Skip Navigation LinksHome > August 2006 - Volume 23 - Issue 8 > Model‐based control of neuromuscular block using mivacurium:...
European Journal of Anaesthesiology:
doi: 10.1017/S0265021506000524
Original Article

Model‐based control of neuromuscular block using mivacurium: design and clinical verification

Schumacher, P. M.*; Stadler, K. S.; Wirz, R.*; Leibundgut, D.*; Pfister, C. A.*; Zbinden, A. M.*

Collapse Box


Background:: Short‐acting agents for neuromuscular block (NMB) require frequent dosing adjustments for individual patient's needs. In this study, we verified a new closed‐loop controller for mivacurium dosing in clinical trials.

Methods:: Fifteen patients were studied. T1% measured with electromyography was used as input signal for the model‐based controller. After induction of propofol/opiate anaesthesia, stabilization of baseline electromyography signal was awaited and a bolus of 0.3 mg kg−1 mivacurium was then administered to facilitate endotracheal intubation. Closed‐loop infusion was started thereafter, targeting a neuromuscular block of 90%. Setpoint deviation, the number of manual interventions and surgeon's complaints were recorded. Drug use and its variability between and within patients were evaluated.

Results:: Median time of closed‐loop control for the 11 patients included in the data processing was 135 [89–336] min (median [range]). Four patients had to be excluded because of sensor problems. Mean absolute deviation from setpoint was 1.8 ± 0.9 T1%. Neither manual interventions nor complaints from the surgeons were recorded. Mean necessary mivacurium infusion rate was 7.0 ± 2.2 μg kg−1 min−1. Intrapatient variability of mean infusion rates over 30‐min interval showed high differences up to a factor of 1.8 between highest and lowest requirement in the same patient.

Conclusions:: Neuromuscular block can precisely be controlled with mivacurium using our model‐based controller. The amount of mivacurium needed to maintain T1% at defined constant levels differed largely between and within patients. Closed‐loop control seems therefore advantageous to automatically maintain neuromuscular block at constant levels.

© 2006 European Society of Anaesthesiology


Article Tools


Article Level Metrics

Search for Similar Articles
You may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search.