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Pharmacokinetics: adaptive feedback control; models

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Articles
Publication: Anesthesiology
Anesthesiology. May 2021: 134(5):792–808
Published: May 2021
... patient etiologies, have been investigated, producing conflicting results. In 2008, Peter et al. 34 published a comprehensive review of nine randomized controlled trials to summarize the studies completed thus far. The authors found that there were no significant beneficial effects of corticosteroid...
Articles
Publication: Anesthesiology
Anesthesiology. September 2020: 133(3):653–665
Published: September 2020
... than established pharmacokinetic models. 15 Closed-loop control of anesthetic agents, fluids, and ventilation has been found to produce better neurocognitive outcomes than manual control of anesthesia. 16 Another recently published study demonstrated that computers can triage chest radiographs...
Articles
Publication: Anesthesiology
Anesthesiology. August 2020: 133(2):439–457
Published: August 2020
... patients with adrenal insufficiency may stimulate ADH secretion, as a result of loss of negative feedback control, leading to further water retention and hyponatremia. 135–138 Previous investigators have shown that 40 to 65% of critically ill patients have high plasma renin activity and low...
Articles
Publication: Anesthesiology
Anesthesiology. February 2020: 132(2):379–394
Published: February 2020
... through the use of food-based reward. However, reinforcement learning problems today are more sophisticated. For example, Padmanabhan et al . 14 used reinforcement learning to develop an anesthesia controller that used feedback from a patient’s bispectral index (BIS) and MAP to control the infusion...
Articles
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Publication: Anesthesiology
Anesthesiology. February 2020: 132(2):253–266
Published: February 2020
... of an established goal-directed fluid therapy protocol. The controller uses both a model layer to formulate a predicted response to a fluid bolus and an adaptive layer for bolus-based error correction during direct fluid management to correct for changes induced by surgical and anesthetic conditions. The system...
Articles
Publication: Anesthesiology
Anesthesiology. December 2019: 131(6):1346–1359
Published: December 2019
... by the indefatigability of the machine’s tactical evaluation of millions and millions of positions. The computer did what it was told, but it did not learn. In anesthesiology practice, the closest example is open-loop target-controlled infusion. Pharmacokinetic models describe the forwards relationship from a drug...
Articles
Publication: Anesthesiology
Anesthesiology. October 2019: 131(4):908–928
Published: October 2019
... active learning has been demonstrated to be effective in many areas of science education, 8 , 10 , 11 more work needs to be done to determine its benefit in graduate medical education. There is a variety of active learning methodologies, which all share some basic principles. First, control shifts...
Articles
Publication: Anesthesiology
Anesthesiology. November 2019: 131(5):1036–1045
Published: November 2019
... EB , Vasinanukorn P , Prathep S , Asim W , Naklongdee J : . Risk factors for reintubation in the post-anaesthetic care unit: A case-control study. Br J Anaesth . 2012 ; 109 : 636 – 42 14. Attaallah AF , Vallejo MC , Elzamzamy OM , Mueller MG...
Articles
Publication: Anesthesiology
Anesthesiology. August 2019: 131(2):233–235
Published: August 2019
... states ( e.g. , fibromyalgia, irritable bowel syndrome, temporomandibular disease) and central neuropathic pain conditions that may share a similar phenotype of central sensitization. A recent quantitative meta-analysis of 21 randomized controlled trials in which dextromethorphan was used...
Articles
CME Article
Publication: Anesthesiology
Anesthesiology. July 2019: 131(1):164–185
Published: July 2019
... of anesthesia involves subcortical autonomic responses. 62 Adult remifentanil pharmacokinetics parameters ( e.g. , Minto model 63 ) continue to be used in target-controlled infusion devices for all ages, despite parameter estimates having bigger values in children when expressed as per kilogram. 17...
Articles
Publication: Anesthesiology
Anesthesiology. June 2019: 130(6):923–935
Published: June 2019
... level was assessed in each patient using the clinician-administered MADRS, the Hamilton Depression Rating Scale (HDRS-21), 27 and the Beck Depression Inventory (BDI-II) scales. 28 A clinical monitoring (pulse, blood pressure, digital pulse oximetry, and electrocardiogram) was then set to control...
Articles
Publication: Anesthesiology
Anesthesiology. January 2018: 128(1):55–66
Published: January 2018
...-loop system has been described extensively in our previous publications. 14–16 , 26 , 27 “As a short review, the system monitors SV, stroke volume variation (SVV), heart rate, and MAP and uses this information to optimize SV. The controller uses both a model layer to formulate a predicted response...
Articles
Publication: Anesthesiology
Anesthesiology. February 2016: 124(2):489–506
Published: February 2016
... is essential for mammalian life, as it was shown in genetic models that mice with global genetic deletion of any of these “miRNA maturation enzymes” are not viable. 23 , 24 In addition to regulatory elements of the miRNA maturation process, pathways that control tissue-specific miRNAs expression have...
Articles
Publication: Anesthesiology
Anesthesiology. October 2015: 123(4):937–960
Published: October 2015
... of Continuing Professional Development. 2014 Available at: www.AnesthesiaEEG.com 70. Schwilden H , Schüttler J , Stoeckel H : Closed-loop feedback control of methohexital anesthesia by quantitative EEG analysis in humans. A nesthesiology 1987 ; 67 : 341 – 7 71. Drummond...
Articles
Publication: Anesthesiology
Anesthesiology. April 2015: 122(4):759–767
Published: April 2015
... of the majority of published pediatric pharmacokinetic models 23 and the wide interpatient variability observed in children 24 suggest a possible key role for closed-loop control in optimizing the administration of total intravenous anesthesia by continuous titration in the pediatric population. Currently...
Articles
Publication: Anesthesiology
Anesthesiology. October 2013: 119(4):848–860
Published: October 2013
... coma. Methods: In six rats, the authors implemented a closed-loop anesthetic delivery system for propofol consisting of: a computer-controlled pump infusion, a two-compartment pharmacokinetics model defining propofol’s electroencephalogram effects, the burst-suppression probability algorithm to compute...
Articles
Publication: Anesthesiology
Anesthesiology. July 2014: 121(1):59–67
Published: July 2014
... a target-controlled infusion system (Base Primea; Fresenius-Vial, Brezins, France) using the pharmacokinetic model by Schnider et al . 25 , 26 The targeted effect-site concentration of propofol for induction was 4 ± 1 μg/ml. When the patient lost consciousness, the lungs were normoventilated through...
Articles
Publication: Anesthesiology
Anesthesiology. August 2012: 117(2):252–262
Published: August 2012
... bolus drug administration are likely to be associated with more respiratory compromise than our models predict. Second, pharmacokinetic models are associated with substantial variability. For example, using target-controlled infusions, median absolute performance errors for propofol and remifentanil...
Articles
Publication: Anesthesiology
Anesthesiology. November 2012: 117(5):1037–1043
Published: November 2012
.... A KDS Model 200 Series infusion pump (KD Scientific, Holliston, MA) was used for continuous hypnotic infusion. The pump was controlled remotely via   its RS 232 serial port by a Macintosh computer using a Keyspan USB-Serial port adapter (Tripp Lite, Chicago, IL). A LabView 8.5 instrument driver using...
Articles
Publication: Anesthesiology
Anesthesiology. February 2012: 116(2):286–295
Published: February 2012
... the integral action of the controller. Delay between each new modification of propofol or remifentanil concentration: it is determined by the time necessary for equilibration of the previous effect site compartment given by the pharmacokinetic models 27 , 28 ( fig. 1 ). A derivative term...