SISTEMA COMPUTARIZADO EN LAZO CERRADO PARA EL SUMINISTRO DE LA ANESTESIA INTRAVENOSA
Palabras clave:
Modelado de sistemas, sistemas de control, anestesia intravenosa, TIVA, farmacocinética, farmacodinamia, biofase, algesímetro, espectroencefalograma, Modeling systems, control systems, intravenous anesthesia, pharmacokinetics, pharmacodynamicsResumen
El sistema de suministro de la anestesia total intravenosa en lazo cerrado es una técnica reciente que ofrece ventajas sobre las técnicas actuales como la estabilidad intraoperatoria y la menor y más segura dosificación. OBJETIVO: El objetivo general de este artículo es el de resumir los hallazgos sobre un nuevo método computarizado sencillo, en lazo cerrado, para suministrar la anestesia total intravenosa de forma automatizada y segura bajo la supervisión permanente del Anestesiólogo. Este sistema se ha desarrollado para la administración de anestesia intravenosa implementando varios subsistemas. Un modelo multicompartimental de distribución de fármacos en el paciente, un algoritmo para determinar la curva de velocidades del hipnótico (propofol) a infundir, un protocolo de comunicación para establecer las velocidades de infusión y un lazo de realimentación para controlar la profundidad hipnótica mediante el índice biespectral. RESULTADO: El resultado final ha sido el desarrollo de un instrumento de fácil uso, con una interfaz interactiva, que facilita la operación anestésica por parte del anestesiólogo valiéndose de un computador convencional y un monitor de profundidad hipnótica. CONCLUSIÓN: Se ha implementado una herramienta informática dotada de un modelo farmacocinético multicompartimental de gran interés académico y clínico, que tal y como se ha demostrado de forma cuantitativa, proporciona idénticos resultados a los ofrecidos por equipos comerciales; con importantes ventajas adicionales como una interfaz de usuario interactiva y la posibilidad de administrar anestesia total intravenosa. PALABRAS CLAVE: Modelado de sistemas, sistemas de control, anestesia intravenosa, TIVA, farmacocinética, farmacodinamia, biofase, algesímetro, espectroencefalograma. COMPUTER SYSTEM IN CLOSED LOOP FOR THE PROVISION OF INTRAVENOUS ANESTHESIA ABSTRACT The delivery system of total intravenous anesthesia in closed loop is a recent technique that offers advantages over current techniques including intraoperative stability and lower and safer dose. OBJECTIVE: The overall objective of this paper is to summarize previous findings on a new computerized method, single closed loop, to provide an automated and safe total intravenous anesthesia under the constant supervision of an anesthesiologist. This system has been developed for the administration of an intravenous anesthetic, implementing various subsystems. A multi-compartment model drug distribution in the patient, an algorithm to determine the speed curve of the hypnotic (propofol) to infuse, a communication protocol to establish the infusion and a feedback loop to control the hypnotic depth using the bispectral index. RESULT: The result has been the development of a user-friendly tool with an interactive interface that facilitates the anesthetic operation by the anesthesiologist using a conventional computer and a monitor of hypnotic depth. CONCLUSION: In conclusion we have has implemented a software tool provided with a pharmacokinetic multicompartimental model, with good academic and clinical interest; this has been demonstrated quantitatively, providing results identical to those offered by a commercial equipment; with significant additional benefits such as interactive user interface and the ability to manage total intravenous anesthesia. KEY WORDS: Modeling systems, control systems, intravenous anesthesia, TIVA, pharmacokinetics, pharmacodynamics, biophase, algesimeter, espectroencephalogram.Biografía del autor/a
Alberto Vanegas-Saavedra, SCARE
Francisco Gómez, San Vicente de Paul
Fabián David Casas A., Universidad de Antioquia
Juan M. Fernández, Universidad de Antioquia.
Álvaro Guarín G, Universidad de Antioquia
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