Hipocrates: a robust system for the control of neuromuscular blockade

An enriched simulation environment for evaluation of closed-loop anesthesia

To simulate and evaluate the administration of anesthetic agents in the clinical setting, many pharmacology models have been proposed and validated, which play important roles for in silico testing of closed-loop control methods. However, to the authors' best knowledge, there is no anesthesia simulator incorporating closed-loop feedback control of anesthetic agent administration freely available and accessible to the public. Consequently, many necessary but time consuming procedures, such as selecting models from the available literatures and establishing new simulator algorithms, will be repeated by different researchers who intend to explore a novel control algorithm for closed-loop anesthesia. To address this issue, an enriched anesthesia simulator was devised in our laboratory and made freely available to the anesthesia community. This simulator was built by using MATLAB(®) (The MathWorks, Natick, MA). The GUI technology embedded in MATLAB was chosen as the tool to develop a human-machine interface. This simulator includes four types of anesthetic models, and all have been wildly used in closed-loop anesthesia studies. For each type of model, 24 virtual patients were created with significant diversity. In addition, the platform also provides a model identification module and a control method library. For the model identification module, the least square method and particle swarm optimization were presented. In the control method library, a proportional-integral-derivative control and a model predictive control were provided. Both the model identification module and the control method library are extensive and readily accessible for users to add user-defined functions. This simulator could be a benchmark-testing platform for closed-loop control of anesthesia, which is of great value and has significant development potential. For convenience, this simulator is termed as Wang's Simulator, which can be downloaded from http://www.AutomMed.org .

A Multiobjective Design of a Patient and Anaesthetist-Friendly Neuromuscular Blockade Controller

During surgeries (especially in long ones), patients are subject to a substantial amount of drug dosage necessary to achieve the required neuromuscular blockade level. This paper aims at the development of a fuzzy controller that satisfies two important goals: 1) an optimization of the amount of drug (atracurium) required to induce an adequate level of relaxation and 2) a concomitant ability to explain the undertaken control decision at the level of natural language. For instance, statements of the form "Since the difference between the target and the current blockade level is near zero, a small quantity of drug infusion is currently being applied", where "near zero" and "small" are linguistic terms that are represented as fuzzy sets. In this sense, we can regard this controller as a construct that is human friendly and highly interpretable (transparent). To address the two objectives outlined above, we consider the use of a multiobjective evolutionary optimization. How the quality of the control action and the controller interpretability are formalized and captured in this optimization framework is presented. The effectiveness of the approach is demonstrated through a comprehensive suite of experiments involving 100 simulated patients (used for training) and 500 patients (forming the test set), validating the approach for application in the operating theater.