title: Hierarchical rule-based monitoring and fuzzy logic control for neuromuscular block.
abstract: OBJECTIVE
  The important task for anaesthetists is to provide an adequate degree of neuromuscular block during surgical operations, so that it should not be difficult to antagonize at the end of surgery. Therefore, this study examined the application of a simple technique (i.e., fuzzy logic) to an almost ideal muscle relaxant (i.e., rocuronium) at general anaesthesia in order to control the system more easily, efficiently, intelligently and safely during an operation.
  
  
  METHODS
  The characteristics of neuromuscular blockade induced by rocuronium were studied in 10 ASA I or II adult patients anaesthetized with inhalational (i.e., isoflurane) anaesthesia. A Datex Relaxograph was used to monitor neuromuscular block. And, ulnar nerve was stimulated supramaximally with repeated train-of-four via surface electrodes at the wrist. Initially a notebook personal computer was linked to a Datex Relaxograph to monitor electromyogram (EMG) signals which had been pruned by a three-level hierarchical structure of filters in order to design a controller for administering muscle relaxants. Furthermore, a four-level hierarchical fuzzy logic controller using the fuzzy logic and rule of thumb concept has been incorporated into the system. The Student's test was used to compare the variance between the groups. p < 0.05 was considered significant.
  
  
  RESULTS
  The system achieved stable control of muscle relaxation with a mean T1% error of -0.19 (SD 0.66) % accommodating a range in mean infusion rate (MIR) of 0.21-0.49 mg x kg(-1) x h(-1). When these results were compared with our previous ones using the same hierarchical structure applied to mivacurium, less variation in the T1% error (p < 0.05) but the same variation in infusion rate were observed. The controller activity of these two drugs showed no significant difference (p > 0.5). However, the consistent medium coefficient variance (CV) of the MIR of both rocuronium (i.e., 36.13 (SD 9.35) %) and mivacurium (i.e., 34.03 (SD 10.76) %) indicated a good controller activity.
  
  
  CONCLUSIONS
  The results showed that a hierarchical rule-based monitoring and fuzzy logic control architecture can provide stable control of neuromuscular block despite the considerable individual variation in neuromuscular block required among patients. Also, there was less variation in T1% error compared with that of previous study on mivacurium. Meanwhile, the consistent medium CV of the MIR of both rocuronium and mivacurium indicated a good controller activity which is able to withstand noise, diathermy effect, artifacts and surgical disturbances.
authors.affiliation: Department of Mechanical Engineering, Yuan Ze University, Chung-Li, Taoyuan, Taiwan. jsshieh@saturn.yzu.edu.tw
authors.forename: J S
authors.initials: JS
authors.lastname: Shieh
authors.forename: S Z
authors.initials: SZ
authors.lastname: Fan
authors.forename: L W
authors.initials: LW
authors.lastname: Chang
authors.forename: C C
authors.initials: CC
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000732:Androstanols / Q000008:administration & dosage*; D000769:Anesthesia, Inhalation; D004558:Electric Stimulation; D004576:Electromyography; D005246:Feedback; D017143:Fuzzy Logic; D006801:Humans; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009126:Muscle Relaxation; D019148:Neuromuscular Blockade; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage*; D000077123:Rocuronium; D014459:Ulnar Nerve / Q000502:physiology
chemical_list: D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D000077123:Rocuronium