• M Neckebroek, C M Ionescu, K van Amsterdam, T De Smet, P De Baets, J Decruyenaere, R De Keyser, and Struys M M R F MMRF http://orcid.org/0000-0003-0421-536X Department of Anesthesiology, University Medical Center Groningen, University of Groningen, H.
• Department of Anesthesia and Perioperative Medicine, Ghent University Hospital, 9000, Ghent, Belgium.
• J Clin Monit Comput. 2019 Aug 1; 33 (4): 675-686.

PurposeWe evaluated the feasibility and robustness of three methods for propofol-to-bispectral index (BIS) post-operative intensive care sedation, a manually-adapted target controlled infusion protocol (HUMAN), a computer-controlled predictive control strategy (EPSAC) and a computer-controlled Bayesian rule-based optimized control strategy (BAYES).MethodsThirty-six patients undergoing short lasting sedation following cardiac surgery were included to receive propofol to maintain a BIS between 40 and 60. Robustness of control for all groups was analysed using prediction error and spectrographic analysis.ResultsAlthough similar time courses of measured BIS were obtained in all groups, a higher median propofol effect-site concentration (CePROP) was required in the HUMAN group compared to the BAYES and EPSAC groups. The time course analysis of the remifentanil effect-site concentration (CeREMI) revealed a significant increase in CeREMI in the EPSAC group compared to BAYES and HUMAN during the case. Although similar bias and divergence in control was found in all groups, larger control inaccuracy was observed in HUMAN versus EPSAC and BAYES. Spectrographic analysis of the system behavior shows that BAYES covers the largest spectrum of frequencies, followed by EPSAC and HUMAN.ConclusionsBoth computer-based control systems are feasible to be used during ICU sedation with overall tighter control than HUMAN and even with lower required CePROP. EPSAC control required higher CeREMI than BAYES or HUMAN to maintain stable control. Clinical trial number: NCT00735631.

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