An advanced closed-loop anesthesia delivery system that monitors brain state to tailor propofol dose and achieve exactly the desired level of unconsciousness could reduce post-op side effects.
If anesthesiologists had a rigorous means to manage dosing, they could deliver less medicine, maintaining exactly the right depth of unconsciousness while reducing postoperative cognitive side effects in vulnerable groups like the elderly. But with myriad responsibilities for keeping anesthetized patients alive and stable, as well as maintaining their profoundly unconscious state, anesthesiologists don't have the time without the technology.
The new system is not the first closed-loop anesthesia delivery system, Brown said, but it advances the young field in critical ways. Some prior systems merely automate a single, stable infusion rate based on general patient characteristics like height, weight and age but gather no feedback about the actual effect on unconsciousness, said Brown, who is also a member of the Institute for Medical Engineering and Science at MIT and the Warren Zapol Professor in Harvard Medical School.
The researchers also built into the system a physiologically principled model of the pharmacokinetics and pharmacodynamics of propofol, which determines how much drug is needed to alter consciousness and how fast a given dose will have that effect. In the study they show that by coupling the model with the unconsciousness marker they could quickly tune the model for each subject.
In other words, rather than a system that automatically maintains the drug dose, the new system automatically maintains the desired level of unconsciousness by updating that dose every 20 seconds. In addition to Brown, Chakravarty, Donoghue and Miller, the paper's other authors are Ayan Waite, Meredith Mahnke, Indie Garwood, Sebastian Gallo.
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