International journal of clinical monitoring and computing
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Int J Clin Monit Comput · Jan 1987
Closed-loop control of blood pressure, ventilation, and anesthesia delivery.
Closed-loop control systems have been in use for over 4,000 years, yet applications in medicine have developed only recently. When compared with manual control, closed-loop controllers for blood pressure, ventilation, and anesthesia delivery provide more rapid and more precise control of mean pressure, end-tidal CO2, and end-tidal anesthetic concentrations. ⋯ It must be remembered however, that the best anesthesiologist may perform better than the controller, particularly in his ability to anticipate clinical events which effect control. Although the convenience, precision of control, and immunity to distractions are reason enough to further pursue their development, their final application to clinical care will depend on the inclusion of appropriate safeguards and supervisory software algorithms to protect the systems from failure.
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Int J Clin Monit Comput · Jan 1987
Carola, a computer system for automatic documentation in anesthesia.
A computer system has been designed for documentation and data acquisition during open heart surgery. This computer system (called 'Carola') processes all patient data during cardiac surgery. More than 50 analogue or digital signals are scanned. ⋯ From december 1983 the first prototype was used on a routine basis, followed by a second unit in June 1984 and a third in December 1985. Up to now more than 12.500 anesthetic hours have been recorded. Since then almost 100% of all anesthetics performed in our cardiothoracic unit have been documented by the computers, including all short procedures without invasive monitoring and all emergencies.
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Computers are beginning to appear in the operating room and intensive care units. At this time most computers are reserved for complex cases. However, it is now possible to discern what role the computer may play in the future, for routine cases. An outline of a conceivable integrated computerized system in anesthesia is presented.
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The place of computerization in intravenous anaesthesia delivery: Although total intravenous anaesthesia may have advantages over inhalational anaesthesia in certain circumstances, it has drawbacks from the point of view of feedback control. The ideal agent is not available, although di-isopropylphenol holds promise. There is an undefinable end-point. ⋯ The anaesthetist is still required for, amongst other things, specifying the desired depth of anaesthesia and varying it during the operation, and for responding to unforeseen crises. It may be hoped that, by liberating the anaesthetist from those tasks which can be automated, more time can be devoted to patient monitoring and other aspects of anaesthetic care, thereby improving patient safety. There is an undoubted place for computerized delivery of anaesthesia in teaching (particularly teaching pharmacokinetic principles) and in research (for standardization of anaesthetic depth).
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To address the problem of auditory alarms on anaesthesia monitoring and delivery devices whose signal is masked by the noises of other operating room equipment, a set of signals having the characteristics of spectral richness, frequency modulation, and temporal patterning were electronically generated, and were tested for detectability against operating room equipment noises in a laboratory setting. A set of signals was identified which can, under these circumstances, be detected with at least 93% accuracy at -24 dB signal-to-noise ratio.