An Open Source Patient Simulator for Design and Evaluation of Computer Based Multiple Drug Dosing Control for Anesthetic and Hemodynamic Variables

Clara M Ionescu,Martine Neckebroek,Dana Copot,Mihaela Ghita

doi:10.1109/access.2021.3049880

Clara M Ionescu, Martine Neckebroek + Show 2 more

Open Access

https://doi.org/10.1109/access.2021.3049880

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Abstract

We are witnessing a notable rise in the translational use of information technology and control systems engineering tools in clinical practice. This paper empowers the computer based drug dosing optimization of general anesthesia management by means of multiple variables for patient state stabilization. The patient simulator platform is designed through an interdisciplinary combination of medical, clinical practice and systems engineering expertise gathered in the last decades by our team. The result is an open source patient simulator in Matlab/Simulink from Mathworks(R). Simulator features include complex synergic and antagonistic interaction aspects between general anesthesia and hemodynamic stabilization variables. The anesthetic system includes the hypnosis, analgesia and neuromuscular blockade states, while the hemodynamic system includes the cardiac output and mean arterial pressure. Nociceptor stimulation is also described and acts as a disturbance together with predefined surgery profiles from a translation into signal form of most commonly encountered events in clinical practice. A broad population set of pharmacokinetic and pharmacodynamic (PKPD) variables are available for the user to describe both intra- and inter-patient variability. This simulator has some unique features, such as: i) additional bolus administration from anesthesiologist, ii) variable time-delays introduced by data window averaging when poor signal quality is detected, iii) drug trapping from heterogeneous tissue diffusion in high body mass index patients. We successfully reproduced the clinical expected effects of various drugs interacting among the anesthetic and hemodynamic states. Our work is uniquely defined in current state of the art and first of its kind for this application of dose management problem in anesthesia. This simulator provides the research community with accessible tools to allow a systematic design, evaluation and comparison of various control algorithms for multi-drug dosing optimization objectives in anesthesia.

Highlights

Progress in medical science, healthcare and clinical practice is often paired with information technology tools and con-The associate editor coordinating the review of this manuscript and approving it for publication was Salman Ahmed .trol expertise of computer based monitoring
This paper describes the various components of the patient simulator in general anesthesia
These results indicate the interaction between the anesthesia parameters and the hemodynamic parameters

Summary

Introduction

It allows data monitoring and management, offers decision-making support and provides patient stabilization during surgical procedures, intensive care and recovery/rehabilitation periods. Results in both simulation and clinical trial testing provide evidence that computer based control of anesthesia outperforms to. Ionescu et al.: Open Source Patient Simulator for Design and Evaluation of Computer Based Multiple Drug Dosing Control manual dosing techniques [1]–[6]. Based on these incentives, the systems and control engineering community steps forward towards optimizing co-administration of drug cocktails to stabilize patient variables in a synergic context of interacting vital sign profiles [7]. Ensuring clinical relevant progress is a challenging task which requires a systematic comparison of algorithms, thereby demanding availability of adequate simulation tools before transferring results to clinical practice for testing

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