Nonlinear Modeling and Feedback Control of Drug Delivery in Anesthesia

Sammanfattning: General anesthesia is a drug-induced reversible state where neuromuscular blockade (NMB), hypnosis, and analgesia (jointly denoted by depth of anesthesia - DoA) are guaranteed. This thesis concerns mathematical modeling and feedback control of the effect of the muscle relaxants atracurium and rocuronium, the hypnotic propofol, and the analgesic remifentanil. It is motivated by the need to reduce incidences of awareness and overdose-related post-operative complications that occur in standard clinical practice. A major challenge for identification in closed-loop is the poor excitation provided by the feedback signal. This applies to the case of drugs administered in closed-loop. As a result, the standard models for the effect of anesthetics appear to be over-parameterized. This deteriorates the result of system identification and prevents individualized control.In the first part of the thesis, minimally parameterized models for the single-input single-output NMB and the multiple-input single-output DoA are developed, using real data. The models have a nonlinear Wiener structure: linear time-invariant dynamics cascaded with a static nonlinearity. The proposed models are shown to improve identifiability as compared to the standard ones.The second part of the thesis presents system identification methods for Wiener systems: a batch prediction error method, and two recursive techniques, one based on the extended Kalman filter, and another based on the particle filter. Algorithms are given for both the NMB and the DoA using the minimally parameterized models.Nonlinear adaptive controllers are proposed in the third part of the thesis. Using the model parameter estimates from the extended Kalman filter, the controller performs an online inversion of the Wiener nonlinearity. A pole-placement controller or a linear quadratic Gaussian controller is used for the linearized system. Results show good reference tracking performance both in simulation and in real trials.Relating to patient safety, the existence of undesirable sustained oscillations as consequence of Andronov-Hopf bifurcations for a NMB PID-controlled system is analyzed. Essentially the same bifurcations are observed in the standard and the minimally parameterized models, confirming the ability of the latter to predict the nonlinear behavior of the closed-loop system. Methods to design oscillation-free controllers are outlined.