Patient specific model based induction of hypnosis using fractional order control

Optimal and safe control of drug delivery systems with continuous infusion protocol is of key importance to avoid over- or under-dosing of the patient. By implementing close-loops one is able to optimize the amount of drug given to the patient. In this paper a robust control methodology is presented. Emerging tools from fractional calculus have been considered and a fractional order PI controller for drug dosing during hypnosis has been designed. In this paper a robust fractional order control of hypnosis is proposed. The controller has been evaluated on an artificial data set of 24 patients and the results indicate that such a control strategy is robust to uncertainty stemming from the inter- and intra-patient variability. (C) 2017, IFAC (International Federation of Automatic Control) Hosting by Elsevier Ltd. All rights reserved

Closed-loop control of anesthesia : survey on actual trends, challenges and perspectives

Automation empowers self-sustainable adaptive processes and personalized services in many industries. The implementation of the integrated healthcare paradigm built on Health 4.0 is expected to transform any area in medicine due to the lightning-speed advances in control, robotics, artificial intelligence, sensors etc. The two objectives of this article, as addressed to different entities, are: i) to raise awareness throughout the anesthesiologists about the usefulness of integrating automation and data exchange in their clinical practice for providing increased attention to alarming situations, ii) to provide the actualized insights of drug-delivery research in order to create an opening horizon towards precision medicine with significantly improved human outcomes. This article presents a concise overview on the recent evolution of closed-loop anesthesia delivery control systems by means of control strategies, depth of anesthesia monitors, patient modelling, safety systems, and validation in clinical trials. For decades, anesthesia control has been in the midst of transformative changes, going from simple controllers to integrative strategies of two or more components, but not achieving yet the breakthrough of an integrated system. However, the scientific advances that happen at high speed need a modern review to identify the current technological gaps, societal implications, and implementation barriers. This article provides a good basis for control research in clinical anesthesia to endorse new challenges for intelligent systems towards individualized patient care. At this connection point of clinical and engineering frameworks through (semi-) automation, the following can be granted: patient safety, economical efficiency, and clinicians' efficacy

Advanced model-based control studies for the induction and maintenance of intravenous anaesthesia

This paper describes strategies toward model-based automation of intravenous anaesthesia employing advanced control techniques. In particular, based on a detailed compartmental mathematical model featuring pharmacokinetic and pharmacodynamics information, two alternative model predictive control strategies are presented: a model predictive control strategy, based on online optimization, the extended predictive self-adaptive control and a multiparametric control strategy based on offline optimization, the multiparametric model predictive control. The multiparametric features to account for the effect of nonlinearity and the impact of estimation are also described. The control strategies are tested on a set of 12 virtually generated patient models for the regulation of the depth of anaesthesia by means of the bispectral index (BIS) using Propofol as the administrated anaesthetic. The simulations show fast response, suitability of dose, and robustness to induce and maintain the desired BIS setpoint

Advanced multiparametric optimization and control studies for anaesthesia

Anaesthesia is a reversible pharmacological state of the patient where hypnosis, analgesia and muscle relaxation are guaranteed and maintained throughout the surgery. Analgesics block the sensation of pain; hypnotics produce unconsciousness, while muscle relaxants prevent unwanted movement of muscle tone. Controlling the depth of anaesthesia is a very challenging task, as one has to deal with nonlinearity, inter- and intra-patient variability, multivariable characteristics, variable time delays, dynamics dependent on the hypnotic agent, model analysis variability, agent and stability issues. The modelling and automatic control of anaesthesia is believed to (i) benefit the safety of the patient undergoing surgery as side-effects may be reduced by optimizing the drug infusion rates, and (ii) support anaesthetists during critical situations by automating the drug delivery systems. In this work we have developed several advanced explicit/multi-parametric model predictive (mp-MPC) control strategies for the control of depth of anaesthesia. State estimation techniques are developed and used simultaneously with mp-MPC strategies to estimate the state of each individual patient, in an attempt to overcome the challenges of inter- and intra- patient variability, and deal with possible unmeasurable noisy outputs. Strategies to deal with the nonlinearity have been also developed including local linearization, exact linearization as well as a piece-wise linearization of the Hill curve leading to a hybrid formulation of the patient model and thereby the development of multiparametric hybrid model predictive control methodology. To deal with the inter- and intra- patient variability, as well as the noise on the process output, several robust techniques and a multiparametric moving horizon estimation technique have been design and implemented. All the studies described in the thesis are performed on clinical data for a set of 12 patients who underwent general anaesthesia.Open Acces

A gain-scheduled PID controller for propofol dosing in anesthesia

6siA gain-scheduled proportional-integral-derivative controller is proposed for the closed-loop dosing of propofol in anesthesia (with the bispectral index as a controlled variable). In particular, it is shown that a different tuning of the parameters should be used during the infusion and maintenance phases. Further, the role of the noise filter is investigated.nonenonePadula, F.; Ionescu, C.; Latronico, N.; Paltenghi, M.; Visioli, A.; Vivacqua, G.Padula, Fabrizio; Ionescu, C.; Latronico, Nicola; Paltenghi, M.; Visioli, Antonio; Vivacqua, Giuli

Performance Analysis of Extracted Rule-Base Multivariable Type-2 Self-Organizing Fuzzy Logic Controller Applied to Anesthesia

We compare type-1 and type-2 self-organizing fuzzy logic controller (SOFLC) using expert initialized and pretrained extracted rule-bases applied to automatic control of anaesthesia during surgery. We perform experimental simulations using a nonfixed patient model and signal noise to account for environmental and patient drug interaction uncertainties. The simulations evaluate the performance of the SOFLCs in their ability to control anesthetic delivery rates for maintaining desired physiological set points for muscle relaxation and blood pressure during a multistage surgical procedure. The performances of the SOFLCs are evaluated by measuring the steady state errors and control stabilities which indicate the accuracy and precision of control task. Two sets of comparisons based on using expert derived and extracted rule-bases are implemented as Wilcoxon signed-rank tests. Results indicate that type-2 SOFLCs outperform type-1 SOFLC while handling the various sources of uncertainties. SOFLCs using the extracted rules are also shown to outperform those using expert derived rules in terms of improved control stability

Event-based MPC for propofol administration in anesthesia

Background and Objective : The automatic control of anesthesia is a demanding task mostly due to the presence of nonlinearities, intra- and inter-patient variability and specific clinical requirements to be meet. The traditional approach to achieve the desired depth of hypnosis level is based on knowledge and experience of the anesthesiologist. In contrast to a typical automatic control system, their actions are based on events that are related to the effect of the administrated drug. Thus, it is interesting to build a control system that will be able to mimic the behavior of the human way of actuation, simultaneously keeping the advantages of an automatic system.Methods : In this work, an event-based model predictive control system is proposed and analyzed. The nonlinear patient model is used to form the predictor structure and its linear part is exploited to design the predictive controller, resulting in an individualized approach. In such a scenario, the BIS is the controlled variable and the propofol infusion rate is the control variable. The event generator governs the computation of control action applying a dead-band sampling technique. The proposed control architecture has been tested in simulation considering process noise and unmeasurable disturbances. The evaluation has been made for a set of patients using nonlinear pharmacokinetic/pharmacodynamic models allowing realistic tests scenarios, including inter- and intra-patient variability.Results For the considered patients dataset the number of control signal changes has been reduced of about 55% when compared to the classical control system approach and the drug usage has been reduced of about 2%. At the same time the control performance expressed by the integrated absolute error has been degraded of about 11%.Conclusions : The event-based MPC control system meets all the clinical requirements. The robustness analysis also demonstrates that the event-based architecture is able to satisfy the specifications in the presence of significant process noise and modelling errors related to inter- and intra-patient variability, providing a balanced solution between complexity and performance. (c) 2022 Elsevier B.V. All rights reserved