Real-time Closed-loop Control in a Rodent Model of Medically Induced Coma Using Burst Suppression

Overview

Journal Anesthesiology

Specialty Anesthesiology

Date 2013 Jun 18

PMID 23770601

Citations 23

Authors

ShiNung Ching

Max Y Liberman

Jessica J Chemali

M Brandon Westover

Jonathan D Kenny

Ken Solt

Patrick L Purdon

Emery N Brown

Affiliations

Soon will be listed here.

Abstract

Background: A medically induced coma is an anesthetic state of profound brain inactivation created to treat status epilepticus and to provide cerebral protection after traumatic brain injuries. The authors hypothesized that a closed-loop anesthetic delivery system could automatically and precisely control the electroencephalogram state of burst suppression and efficiently maintain a medically induced 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 in real time from the electroencephalogram the brain's burst-suppression state, an online parameter-estimation procedure and a proportional-integral controller. In the control experiment each rat was randomly assigned to one of the six burst-suppression probability target trajectories constructed by permuting the burst-suppression probability levels of 0.4, 0.65, and 0.9 with linear transitions between levels.

Results: In each animal the controller maintained approximately 60 min of tight, real-time control of burst suppression by tracking each burst-suppression probability target level for 15 min and two between-level transitions for 5-10 min. The posterior probability that the closed-loop anesthetic delivery system was reliable across all levels was 0.94 (95% CI, 0.77-1.00; n = 18) and that the system was accurate across all levels was 1.00 (95% CI, 0.84-1.00; n = 18).

Conclusion: The findings of this study establish the feasibility of using a closed-loop anesthetic delivery systems to achieve in real time reliable and accurate control of burst suppression in rodents and suggest a paradigm to precisely control medically induced coma in patients.

Citing Articles

Burst-Suppression EEG Reactivity to Photic Stimulation-A Translational Biomarker in Hypoxic-Ischemic Brain Injury.

Paslaru A, Calin A, Morozan V, Stancu M, Tofan L, Panaitescu A Biomolecules. 2024; 14(8).

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Closed-loop control of anesthetic state in nonhuman primates.

Chakravarty S, Donoghue J, Waite A, Mahnke M, Garwood I, Gallo S PNAS Nexus. 2023; 2(10):pgad293.

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Machine learning reveals interhemispheric somatosensory coherence as indicator of anesthetic depth.

Schmidt D, English G, Gent T, Yanik M, von der Behrens W Front Neuroinform. 2022; 16:971231.

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Association Between Burst-Suppression Latency and Burst-Suppression Ratio Under Isoflurane or Adjuvant Drugs With Isoflurane Anesthesia in Mice.

Wang D, Guo Q, Liu D, Kong X, Xu Z, Zhou Y Front Pharmacol. 2021; 12:740012.

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Constructing a control-ready model of EEG signal during general anesthesia in humans.

Abel J, Badgeley M, Baum T, Chakravarty S, Purdon P, Brown E IFAC Pap OnLine. 2021; 53(2):15870-15876.

PMID: 34184002 PMC: 8236287. DOI: 10.1016/j.ifacol.2020.12.243.

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