title: Open loop control of multiple drug effects in anesthesia.
abstract: Current open-loop computer-controlled infusion pumps do not explicitly control the transient adverse side effects of intravenous drugs during anesthesia. We used optimal control principles to synthesize a single-input multiple-output controller that regulates concentrations at the site of desirable drug effect while penalizing excessive side-effect drug concentrations. The cost function incorporates model-based predictions of future effect-site concentrations, and the capability of the anesthesiologist to anticipate upcoming surgical events. The controller was evaluated and then compared with alternative control strategies through computer simulation of a physiologically based pharmacokinetic model for the intravenous drug alfentanil. Multiple-effect control offers an analytic approach to limit the overshoot in adverse side-effect concentrations at the consequence of increasing the time to achieve the desired drug effect.
authors.affiliation: Department of Anesthesiology, University of California, Los Angeles 90024, USA.
authors.forename: D R
authors.initials: DR
authors.lastname: Wada
authors.forename: D S
authors.initials: DS
authors.lastname: Ward
mesh_terms: D015760:Alfentanil / Q000008:administration & dosage / Q000493:pharmacokinetics* / Q000494:pharmacology; D000465:Algorithms; D003198:Computer Simulation; D005246:Feedback; D006801:Humans; D007260:Infusion Pumps; D008954:Models, Biological
chemical_list: D015760:Alfentanil