• Konrad S Stadler, Peter M Schumacher, Sibylle Hirter, Daniel Leibundgut, Thomas W Bouillon, Adolf H Glattfelder, and Alex M Zbinden.
• Automatic Control Laboratory, Swiss Federal Institute of Technology (ETH), Physikstrasse 3. CH-8092 Zurich, Switzerland. kss@ieee.org
• IEEE Trans Biomed Eng. 2006 Mar 1; 53 (3): 387-98.

AbstractDuring general anesthesia drugs are administered to provide hypnosis, ensure analgesia, and skeletal muscle relaxation. In this paper, the main components of a newly developed controller for skeletal muscle relaxation are described. Muscle relaxation is controlled by administration of neuromuscular blocking agents. The degree of relaxation is assessed by supramaximal train-of-four stimulation of the ulnar nerve and measuring the electromyogram response of the adductor pollicis muscle. For closed-loop control purposes, a physiologically based pharmacokinetic and pharmacodynamic model of the neuromuscular blocking agent mivacurium is derived. The model is used to design an observer-based state feedback controller. Contrary to similar automatic systems described in the literature this controller makes use of two different measures obtained in the train-of-four measurement to maintain the desired level of relaxation. The controller is validated in a clinical study comparing the performance of the controller to the performance of the anesthesiologist. As presented, the controller was able to maintain a preselected degree of muscle relaxation with excellent precision while minimizing drug administration. The controller performed at least equally well as the anesthesiologist.

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