Individualized closed-loop anesthesia through patient model partitioning

Closed-loop controlled drug dosing has the potential of revolutionizing clinical anesthesia. However, interpatient variability in drug sensitivity poses a central challenge to the synthesis of safe controllers. Identifying a full individual pharmacokinetic–pharmacodynamic (PKPD) model for this synthesis is clinically infeasible due to limited excitation of PKPD dynamics and presence of unmodeled disturbances. This work presents a novel method to mitigate inter-patient variability. It is based on: 1) partitioning an a priori known model set into subsets; 2) synthesizing an optimal robust controller for each subset; 3) classifying patients into one of the subsets online based on demographic or induction phase data; 4) applying the associated closed-loop controller. The method is investigated in a simulation study, utilizing a set of 47 clinically obtained patient models. Results are presented and discussed.

Clinical relevance—The proposed method is easy to implement in clinical practice, and has potential to reduce the impact from surgical stimulation disturbances, and to result in safer closed-loop anesthesia with less risk of under- and over dosing.