Development of a remote-controlled, automated total intravenous anesthesia system

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The object of this study is to develop a remote computer-controlled system for total intravenous anesthesia (TIVA) using three anesthetic drugs : propofol for hypnosis, fentanyl for analgesia, and vecuronium for muscle relaxation.We initially developed a target-controlled infusion (TCI) system of a drug that includes a personal computer, a computer-controlled infusion pump, and a self-made software. This system calculates estimated blood concentration or estimated effect-site concentration based on the pharmacokinetic and pharmacodynamic model, and controls the infusion rate to maintain a desired concentration. We added a 4-serial-port PCI-card to control three infusion pumps by one computer.As the information from a patient, the Bispectral Index for hypnotic level and the single twitch height for muscle relaxation were used. Then we developed a system to control infusion rates of three drugs. For propofol, that calculates the relation between the Bispectral Index and the estimated effect-site concentration by real-time processing and controls the propofol infusion rate to maintain a desired Bispectral Index value. For vecuronium, the system feedbacks the single twitch height and controls the vecuronium infusion rate. Adding the TCI of fentanyl, this, one computer three pumps system were used in actual anesthesia practice and produced stable anesthesia.Finally we remote-controlled the former system by other personal computer via LAN within our hospital using remote-control software. We used this final system to some patients and could induce and maintain stable anesthesia. We expect that in the near future, many clinicians will use a completely automated anesthesia system that integrating other physiological information and controlling ventilators, fluid infusion, etc.