Automatic closed-loop anesthesia: a scoping review

Abstract

Background: The field of anesthesia has historically relied on manual administration, requiring anesthesiolgists to adjust dosages based on patient and surgical needs. With technological advancements, closed-loop systems have emerged to automate anesthesia administration, enhancing dosing accuracy, reducing workload, and improving patient safety. This scoping review investigates the application of closed-loop anesthesia across various clinical contexts, such as hypnosis, hemodynamic management, muscle relaxation, ventilation, and glucose control.

The review employs a comprehensive methodology, adhering to contemporary scoping review guidelines. A thorough search of databases and grey literature yields a diverse collection of studies. A total of 327 articles are assessed, with 121 articles meeting inclusion criteria. Various closed-loop controllers are employed, of which Proportional Integral Derivative (PID) is the most frequent.

In the context of hypnosis, closed-loop systems demonstrate improved time on target, performance, and reduced drug consumption. Similarly, in hemodynamics, closed-loop administration of fluids and vasopressors results in optimized blood pressure and heart rate control. Muscle relaxation studies highlight the role of closed-loop controllers in maintaining appropriate levels of neuromuscular blockade.

While closed-loop systems show promise in improving anesthesia delivery, manual intervention remains necessary due to the dynamic nature of surgical settings. The review underscores the potential benefits of closed-loop anesthesia, including enhanced safety, reduced workload, and improved patient outcomes. However, the heterogeneity of study designs and applications necessitates cautious interpretation of findings. As technology continues to advance, refined closed-loop systems hold the potential to play an increasingly significant role in routine clinical anesthesia practice.