A computer-assisted system for total intravenous anesthesia (CAS-TIVA): man-machine interface and clinical practice

computer-controlled infusion pump system which can manage the delivery of t he three drugs, propofol, fentanyl, and vecuronium, was developed for maint aining total intravenous anesthesia (TIVA) through the use of computing tec hnologies. The software for this system runs on a Macintosh operating syste m. The system manages target-controlled infusion of propofol and fentanyl f or both the central compartment and effect-site compartment, as well as sim ple continuous infusion and bolus injection of these drugs. The system also manages closed-loop control (CLC) of drug delivery with information on the Bispectral Index((TM)) (BIS) for propofol and fentanyl infusion, and infor mation on the %T1 obtained from a Relaxograph (Datex Engstrom, Finland) for vecuronium infusion. Anesthesiologists using the system can readily recogn ize the condition of general anesthesia by monitoring the graphical trends of blood/effect-site concentration of propofol and fentanyl, BIS value, and %T1, and they can operate this system with an easy-to-use graphical-user i nterface. This system was safely used on more than 25 patients, though it w as recognized that further improvement is needed in the algorithm for CLC. With improvements in computing technologies in the near future, this machin e for intravenous anesthesia will feature intelligent management for genera l anesthesia.