Volatile Anaesthetics.- Adaptive Closed-Loop Control of End-Tidal Concentrations of Volatile Agents.- Fuzzy Control of Arterial Blood Pressure by Volatile Anaesthetics.- Model-based Adaptive Control of Volatile Anaesthetics by Quantitative EEG.- b) Intravenous Anaesthetics.- The Target of Control: Plasma Concentrations or Drug Effect.- Open-Loop Control Systems and Their Performance for Intravenous Anaesthetics.- Feedback Control of Intravenous Anaesthetics by Quantitative EEG.- Adaptive Control of Intravenous Anaesthesia by Evoked Potentials.- c) Neuromuscular Blocking Agents and Vasoactive Drugs New Drug-Delivery Devices.- Model-basedAdaptive Control of Neuromuscular Blocking Agents.- Supervisory Adaptive Control of Arterial Blood Pressure by Vasoactive Agents.- New Drug-Delivery Devices for Volatile Anaesthetics.- New Drug-Delivery Systems for Intravenous Anaesthetics.- V Nonmedical Aspects of Automated Control: Requirements and Liability for Automated Systems.- The Technical Point of View.- Regulatory Aspects.- The Manufacturer's Point of View.