Table Of ContentCOMPUTINO IN ANESTHESIA AND INTENSIVE CARE
DEVELOPMENTS IN CRITICAL CARE
MEDIClNE AND ANESTHESIOLOGY
Other volumes in this series:
Prakash, Omar (ed.): Applied Physiology in Clinical Respiratory Care. 1982.
ISBN 9O-247-2662-X.
McGeown, Mary G.: Clinical Management of Electrolyte Disorders. 1983.
ISBN 0-89838-559-8.
Scheck, P.A., Sjöstrand, V.H., and Smith, R.B. (eds.): Perspectives in High
Frequency Ventilation. 1983. ISBN 0-89838-571-7.
Stanley, Tb.H. and Petty, W.C. (eds.): New Anesthetic Agents, Devices and Mo
nitoring Techniques. 1983. ISBN 0-89838-566-0.
COMPUTING IN ANESTHESIA
AND INTENSIVE CARE
edited by
OMAR PRAKASH, MD
Thoraxeentrum. Academic Hospital Dijkzigt.
Erasmus University. Rotterdam
associate editors
SIMON H. MEY M.Sc and RICHARD W. PATTERSON MD
Thoraxeentrum. University 01 California Medical Center.
Rotterdam Los Angeles
1983 MARTINUS NIJHOFF PUBLISHERS
a member of the KLUWER ACADEMIC PUBLISHERS GROUP
BOSTON / THE HAGUE / DORDRECHT / LANCASTER
DIstrlbuton
for the United States and Canada: IOuwer Boston. Inc •• 190 Old Derby Street.
Hinaham. MA 02043. USA
for all other collntries: IOuwer Academic Publishers OrouP. Distribution Center.
P .O.Box 322. 3300 AU Dordrecht. The Netherlands
Library or Congress Catalog Card Number 83·17301
ISBN-13:978-94-009-6749-6 e-ISBN-13:978-94-009-6747-2
DOI: 10.10071978-94-009-6747-2
Copyright
© 1983 by Martinus Nijhoff Publishers. Boston.
Reprint ofthe original edition 1983
All rights reserved. No part of this publication may be reproduced. stored in a
retrieval system. or transmitted in any form or by any means. mechanical.
photocopying. recording. or otherwise. without the prior written permission of
the publishers.
Martinus Nijhoff Publishers. 190 Old Derby Street. Hingham. MA 02043. USA.
P R E F ACE
This volume represents selected topics in Computing in
Anesthesia and Intensive Care and contains the proceedings
of the Second International Symposium, held in Rotterdam,
September 6-10, 1983.
This monograph provides the role of Computing in Anes
thesia and Intensive Care, covering a wide range of topics:
Education, Monitoring, Innovative Techniques, Computer
Assisted Intravenous Anesthesia, Data Management and Closed
Loop Systems.
At tre outset, I must thank the keynote speakers and
others for submitting their manuscripts promptly. I express
my gratitude to R.W. Patterson, Simon Heij and Bas van der
Borden for helping me to edit this volume. Finally, thanks
are due to E.N.R. Rulf, Norma van Toornburg and Claudia
Dijkstra for their help and cooperation.
July, 1983 Omar Prakash, rl.D.
CONTENTS
Preface V
Contributors XI
computer operating systems for patient monitoring 1
A.K. Ream
On the use of computers in the practice of
anaesthesia ..•..•..•.....•........•••............... 11 ••
D. Daub and K.A. Lehmann
Computerized data acquisition and display in
anesthesia ...•....•.............•...••...•.......... 25
J.E.W. Beneken, J.A. BIom, A.P. Meijler,
P. Cluitmans, Joh. Spierdijk, A. Nandorff,
R. Nijhuis, H.M. van Kessel
Microcomputer based automatie capture of signals
from non-invasive instruments •....•..•••••.•.••.•... 44
N.H. Naqvi
Physiologie monitoring of critically ill patients:
computerized da ta acquisition, outcome prediction,
organisation of therapy and prospective clinical
trials.............................................. 61
W.C. Shoemaker
Set up and results ICU database .•...............•... 78
J.A. Leusink and R. van Staden
An interactive information system for anaesthesia 86
G.L. Olsson
Automated analysis of the esophageal accelerogram
as a minimally invasive monitor of manifest
contractile state ............•.......•.............. 96
R.S. Wiley, L.S. Shepard, L.B. Wolfenson
Information transfer from operating room to ICU ..... 107
R.M. Peters
Energy metabolism ..........•......•..•.......••..... 116
S. Bursztein and Z. Bshouty
Gas distribution and ventilation-perfusion
relationships during anaesthesia and in acute
respiratory failure ........ - •.•...•........•..•..... 121
G. Hedenstierna and S. Baehrendtz
Continuous monitoring of intrathoraeie fluid .•...... 141
H.H.M. Karsten, J.H. Meijer, S.J. Hengeveld,
J.B.V.M. Delemarre, J.A. Leusink, G.A. Schurink,
H. Schneider
The potential of computer modelling techniques
in intensive care medicine ...•.•..•••...•..•.......• 153
C.J. Hinds and C.J. Dickinsan
VIII
An interaetive program for intravenous drug
infusion management •••••••.••••••••.••••••.•.••••••• 170
M.N. Skaredoff and P.J. Poppers
Computer assisted learning in anaesthesiology •.••••• 184
J.W.R. Melntyre
Teaehing with "ATTENDING": Tutorial use of an
expert system •••••••••••••••••••••••.••••••••••••••• 193
P.L. Miller, D. Angers, J.R. Keefer,
N. Sudan, G. Tanner
Introductory courses in eomputing for anaesthetists • 202
J.H. Kerr, B.J. Harrison, W.L. Davies
The use of computer-genera ted numbers in
interpret ing the EEG •••••.••.•••••..•••••••••••••••. 2 14
N. Ty Smith and I.J. Rampil
Automatie EEG monitoring during anesthesia •.••.••••• 227
A.J.R. Simons and R.A.F. Pronk
Computerized EMG and EEG correlates of
consciousness ••.•••••••.••..•••••••••••••••••••.•••• 258
H.L. Edmonds Jr., Y.K. Yoon, S.I. Sjogren,
H.T. Maguire, C.P. McGraw
Computer control of anesthesia delivery ••...••••••.. 269
D.R. Westenskow, W.S. Jordan, J.K. Hayes,
T.D. East
Computer controlled anaesthesia ••..••.••••••.••••••• 279
J.M. Evans, A. Fraser, C.C. Wise, W.L. Davies
Computer regulated sonium nitroprusside
infusion for blood pressure control .••••••.•••.••.•• 292
N.L. Pace and D.R. Westenskow
Computer controlled infusion of drugs during
anesthesia: methods of muscle relaxant and
narcotic administration .••••.••••••.•••••••.•••••••• 302
G. Ritchie, J. Spain, J.G. Reves
Oxygen requirements during anesthesia •••••••..•••••. 316
S.F. Sullivan
Real time oximetry ••.•••.••.•••••••••.••••••.•.•..•• 328
M. Yelderman and J. Corenmen
Graphic presentation of blood gas data •••••••••••.•• 342
P.M. Osswald, J. Bernauer, H.J. Bender,
H.J. Hartung
Teaching the interpretation of acid-base and
blood gas parameters by computer application •••.•••. 354
E. Voigt
Vis~al evo~ed po~entials during cardiac surgery,
bas1c cons1dera t10ns •••••••••••.••••.•••••.••.•••••• 366
w. Russ, D. Kling, B. von Bormann, G. Hempelmann
Phosphorus nuclear magnetic resonance (31 P NMR) :
a computer based instrument for studying brain
hypoxia •.••••••.•••••••••••••••••••.•••••••••.•••••• 386
M. Hilberman, V.H. Subramanian, L. Gyulai,
B. Chance
Measuring pulmonary blood flow with an 8085 •••.•.••. 402
J.M. Bellville, L. Arena, o. Brovko,
D.M. Wiberg
IX
A microcomputer-based charting system for
documentation of heamodynamic, respiratory
parameters and drug administration during
cardiac anaesthesia ••.••.••••..•.•.•.•.•.•..•.••••.. 416
S.G. van der Borden, O. Prakash,
S.H. Meij
Computer control of Intravenous anesthesia •••••••••• 423
T.H. Stanley
Contributors
Angers, D. Department of Anesthesiology, Yale University School
of Medicine, New Haven, CT 06510, USA.
Arena, L. Department of Anesthesiology, UCLA School of Medicine,
Los Angeles, USA.
Baehrendtz, S. Department of Medicine I, South Hospital, Stock
holm, Sweden
Bellville, J.W. Department of Anesthesiology, UCLA School of
Medicine, Los Angeles, USA.
Bender, H.J. Department of Anaesthesiology, University of
Heidelberg, Mannheim, West Germany.
Beneken, J.E.W. Division of Medical Electrical Engineering,
University of Technology, Eindhoven, The Netherlands.
Bernauer, J. Department of Anaesthesiology, University of
Heidelberg, Mannheim, West Germany.
BIom, J.A. Division of Medical Electrical Engineering, University
of Technology, Eindhoven, The Netherlands.
Borden, S.G., van der. Thorax Centrum, Erasmus University,
Universlty Hospital Dijkzigt, PO Box 1738, 3000 DR Rotterdam,
The Netherlands.
Bormann, B., von. Department of Anaesthesiology and Intensive
Care, Justus Liebig University, Giessen, West Germany.
Brovko, o. Department of Anesthesiology, UCLA School of Medicine,
Los Angeles, USA.
Bshouty, Z. Intensive Care Department, Rambam, Medical Center and
Technion School of Medicine, Haifa, Israel.
Bursztein, S. Intensive Care Department, Rambam, Medical Center
and Technion School of Medicine, Haifa, Israel.
Chance, B. Department of Biophysics, University of pennsylvania,
Philadelphia, PA 19104, USA.
Cluitmans, P. Division of Medical Electrical Engineering,
University of Technology, Eindhoven, The Netherlands.
Corenmen, J. Department of Anesthesia, Stanford University School
of Medicine, Stanford, CA 94305, USA.
Davies, W.L. Nuffield Department of Anaesthetics, John Radcliffe
Hospital, Oxford OX3 9DU, Uni ted Kingdom. .
Daub, D. Department of Anaesthesiology, University of Technology,
Aachen, West Germany.
Delemarre, J.B.V.M. Department of Cardiovascular Surgery, St.
Antonius Hospital, Utrecht, The Netherlands.
Dickinson, C.J. Anaesthetics Laboratory, St. Bartholomew's
Hospital, West Smithfield, London EC1A 1BE, United Kingdom.
East, T.D. Department of Anesthesiology, University of Utah,
Salt Lake City, UT 84132, USA.
Edmonds, H.L.,Jr. Department of Anesthesiology, University of
Louisville, Louisville, Kentucky 40292, USA.
Evans, J.M. Nuffield Department of Anaesthetics, The Radcliffe
Infirmary, Oxford OX2 6HE, United Kingdom.
Fraser, A. Nuffield Department of Anaesthetics, The Radcliffe
Infirmary, Oxford OX2 6HE, United Kingdom.
xrr
Gyulai, L. Department of Biophysics, University of Pennsylvania,
Philadelphia, PA 19104, USA.
Harrison, B.J. Nuffield Department of Anaesthetics, John
Radcliffe Hospital, Oxford OX3 9DU, United Kingdom.
Hartung, H.J. Department of Anaesthesiology, University of
Heidelberg, Mannheim, West Germany.
Hayes, J.K. Department of Anesthesiology, University of Utah,
Salt Lake City, UT 84132, USA.
Hedenstierna, G. Department of Clinical Physiology, Huddinge
Hospital, Stockholm, Sweden.
Hempelmann, G. Department of Anaesthesiology and Intensive Care,
Justus Liebig University, Giessen, West Germany.
Hengeveld, S.J. Department of Instrumentation and Automation, St.
Antonius Hospital, Utrecht, The Netherlands.
Hilberman, M. Department of Anesthesia, University of Pennsylvania
Philadelphia, PA 19104, USA.
Hinds, C.J. Anaesthetics Laboratory, St. Bartholomew's Hospital,
West Smithfield, London EC1A 7BE, Uni ted Kingdom.
Jordan, W.S. Department of Anesthesiology, University of Utah,
Salt Lake City, UT 84132, USA.
Keefer, J.R. Department of Anesthesiology, Yale University School
of Medicine, New Haven, CT 06510, USA.
Kerr, J.H. Nuffield Departrnent of Anaesthetics, John Radcliffe
Hospital, Oxford, OX3 9DU, united Kingdom.
Kessel, H.M. van. Department of Anesthesiology, Leyden University
Hospital, Leiden, The Netherlands.
Kling, D. Department of Anaesthesiology and Intensive Care, Justus
Liebiq University, Giessen, West Germany.
Korsten, H.H.M. Department of Anaesthesiology, St. Antonius
Hospital, Utrecht, The Netherlands.
Lehmann, K.A. Department of Anaesthestology, University of
Technology, Aachen, West Germany.
Leusink, J.A. Department of Anaesthesiology, St. Antonius Hospital
Utrecht, The Netherlands.
Maguire, H.T. Department of Anesthesiology, University of
Louisville, Louisville, Kentucky, 40292, USA.
McGraw, C.P. Department of Surgery, University of Louisville,
Louisville, Kentucky, 40292, USA.
McIntyre, J.W.R. Department of Artaesthesia, University Hospital,
Edmonton, Alberta, Canada.
Meij, S.H. Thorax Centrum Erasmus University, University
Hospital Dijkzigt, PO Box 1738, 3000 DR Rotterdarn, The
Netherlands.
Meijer, J.H. Department of Medical Physics, Free University,
Amsterdam, The Netherlands.
Meijler, A.P. Division of Medical Electrical Engineering,
University of Technology, Eindhoven, The Netherlands.
Miller, P.L. Department of Anesthesiology,Yale University, School
of Medicine, New Haven, CT 06510, USA.
Nandorff, A. Department of Anesthesiology, Leyden University
Hospital, Leiden, The Netherlands.
Naqvi, N.H. Department of Anaesthetics, Bolton Royal Infirmary,
Bolton, Lancashire, United Kingdom.
Nijhuis, R. Department of Anesthesiology, Leyden University
Hospital. Leiden, The Netherlands.
