AU2021100883A4 - Fuzzy Logic Based Automatic Intravenous Anesthesia Delivery and Monitoring System - Google Patents

Abstract

Our invention "Fuzzy Logic Based Automatic Intravenous Anesthesia Delivery and Monitoring System" is a improved automatic anaesthesia delivery , monitoring system comprising: (a) at least one of a bispectral index monitor and an anaesthesia vital sign monitor interfaced with a computer to receive input from patient; (b) at least one pump for controlling delivery of drug based on the feedback from patient; (c) said computer having specific software for controlling said pump(s) and for fine tuning the dosage based on patient's response and requirements. The invention is also a apparatus for total intravenous anesthesia includes at least one supply and infusion pump for an intravenous anesthesia agent carried by the apparatus housing and at least one monitor for monitoring the characteristics of the patient during the total intravenous anesthesia. The invention also includes the at least one intravenous anesthesia agent preferably includes a first intravenous anesthesia agent, and more preferably, an analgesic, having a relatively quick offset so that the effects wears off relatively quickly upon stopping intravenous infusion. At the time of monitoring the patient the apparatus preferably includes at least one of an electrocardiogra:1: blood oxygen monitor2: blood carbon dioxide monitors3: inspiration/expiration oxygen4: inspiration/expiration carbon dioxide5 blood pressure monitor6: pulse rate monitor7: respiration rate monitor8: patient temperature monitor. Eexample: The first intravenous anesthesia agent may be an esterase metabolized opioid, such as remifentanil. A second supply of a second intravenous anesthesia agent carried by the housing may also be included and the second supply may be another anesthesia agent, such as propofol etc. 20 25 QUICK SO OF5FAM- 12 24MPC7 FN INFSIO | EK 50--95 lNU1C EININ TEME 46nN NE 43 L-7- PU P&- - --47 alUiuna OTHEF-(:o FIG.F 2 SASHMTCBOKDARA LUTAIGPRIN F H 6PAAU PIRAT 573 posver i 47Vpoe 5PI J(OL s Se GPO2 i Gmo flPro0 10 (O21 e ro G PIO GSA Vproo GP13 (WM1) Ground rPO194(POILFS) GPlo010 GPIO217 GPI0 20 (PCM.DIN) 3V3poed GPI0 214PM.Or FIG.3: STRUCTURE 9Goun

Description

QUICK SO OF5FAM- 12

24MPC7 FN INFSIO | EK

50--95 lNU1C EININ TEME 46nN

NE 43

L-7- PU P&- - --47 alUiuna

OTHEF-(:o FIG.F 2 SASHMTCBOKDARA LUTAIGPRIN F H 6PAAU PIRAT

573 posver i 47Vpoe

5PI J(OL s Se GPO2 i Gmo

flPro0 10 (O21 e ro

G PIO GSA Vproo GP13 (WM1) Ground rPO194(POILFS) GPlo010 GPIO217 GPI0 20 (PCM.DIN)

3V3poed GPI0 214PM.Or

FIG.3: STRUCTURE 9Goun

Fuzzy Logic Based Automatic Intravenous Anesthesia Delivery and Monitoring System

FIELD OF THE INVENTION

Our invention is related to a Fuzzy Logic Based Automatic Intravenous Anesthesia Delivery and Monitoring System and also animproved automatic anesthesia delivery system. BACKGROUND OF THE INVENTION

Anaesthesia is a medically induced clinical state that inhibits patients from sensing pain during surgery. The word anaesthesia is originated from two Greek words "an" meaning "without" and "aesthesis" meaning "sensation". When anaesthesia works the patient feels no pain during the procedure and often does not remember the surgical proceedings. There are two types of anaesthesia namely General Anaesthesia (GA) and Regional Anaesthesia (RA). General anaesthesia is a drug-induced, reversible state that leads to loss of consciousness, loss of pain perception and loss of thought processing of the surgical procedures. Regional anaesthesia is accomplished using drugs that temporarily block the sensation of pain in a certain area of the body while the patient remains awake. Estimation of patient's Depth of Anaesthesia (DoA) during GA is one of the current challenges in anaesthesia research because too little anaesthetic drugs can make a patient aware during surgery. On the other hand, too much anaesthetic drugs can result in anaesthetic overdosing that leads to prolonged recovery from anaesthesia. Therefore, continuous monitoring and estimation of anaesthesia prevent patient awareness due to the inadequate dose of anaesthetic drugs and avoid the overdose of anaesthetic drugs by optimizing the quantity of drug delivered to a patient during surgery. Many of the anaesthesiologist control and monitor the DoA by observing the parameters such as Blood Pressure(BP), Heart Rate(HR), Pulse Rate (PR), Blood Oxygen Saturation Level (Sp02), Mean Arterial Pressure (MAP), Body movement and Airway Pressure etc. In normal conditions, anaesthesiologist continuously monitors these parameters of the patient and according to that inject the anesthesia drug. The proposed system will help in decision making to the doctors by advising appropriate amount of drug dosage. It will continuously monitor the parameters of patient and according to current status, it decides the dosage that needs to be injected to anesthetize the patient. India is a developing country and still, in 20th century we are lacking behind in providing a good healthcare facility to the population. In rural areas of India, the number of people is dying because of improper sanitization. In rural areas, there is limitation on healthcare providers. A single doctor need to take care of multiple patients at a single time. During surgery, a single anaesthesiologist take care of multiple patients periodically. Ethically this is not correct. During surgery, anaesthesiologists' play an important role as they anesthetize the patient and monitors their biological parameters throughout the surgery. A single anesthesiologist cannot handle two or more cases of surgery at a time. The proposed system can help anesthesiologist while decision making. The device will continuously monitor the parameter of the patient and done decision making based on parameter values.

Anaesthetic agents are administered routinely based on predetermined dose requirement which is according to patients' age and body weight. MAC (Minimum Alveolar concentrations) of anaesthetic agents as well as plasma drug concentrations required for producing anaesthetic state vary in different individuals depending upon the altered drug pharmacokinetic (what body does to the chug) as well as dynamics (what drug does to body) due to different disease states (pathological states) of patient population visiting for anaesthesia and surgery. Even among normal healthy individuals, there are variations in pharmacokinetic (drug disposition by body) and pharmacodynamics (drug effect on body) of anaesthetic drugs used in clinical scenarios.

Consequently, administration of anaesthetic drugs is titrated using hypertension and tachycardia (alteration in haemodynamics) as indicators of inadequate depth of anaesthesia. However, the disadvantage associated with the same is that, blood pressure and heart rate are not reliable indicators of depth of anaesthesia as a large number of cardiovascular drugs like p-blockers and other anti-hypertensive may affect the blood pressure and heart rate. In view of this, there is need to monitor objectively the drug effect or depth of anaesthesia. EEG has been used to indicate the depth of anaesthesia, but the ideal control variable for the delivery of anaesthetic is still unknown. Various electrophysiological (EEG) variables have been used in an attempt to provide measure of anaesthetic depth 2 though the success is limited 24 . Simple measures of EEG like spectral edge frequency (SEF), Median edge frequency (MEF) correlate poorly with clinical parameters of depth of anaesthesia. The Bispectrality index (BIS) is a derived variable of the EEG that provides a measure of the consistency of phase and power relationships among the various frequencies of the EEG5 . The BIS describes the complex EEG pattern as a single variable which has been used for control of anaesthesia and approved by FDA for anesthetic depth monitoring.

Attempts have been made in the West to control anaesthetic agent's delivery using closed loop drug delivery. Various parameters such as median frequency of EEG or auditory evoked potentials have been applied as controlled variable for closed loop control of hypnotic anesthetic drugs in the literature. All these attempts have used Target Controlled infusion pumps for titrating the drug delivery to different indicators of depth of anaesthesia. In spite of that, no closed loop anaesthesia system is available commercially. Target controlled infusion pumps are not only 3-4 times constlier than the simple syringe pump but they also require special prefilled syringes of drug for controlling the delivery of Propofol. None of the systems developed so far incorporate both intravenous as well as inhalational anaesthetic agents together. None of the system provides versatility to the anaesthetist or user to change from one type of anaesthesia i.e. intravenous anaesthesia to other type of anaesthesia i.e. inhalational anaesthesia and vice versa. None of the system suggested earlier incorporate safety features regarding the effect of anaesthetic agent on blood pressure and heart rate and controlling anaesthetic delivery governed by these factors. Normally the drug is administered and the monitoring equipment monitors the effect. The clinician reads the display of the monitor and then changes are made in the drug delivery system to alter the rate of delivery of the drug. The process is repeated after observing the changes in the monitored value, which may cause the following: L Time delay in display of the monitored value,

2. Time delay in reading the value, 3. Time delay in comprehending the change in monitored value, 4. Time delay in altering manually the drug delivery, S. Human error in reading, judging and altering the drug dosage.

Further, reference may be made to "A new closed-loop control system for isoflurane using Bispectral index wherein Automatic control of depth of hypnosis using the BispectralIndex (BIS) can help to reduce phases of inadequate control. Yet further, reference may be made to "Titration of propofol for Anesthetic induction and maintenance guided by the Bispectral index. This report describes a closed-loop titration of propofol target control infusion based on a proportional-differential algorithm guided by the Bispectral Index (BIS) allowing induction and maintenance of general anesthesia and compares this to manual propofol target control infusion.

There is a continuing trend in health care to significantly reduce and replace in-patient hospital care with ambulatory care. For example, ambulatory surgery now accounts for over 60% of all operations performed in the United States, and is expected to increase to % of all procedures by the year 2000. This trend is likely to continue as surgeons embrace the ongoing development of minimally invasive surgical techniques, as third party payers reduce or restrict payments for health care, and as the acceptance by patients and society grows for ambulatory care. The traditional delivery of anesthesia for in-patient hospital care typically relies heavily on the use of inhalation anesthesia agents. For example, the Excel series anesthesia systems from Ohmeda include a hypoxic guard, sophisticated electronic ventilation, flow management systems, vaporization and breathing circuits. The systems offer a choice of monitors, vaporizers, ventilators, and offer drawers or shelves for storage. Unfortunately, the bulkiness of even advanced conventional inhalation equipment severely hinders the portability of the equipment and thereby limits the possible locations where the equipment may be used.

Another significant shortcoming for traditional inhalation anesthesia systems is that scavenging or ventilation systems are required by various governmental regulations, such as OSHA regulations in the United States. In other terms, complicated and expensive room ventilation as in a traditional operating theater is needed for conventional inhalation systems to comply with various regulations. As reported in the March 1997 issue of Anesthesiology News, "[t]he transitions from the hospital to the free-standing surgical center to the office surgical suite continues to escalate." Accordingly, the ambulatory trend in health care creates new geographic sites that may be desirably served by an unburdened anesthesia delivery system.

There are several anesthesia techniques which do not necessarily require the use of vaporized inhalants. Total intravenous infusion anesthesia (TIVA) uses liquid intravenous agents in place of the conventional vaporized inhalants. Along these lines, target controlled infusion (TCI) is a way of administering an intravenous anesthesia agent using a computer to monitor the patient and control an infusion pump. Using a computer with a pharmacokinetic program permits control of a desired plasma concentration of an agent, such as propofol, without overshooting the desired level. Unfortunately, conventional intravenous agents for TIVA or TCI may have relatively long offset times, that is, relatively long times before the anesthesia and other effects wear off in the patient. Some agents may result in active metabolites that additionally remain for a relatively long time after stopping delivery of the anesthesia. Moreover, a quick onset and quick offset analgesia agent has not been previously available. In view of the prior shortcomings of conventional TIVA agents, there has been no incentive to develop efficient integrated platforms for using TIVA or TCI in an ambulatory setting.

PRIOR ART SEARCH US9357965B22016-06-07System and method for guidance of anesthesia, analgesia and amnesia Tobias et al.2002Initial experience with dexmedetomidine in paediatric-aged patients Hemmerling et al.2013Evaluation of a novel closed-loop total intravenous anaesthesia drug delivery system: a randomized controlled trial Alvis et al.1985Computer-assisted Continuous Infusions of Fentanyl during Cardiac Anesthesia Comparison with a Manual Method Wong et al.2011The effect of manipulation of the programmed intermittent bolus time interval and injection volume on total drug use for labor epidural analgesia: a randomized controlled trial Pruszkowski et al.2007Effects of propofol vs sevoflurane on arterial oxygenation during one-lung ventilation Barr et al.1999Nitrous oxide does not alter bispectral index: study with nitrous oxide as sole agent and as an adjunct to iv anaesthesia.

Tackley et al.1989Computer controlled infusion of propofolAU2003243213B22009-01 08Method and appratus to decrease the risk of intraneuronal injection during administration of nerve block anesthesiaDE60209784T22006-11-30INFUSION DEVICE WITH C02 MONITORINGCA2472098C2015-01-06Apparatuses and methods for automatically assessing and monitoring a patient's responsiveness Agarwal2009Comparison of closed loop vs. manual administration of propofol using the Bispectral index in cardiac surgery Borgeat et al.1997Patient-controlled analgesia after major shoulder surgery patient-controlled interscalene analgesia versus patient controlled analgesia US8326545B22012-12-04System and method for displaying a pharmacokinetic and pharmacodynamics drug model AU2004296821B22011-05-12Patient-controlled analgesia with patient monitoring system EP2605698B12020-04-15Central site photo plethysmography, medication administration, and safety AU2005209275B22011-05-26System for adaptive drug delivery US4237925A1977-01-181980-12-09Citizen Watch Co., Ltd. Anesthesia apparatus US4308866A1978-11-021982-01-05University Of Southern California Infusion controlling apparatus and method US4681378A1985-02-041987-07-21Microcomputer Accessories, Inc. Modular cable management system for related electronics equipment US4756706A1985-01-231988-07-12American Hospital Supply Corporation Centrally managed modular infusion pump system EP0401579A11989-06-031990-12-12Riwoplan Medizin- Technische Einrichtunsgesellschaft MbhMobile instrument table US5419316A1991-08-211995-05-30Bernstein; Jerome Anesthesia evaporators

US5466700A *1993-08-301995-11-14Glaxo Wellcome Inc. Anesthetic use of N-phenyl-N (4-piperidinyl)amides US5560352A1993-11-161996-10-OlHewlett-Packard Company Anesthesia protocol system and method of controlling the same US5895371A *1996-08-271999-04-2OSabratek Corporation Medical treatment apparatus and method.

OBJECTIVES OF THE INVENTION 1. The objective of the invention is to a Can be use in those places where there is unavailability of patient monitor or similar products. 2. The other objective of the invention is to the output of sensors (vital parameters) can directly process and display on display unit. Intermediate steps of decoding the received data are eliminated here. 3. The other objective of the invention is to no dependency on third party software (Mirth connect) 4. The other objective of the invention is to propose an improved automatic anaesthesia delivery system which overcomes disadvantages of the prior art. 5. The other objective of the invention is to propose an improved automatic anaesthesia delivery system which controls delivery of anaesthetic agent by closed loop method using BIS as well as inhalational anaesthetic agent concentrations in the lungs. 6. The other objective of the invention is to propose an improved automatic anaesthesia delivery system which is efficient. 7. The other objective of the invention is to propose an improved automatic anaesthesia delivery system which results in reduction of clinical workload and faster response.

SUMMARY OF THE INVENTION

Depth of Anaesthesia (DoA): Depth of Anaesthesia is defined as the drug-induced probability of non-response to stimulation calibrated against the strength of the stimulus and difficulty of suppressing the responses. DoA depends on three main factors: (1) The equilibration of drug's concentration in plasma with concentration of drug at its site of action and with measured drug effect (2) The relationship between drug concentration and drug effect (3) The influence of noxious stimuli

Phases of General Anaesthesia: GA has four phases: Awake phase: This phase is 5-10 minutes before administration of IV anaesthetic agent. At this phase patient is premediated and all the essential monitors are attached to the patient.

Induction phase: The time of administration of IV anaesthetic agents to the absence of response to the verbal stimuli checked by the anaesthesiologist is the Induction phase. Usually, it is 1-5 minutes after the administration of IV anaesthetic agents. During this phase laryngoscopy and intubation are done. Maintenance phase: The period after the insertion of endotracheal tube and administration of inhalation agent till the end of the surgery.

Recovery phase: The period after the cutoff of inhalation agent and administration of reversal agent (Neostigmine and Glycopyrrolate) to till the Return of Consciousness (RoC).

Effect of General Anaesthesia on patient's vital Parameters:

As the anaesthetic drugs affect Central Nervous System (CNS) as well as autonomic nervous system, the autonomic nervous system activity should be evaluated to improve the accuracy of estimation of DoA. The most common way of determining the activity of the autonomic nervous system is that the quantification of the changes in Heart Rate (HR) which is measured from the electrocardiogram (ECG) signal, blood saturation level (Sp02), Pulse Rate (PR) and Mean Arterial Pressure (MAP).

The administration of hypnotic drugs such as propofol causes decrease in BP and minimal change in HR whereas laryngoscopy and intubation cause an immediate increase in HR, PR and BP which last for 5 minutes. Hence, opioid and local anaesthetic drugs are given to bring down the BP, PR and HR which in turn suppress the stress response of Laryngoscopy and Intubation. During the surgical procedure various surgical stimuli such as skin incision, sternotomy, skin closure, opening of peritoneal cavity etc. may lead to increase in HR, PR and BP. The hypnotic drugs have poor analgesic effect whereas opioids have good analgesic property. Inhalation agents and opioid play an important role in the maintenance period of anaesthesia. Inadequate analgesia in the maintenance phase of anaesthesia is reflected by increase in HR more than 90bpm and 15 percent increase in systolic blood pressure from the initial blood pressure of the patient (Baseline BP).

Motivation: Estimation and monitoring of patient's DoA have been changing with the evolution of technology. For decades, depth of anaesthesia was estimated based on patient clinical parameters and reactions like sweating, tearing, and many more. However, the characteristics of these parameters are patient dependent and hence accurate estimation of patient's Depth of Anaesthesia during surgery is a challenging task. One of the most formidable complications of anaesthesia is the awareness of the patient during surgery due to the inadequate doses of anaesthetic drugs. On the other hand, overdose of anaesthetic drugs can cause prolonged recovery from anaesthesia. Accurate estimation of the anaesthetic depth will prevent these complications. The developments in mathematical modelling of biological systems fascinate researchers to study various biological parameters simultaneously. The extracted parameters are used for the estimation of Depth of Anaesthesia. The effect of anaesthetic drugs, the degree of surgical stimuli and pain varies from patient to patient. Also, the use of concomitant analgesic drugs produces different results. The indicators HR, Sp02, PR and BP, MAP reveals the adequacy of analgesic drugs which are the classical parameters used by the anaesthesiologist. Intelligent modelling of these multiple parameters derived from clinical and physiological measures accelerate the accurate estimation of DoA.

Anaesthetic Drugs: When drug is injected into body it gets distributed into body parts. The characteristics of drug absorption, distribution, metabolism and elimination is termed as Pharmacokinetic.To reach the concentration of drug at their site of action, drugs need to pass through the cell membrane. Pharmacokinetic concept includes distribution and clearance of drug. The volume of distribution represents the apparent dilution of a drug from the concentrated form in the syringe to the far more diluted form in the blood and then to that in different organs. Clearance is the process that removes the drug from body by various means such as excretion and sweating. The time required to remove a drug from the body is determined by the ratio of volume to clearance. There are various drugs like ketamine, etomidate and midazolam are administered intravenously to produce sedation or anesthesia. The drug used most often clinically is propofol, because of its beneficial pharmacological profile. 1. Propofol has anti-emetic effect. 2. Propofol provides rapid target achievement and rapid recovery of consciousness. 3. Propofol is available in standard solution worldwide. 4. Propofol provides cerebral protective effect. Therefore, propofol is the anesthetic drug chosen for this study. The anesthetic drug is directly infused into blood. Later, the drug is carried to major organs like heart, lungs, brain and kidneys. At the end, the drug goes to the smaller tissues, ligaments and fat etc. Fuzzy Logic System: Fuzzy logic is a form of many-valued logic; it deals with reasoning that is fixed or approximate rather than fixed and exact. Fuzzy logic variables may have a truth value that ranges in degree between 0 and 1". It is simply a conclusion reached by a rule-based algorithm, "Fuzzy Logic", using linguistic variables that are utilized to form membership functions (MFs) which may or may not have overlapping boundaries. The input to the rule-based may or may not have absolute values such as yes or no, 0 or 1; therefore, the values can be varied between 0 and 1. The algorithm scans all the input/s values and generates output decision reflecting the status of the monitored object/s. i.e., the Fuzzy logic system is a simple, rule-based system that can be used to monitor biological parameters that could be difficult or impossible to model with simple linear mathematics. Fuzzy logic-based algorithms have shown a potential to improve clinician performance by imitating human thought processes in complex circumstances and accurately executing repetitive tasks to which humans are ill suited. There are two types of fuzzy inference system as Type Fuzzy Inference System (T1FIS) and Type2 Fuzzy Inference System (T2FIS). For present system we have implemented T2FIS T2FIS: A fundamental approach of modern science to understand a phenomenon is to characterize it in quantitative terms and to validate it to an acceptable degree of accuracy. Lotfi Zadeh introduced the concept of fuzzy set in 1965. A fuzzy set is characterized by membership function, which assigns to each object a grade of membership between zero and one. Such a fuzzy set is referred to as a Type 1 fuzzy set, which is restricted to the fuzzy subset of a universe of discourse. Some circumstances are so fuzzy that we have trouble in determining the membership grade even as a crisp number in (0,1), we can define this circumstances as fuzzy set of a type 1 fuzzy set. This is called as type 2 fuzzy set. In view of the foregoing background, it is therefore an object of the present invention to provide an apparatus and associated methods for delivering total intravenous anesthesia to a patient, such as in an ambulatory setting. The present invention is provided by an apparatus for total intravenous anesthesia which comprises at least one supply and delivery means for an intravenous anesthesia agent carried by the apparatus housing, and at least one monitor for monitoring a characteristic of the patient. Moreover, the at least one intravenous anesthesia agent preferably includes a first intravenous anesthesia agent having a relatively quick offset so that the effects thereof wear off relatively quickly upon stopping the intravenous infusion. Intravenous infusion of the at least one anesthetic agent results in total intravenous anesthesia in the patient and without using an inhaled anesthesia agent.

For monitoring the patient, the apparatus preferably includes one or more monitors carried by the apparatus housing for monitoring patient characteristics. The monitors may include one or more of an electrocardiogram, a blood oxygen monitor, a blood carbon dioxide monitor, an inspiration oxygen monitor, an expiration oxygen monitor, an inspiration carbon dioxide monitor, an expiration carbon dioxide monitor, a blood pressure monitor, a pulse rate monitor, a respiration rate monitor, and a patient temperature monitor, for example. Any of these monitors, or combinations of monitors may be included in the relatively compact housing of the apparatus. In addition, the apparatus may also include at least one recorder cooperating with the monitors to provide a record of a respective monitored patient characteristics.

Also relating in part to monitoring, the apparatus may also preferably include telecommunication means carried by the housing to be available for providing a telemetry and/or voice communications channel to another site. The telecommunications means may include a wireless transceiver, such as a transceiver for cellular telephone communications. The apparatus also preferably includes a back-up battery power supply carried by the housing so that the apparatus is operable in the event of a power outage. The housing also desirably has an upper surface defining a horizontal work surface. In addition, wheels or castors may be provided on the housing of the apparatus to increase its portability. A storage cabinet may also be associated with the housing of the apparatus for storing consumables used for total intravenous anesthesia.

Returning again to the first anesthesia agent, the first relatively quick offset anesthesia agent is preferably a quick onset and quick offset analgesia agent. The relatively quick offset is preferably defined by a relatively short biological half-life not greater than about minutes. For example, the first intravenous anesthesia agent may comprise an esterase metabolized opioid, such as remifentanil. A second supply of a second intravenous anesthesia agent carried by the housing may also be included. The second supply may be another anesthesia agent, such as the amnestic propofol, for example. A method aspect of the invention is for administering total intravenous anesthesia to a patient. The method preferably comprises the step of providing a housing carrying at least one supply of an intravenous anesthesia agent, at least one infusion pump for delivering the intravenous anesthesia agent, and at least one patient characteristic monitor. The method also preferably includes the step of controllably intravenously delivering the intravenous anesthesia agent to the patient from the supply carried by the housing and using the infusion pump also carried by the housing so that total intravenous anesthesia is achieved in the patient.

Moreover, the at least one intravenous anesthesia agent is preferably provided by a first intravenous analgesic having a relatively quick offset so that effects wear off relatively quickly upon stopping intravenous infusion. The method also preferably includes the step of monitoring at least one patient characteristic using the associated patient characteristic monitor carried by the housing during administration of total intravenous anesthesia. For example, the step of monitoring may include monitoring one or more of the patient's heart activity, blood oxygen level, carbon dioxide blood level, blood pressure, pulse rate, respiration rate and temperature. The method may also include the step of providing the housing including a telecommunications transceiver. Accordingly, the method may further include the step of using the telecommunications transceiver for providing at least one of telemetry and voice communications during administration of total intravenous anesthesia.

BRIEF DESCRIPTION OF THE DIAGRAM Figure. Process of General Anaesthesia Figure. 2-A. The Open Systems Interconnection (OSI) model of HL7 FIG. 2 is a schematic block diagram illustrating portions of the apparatus (Prior art) Fig.3: Structure Fig4: Arduino Fig.5: Processor Fig. 6: Interface Fig.7: Flow Chart Fig.8: track DESCRIPTION OF THE INVENTION

The process of GA is presented in Figurel. The three main components that an anaesthesiologist has to suppress through anaesthetic drugs are consciousness, sensitivity to pain and patient movement. Anaesthesiologist uses Intravenous (IV) anaesthetic drugs for suppressing consciousness and would induce a state of unconsciousness called Amnesia (Hypnosis). Opioid drugs were used by the anaesthesiologist to suppress the pain and would lead to a state of insensitivity to pain called Analgesia. The muscle relaxant drugs were provided to prevent patient's movement and would result in a state of muscle relaxation called Akinesia. The combination of hypnotic, analgesic and muscle relaxation drugs is referred as 'triad of anaesthesia'. The standard dose of these drugs is calculated based on the patient's vital parameters like heart rate, blood pressure, oxygen saturation level in blood, body weight and age. Dose ratio can be modified according to the relative importance of each component depending on the surgical and patient factors like previous history, the physical condition of the patient, complexity of the surgery. Health Level Seven (HL7):Health Level Seven or HL7 refers to a set of international standards for transfer of clinical and administrative data between software applications used by various healthcare providers. These standards focus on the application layer, which is "layer 7". The HL7 standards are produced by Health Level Seven International, an international standards organization, and are adopted by other standards issuing bodies such as American National Standards Institute and International Organization for Standardization. Hospitals and other healthcare provider organizations typically have many different computer systems used for everything from billing records to patient tracking. All of these systems should communicate with each other (or "interface") when they receive new information, or when they wish to retrieve information, but not all do so. HL7 International specifies a number of flexible standards, guidelines, and methodologies by which various healthcare systems can communicate with each other. Such guidelines or data standards are a set of rules that allow information to be shared and processed in a uniform and consistent manner. These data standards are meant to allow healthcare organizations to easily share clinical information.

1. The physical layer deals with data at a bit level. 2. The data link layer breaks input data into data frames and the receiver returns acknowledgement frames. 3. The network layer controls the transmission of packets of data, including routing and control of traffic congestion. 4. The transport layer manages data from the session layer, if necessary splitting it into smaller sections. 5. The session layer allows machines to communicate, this includes synchronization of activity. 6. The presentation layer manages the syntax and semantics of information, this may also include data compression and encryption. 7. The application layer defines file structure and transfer, and manages compatibility between different systems.

FIG. 2, the second or anesthesia platform 12 is now described in greater detail. The anesthesia platform 12 includes a generally rectangular housing 22, which is also illustratively mounted on wheels or castors 18 for portability. The upper portion of the housing 22 also defines a usable work surface. An intravenous (IV) bag support 30 illustratively carries two IV supplies in the form of bags 25, 27. The IV bag support 30 may be telescoping, collapsible or otherwise removable to further facilitate portability of the anesthesia platform 12.The first IV bag 25 carries a first anesthesia agent 26, and the second bag 27 carries the corresponding second agent 28. In addition, the flow of the first and second intravenous anesthesia agents 26, 28 is controlled in the illustrated embodiment by corresponding first and second infusion pumps 31, 32. The pumps include controls 33, such as for setting flow rates, as well as indicators 34 of the volume delivered, which are schematically illustrated in FIG. 2. Other intravenous delivery means are also contemplated by the present invention, as would be readily understood by those skilled in the art. For example, infusion pumps 31, 33 may not be needed in other embodiments of the invention.

One aspect of the present invention is based upon the recent development of a quick acting and quick offset analgesic agent, remifentanil, by Glaxo Wellcome. More particularly, remifentanil is an ultra-short acting analgesic with a relatively short biological half-life of about 6 to 10 minutes. Remifentanil is an esterase metabolized opioid which leaves no active metabolites. The extremely rapid achievement of the peak effect for any dose makes it relatively easy to recognize the dose-effect relationship and facilitates titration of dose versus effect, allowing rapid control of responses to noxious or painful stimuli. Accordingly, in one embodiment of the invention the first anesthesia agent 26 delivered by the anesthesia platform 12 is remifentanil hydrochloride. Other similar quick offset agents may also be developed and used as would be readily understood by those skilled in the art.

For total intravenous anesthesia using remifentanil as the first agent 26, it may also be preferred to include a second anesthesia agent 28. In particular, Zeneca's propofol may be used as the second agent 28, and which is generally considered to be an ultra-short acting amnestic. Propofol may sometimes be considered as at least partially a hypnotic or sedative agent as would be readily understood by those skilled in the art. Propofol, like remifentanil, also leaves virtually no active metabolites. Another suitable amnestic anesthesia agent may be midazolam, for example, as would also be readily understood by those skilled in the art.In other embodiments, the second intravenous anesthesia agent 28 may be at least one of an amnesia, analgesia, muscle relaxation and sedation agent. The second intravenous anesthesia agent 28 may preferably induce and maintain general anesthesia as does propofol, for example. In yet another embodiment, the second intravenous anesthesia agent may be the same as the first intravenous anesthesia agent to thereby provide a back-up to the first supply 25 and the first infusion pump 31. Of course, other intravenous anesthesia agents may also be used in conjunction with the first and second agents described above, and as would be readily understood by those skilled in the art.

It is recognized by the invention that the combination of the currently available agents, remifentanil and propofol, or like agents with rapid half-lives and virtually no active metabolites, facilitate total intravenous anesthesia in the out-patient setting. Cost effectiveness may also be realized by decreasing recovery room times which may be further realized and potentially beneficial in outcome based medicine.To effectively deliver the anesthesia as described above and also meet typical regulatory and medical guidelines, adequate patient monitoring is also desired. Accordingly, the anesthesia platform 12 also includes monitors for monitoring patient characteristics. In addition, since it may also be desirable to record the monitored characteristics, the illustrated embodiment includes schematically illustrated monitors/recorders 40 for patient characteristics. More particularly, as shown in FIG. 2, the monitors/recorders 40 may include: an electrocardiogram (EKG) 41; an oxygen monitor 42 for one or more of blood oxygen level, an inspired oxygen level, and an expired oxygen level; a carbon dioxide monitor 43 for one or more of blood carbon dioxide level, an inspired carbon dioxide level, and an expired carbon dioxide level; a blood pressure monitor 44, a pulse rate monitor 45, a respiration rate monitor 46, a patient temperature monitor 46, and one or more other monitors 47 as would be readily understood by those skilled in the art.

As would also be understood by those skilled in the art, the various monitors/recorders 40 may be any of several types commercially offered by a number of medical device manufacturers and distributors. Of note, the monitors/recorders 40 are desirably relatively compact to permit the overall anesthesia platform 12 to also be relatively compact. The monitors/recorders 40 may also desirably be modular to facilitate replacement and repair. Multiple component monitors from various manufacturers can be modified, packaged, and compartmentalized into the single, stand-alone anesthesia platform 12 as illustrated. Also somewhat relating to monitoring of the patient, the anesthesia platform 12 may also include telecommunications means for providing one or both of a telemetry channel or a voice communications channel to a remote location. In the illustrated embodiment, a cellular telephone 60 may provide one or both of telemetry and telephone functions via the cellular telephone network as would be readily understood by those skilled in the art. The cellular telephone 60 may be beneficial in that it allows the anesthesia platform 12 to be positioned and relocated without concern for hardwired connections to the telephone network, yet the telephone or telemetry capability is readily available along with the other devices carried by the platform.

The illustrated anesthesia platform 12 also includes other devices and/or systems conveniently packaged within or carried by the overall housing 22. Moreover, these devices may provide highly desirable care during total intravenous anesthesia. In other words, these devices may provide basics for care and, in particular, may provide the basics for short term resuscitation of the patient. For example, the anesthesia platform 12 carries an oxygen cylinder 50, as oxygen may typically be used during the anesthesia. The oxygen may be made available for delivery to the patient via a control panel 51 including one or more gages 52, control valves 53, and outlet ports 54, as schematically illustrated in FIG. 2. Alternately or in addition to the oxygen cylinder 50, oxygen may be generated and supplied via the control panel 51 by a conventional oxygen generator 55 as would be readily understood by those skilled in the art.

The anesthesia platform 12 may also preferably carry a ventilator pump and circuits 57 operable via the schematically illustrated controls 58 and deliver ventilation through the schematically illustrated outlet port 59. Of course, the ventilator is also illustratively connected to the oxygen supply as would be readily understood by those skilled in the art. For other procedures as would be appreciated by those skilled in the art, the platform 12 also carries a defibrillator 65 and a suction pump 70. The defibrillator 65 also includes paddles or electrodes 66 to be applied to the patient as would also be readily understood by those skilled in the art. The suction pump 70 makes suction available via the illustrated port 71.Yet another aspect of the anesthesia platform 12 is that it can be self-powered, such as during a utility system power outage. Accordingly, the platform 12 includes the schematically illustrated power supply 75 which may include controls, auxiliary power outlets, and also rechargeable back-up batteries as would be readily understood by those skilled in the art. The various other electrically powered devices may be fed power from the power supply via the illustrated power bus 76.

Those of skill in the art will recognize that the anesthesia platform 12 may include yet other monitoring and devices for performing short term resuscitation or other procedures. In addition, one or more storage compartments may be provided in the housing 22. The anesthesia platform 12 contains those items for delivering total intravenous anesthesia, including support drugs, and equipment organized in a methodical, ergonomically and reproducible fashion. Field support for the storage platform 11 and anesthesia platform 12 of the illustrated apparatus 10 may be through the creation of an organization and system to provide maintenance, resupply, reserialization, service, and associated documents as would be readily understood by those skilled in the art. The invention may be used in many applications, particularly for ambulatory surgery, such as, for example, for cosmetic surgery, dermatology, dentistry and podiatry. Associated applications may likely include critical care services in transport, military applications, MRI, and commercial airlines. Accordingly, many modifications and other embodiments of the invention will come to the mind of one skilled in the art having the benefit of the teachings presented in the foregoing descriptions and the associated drawings. Therefore, it is to be understood that the invention is not to be limited to the specific embodiments disclosed, and that modifications and embodiments are intended to be included within the scope of the appended claims.

Feature Extraction: A feature is a functional component extracted from a signal or from a set of data that represent the characteristics of data/signal without losing significant information embedded in the data. The variations in vital parameters of patient may be seen due to the effects of anaesthetic drugs. The effect may be reflected as amplitude and frequency variations. Feature extracted vital parameters depicts these amplitude and frequency variations and thus the hypnotic state of the patient. Therefore, features extracted from all vital parameters of patients are necessary for the accurate estimation of DoA.

Feature extraction from vital parameters: The introduction of vital parameters in the estimation of DoA helps to provide information about changes in clinical parameters which are necessary for anaesthesia decision-making. An increase in HR, PR, BP or SpO2 is an indicator of increased sympathetic activity and parasympathetic activity. The sympathetic activity of the body is the intense physical activity and is usually called fight or-flight response. The parasympathetic activity is the opposite effect i.e. it relaxes the body and inhibits or slows many high energy functions. Therefore, feature extraction from these hemodynamic variables is more appropriate to study the analgesic state of the patient. The features extracted from the parameter are Change in Heart RAtIS), Change in Mean Blood Pressure4MBP) and Pulse Pressure (PP).The feature extracted from HR is AHR and is calculated using the equation AHR = (HR at the moment/baseline HR baseline HR) x 100 The features extracted from BP signals arA Mean Arterial Pressure (AMAP) which are calculated using the equations MAP = ((SBP + 2) x DBP)/ 3 AMAP = (MAP at the moment - baseline MAP baseline MBP) x 100 Where baseline HR and baseline MBP are the average of HR and MBP collected from each patient before inducing the anaesthetic drugs. General Purpose Input Output (GPIO):Raspberry Pi has two rows of pins on one side of it. These pins are called GPIO connector. The GPIO connector allows attachment of electronic hardware to the Raspberry Pi. It is an alternative option for a USB port. The pins which are labeled as GPIO can all be used as general-purpose input/output pins. It means that they can be defined to be either an input or an output pin. The pins are listed from top left corner, so that odd numbers are at the left side and even numbers are at the right side. Some of the GPIO connector's pins have extra labels after the pin name. They are markings for special features. For instance, GPIO2 and 3, have the labels of SDA and SCL. These pins are data and clock lines for a serial bus type. This serial bus type is called 12C and it is popular for communicating with peripherals such as sensors.

When using the GPIOas an input there are two states, it can be either "1" or "0".These states are described as voltage levels. The voltages which are above the 1.7V gives the first state "1" and the voltages below 1.7V gives the second state "0".For instance, if the GPIOgets the voltage of 1.65V it's input state would be "0".

Instead if the GPIO pin is defined to be an output there are also two states. These states are logical 1 and 0. When the GPIO pin is at the logical state 1, it means that the voltage level is then 3.3V. The logical state 0 is describing the voltage level ofOV. All the GPIO pins are 3.3V pins and connecting them to higher voltage could damage Raspberry Pi. The maximum current from any of the GPIO pin is 16mA. This means that the pins can be used for controlling only small devices or lights which consumes low current.

Programming languages: There are considerable numbers of programming languages which have been adapted for Raspberry Pi. Python programming language is recommended by The Raspberry Pi foundation. Basically, any programming language which can be compiled for ARMv6 can run on the Raspberry Pi. On the Raspberry Pi there are preinstalled several languages for example C, C++, Java, Scratch and Ruby. Arduino Uno is a microcontroller board based on 8-bit ATmega328P microcontroller. Along with ATmega328P, it consists other components such as crystal oscillator, serial communication, voltage regulator, etc. to support the microcontroller. Arduino Uno has 14 digital input/output pins (out of which 6 can be used as PWM outputs), 6 analog input pins, a USB connection, A Power barrel jack, an ICSP header and a reset button.

The 14 digital input/output pins can be used as input or output pins by using pinMode() digital Read () and digital Write () functions in Arduino programming. Each pin operates at 5V and can provide or receive a maximum of 40mA current, and has an internal pull-up resistor of 20-50 KOhms which are disconnected by default. Out of these 14 pins, some pins have specific functions as listed below: Serial Pins 0 (Rx) and 1 (Tx): Rx and Tx pins are used to receive and transmit TTL serial data. They are connected with the corresponding ATmega328P USB to TTL serial chip. External InterruptPins 2 and 3: These pins can be configured to trigger an interrupt on a low value, a rising or falling edge, or a change in value. PWM Pins 3, 5, 6, 9 and 11: These pins provide an 8-bit PWM output by using analog Write () function. SPI Pins 10 (SS), 11 (MOSI), 12 (MISO) and 13 (SCK): These pins are used for SPI communication. In-built LED Pin 13: This pin is connected with an built-in LED, when pin 13 is HIGH LED is on and when pin 13 is LOW, its off. (j9Backlight Power switch: Controls the backlight turned on and off to save power. ®®USB Touch / power supply connector: For power supply and touch output, the functions of the both are the same, can just use one of them. ®HDMI interface: For connecting motherboard and LCD monitor to HDMI transmission.

Input system: For proposed system, the input is taken from patient monitoring device. It is an external entity for built system. In normal scenarios, multi-parameter monitors are connected to patient and then it measures and analyses various vital parameters of patient. These parameters are Mean Arterial Pressure (MPA), Heart Rate (HR), Pulse Rate (PR) and Blood Oxygen Saturation Level (Sp02).The data of these vital parameters are sent to local system to ethernet connection through Mirth connector. The received data is in HL7 format i.e. encrypted format so for further analysis we converted into normal readable format. For current study we have considered multi-parameter monitors of Nihon-Kohen

Data processing system: This is one of the important and core parts of our system. This system consisting of controlling system. The controlling is done by Raspberry Pi 3B+ and Arduino Uno works as supportive controller. 7-inch display screen has been implemented for better experience of graphical user interface. The data which transferred from patient monitor is processed into Raspberry Pi 3B+ controller. The Raspberry Pi 3B+ and Arduino Uno are interfaced with each other so that they communicate with each other. The communication taking place between Raspberry Pi 3B+ and Arduino Uno is bidirectional. Here bidirectional means Raspberry Pi 3B+ can transfer the data to Arduino Uno and at the same time Arduino Uno can also transfer the data to Raspberry Pi 3B+.

Output system: In the proposed system, the syringe pump is considered as an output system. The stepper motor present inside the syringe pump is controlled entity and it is controlled by the stepper motor driver and microcontroller. Syringe pump allows precise delivery of drug into patient body.

Software setup:Arduino and Raspberry Pi 31+ software setup

Download and install Arduino IDE.

When connecting the Arduino with a USB cable, it appears as/dev/ttyACMO, or /dev/ttyUSBO (sometimes the number can be different, for example/dev/ttyACM1).

Connect Raspberry Pi to a screen, mouse, keyboard, and open a terminal.

Run ls /dev/tty* on terminal. After running the command, you will find a list of commands. We need to select the command that connects Raspberry Pi to Arduino. At this point if not sure which device is the Arduino board, simply disconnect the board (remove the USB cable) and run is /dev/tty* again. This will easily spot the serial device name of Arduino.

Install Python Serial library on Raspberry Pi 3B+Need to install a library to be able to use the Serial interface with Python. We have used pSeries library for this purpose. To install it use python -m pip install pyserial command on terminal.Once all steps are done then we need to run the required code snippet.

Interfacing A4988 motor driver and Arduino Uno: One of the major parts of the data processing system is to drive the motor by motor driver and Arduino Uno in controlled manner. Here we have implemented A4988 motor driver with CNC motor driver shield. The CNC motor driver shield is directly connected to Arduino Uno. This CNC motor driver shield is connected to A4988 motor driver. This motor driver is connected to heatsink to avoid excessive heating. describes the working flow diagram of proposed system. The initial part of system consists of collecting data of vital parameters of patient and that is done by patient monitors. Once the data is received on local system, the appropriate protocol is used to decode the data. Required data is then extracted from the received data. Fuzzy rule base system has been implemented on received data and appropriate dosage of drug is selected. If user/doctor wants to interrupt the decision taken by automated system (due to some conflict in drug dosage suggestion) then user/doctor needs switch to manual mode.

The system will generate a pop-up message to ensure that manual mode is not selected accidently. User/doctor can then select the appropriate drug dosage and then come out of manual mode and continue using automated mode. If the decision taken by the system is correct and user/doctor agrees with drug dosage suggested by the system, then user/doctor will connect the drug loaded syringe to syringe pump and will press OK. After pressing Ok, signals are passed to Arduino Uno board that activates the A4988 motor driver and then pulses are feed to motor. Motor starts moving in clockwise direction and inject drug into patient body.

Medical Data Acquisition: Data acquisition for this study was done from multipara meter patient monitoring device. In any routine surgery, patient monitor is used to visualize and analyse patient vital parameters like HR, BP, MAP, PR, Sp02. The current system extracts the data from patient monitors and not implementing external sensor to sense vital parameters. As there are no external sensors are connected to patient body, we make sure there is no harm to patient. The data of patient parameters is already pre processed as we are using it directly from patient monitors. To maintain patient authenticity, the received data is in encrypted format of Health Level Seven (HL7) format. The specific protocol is required to decode the data.

Example of Level Seven (HL7):

MSH|A~-\&IFDHL7|JOHNSON LABSIIP1055|201007231634||ORUAR01IP1055 0000047907|P2.3|1||NEINE PIDI1IJQ4988|108512373|ISAMPL ESAJUNIORI|01/10/1948A53 YMIIIA******AAI^|||||

ADDINON FASTING OBR|1111085123731CHEMA---* CHEMISTRY 11201007221041111111112010072223121|P1055ASCI DULUTH/PHSARTE 29,PO BOX 244ADULUTH, MN 19426A(945)443-1234|RECEPTION, NEWI11120100723163411RII OBX1|NMI0135-4ATotalProtein|17.3|gm/dlI5.9-8.4||IF OBX|2|NMI0033-1AAlbumin|13.9|gm/dlI3.2-5.21||IF OBX13|NMI1753-3AGlobulin||3.4|gm/dLI1.7-3.7111IF OBX14|NMI0641-1AA/G Ratiol11.1111.1-2.9111IF OBXI5INMI1976-0AGlucose||296|mg/dLI70-99HIIIIF OBX16|NMI0148-7ASodiumI134|mmol/L|133-145111IF OBX17|NMI0129-7APotassium||4.3|mmol/LI3.3-5.3IIIF OBX18|NMI0057-0AChloride|l96|mmol/L196-1081||IF OBX|9|NMI0052-1AC02||24|mmol/L121-291IIIF OBX110|NMI0049-7ABUNI17|mg/dlI7-25IIIF OBX11|NMI0070-3ACreatininel1.1|mg/dlI0.6-1.3IIIF OBX112|NMI090013-4Ae-GFRI17011>60 mL/min/1.73m2IIIF OBX113|NMI1427-4ABUN/CreatRatio|115.51110-28111IF OBX114|NM10050-5ACalcium|18.9|mg/dlI8.4-10.4I|IIF OBX115|NMI0157-8AUricAcid||6.2|mg/dlI2.4-7.0IIIF OBXI16INMI0114-9AIron||87|mcg/dlI30-160IIIF OBX171NMI0043-0ABilirubin,Total10.6|mg/dI0.1-1.01|||F OBX118|NMI0117-2ALDHII190|u/1194-2501IIIF OBX119|NMI0185-9AAlkPhos|163|u/ll39-1201||IF

OBX|20|NMI0146-1AAST (SGOT)133|u/l0-37|||F OBX|21|NMI0127-1APhosphorous|12.8|mg/dl12.6-4.51|||F OBX|22INMI0147-9AALT (SGPT)||55|u/LIO-40|HII|IF OBX|23INMI0093-5AhG-GTP|133|u/L17-511||F

Software for extracting HL7 data

Mirth Connect: Mirth is middleware that connects health information systems so they can exchange clinical and administrative data. Mirth is released under the Mozilla Public License v1.1 and is professionally supported by Web Reach, a Health information technology (IT) solutions company based in California. In any healthcare industry, some systems might actively use HL7 or DICOM images, while others simply have a database to read from or communicate with XML and comma separated values. Add to that the lack of control administrators have over current and legacy applications, and the healthcare interoperability problem becomes apparent. This is where Mirth steps in as the easy to use and deploy middleware solution. Mirth can lie between any number of health information systems, whether they speak a standard healthcare language or not, and help them communicate. Mirth is a flexible health IT infrastructure component and can serve many roles. It can provide central integration exchange at a hospital, an information gateway for a clinic or reference lab, or an information exchange for a Health Information Exchange (HIE) or Local Health Integration Network (LHIN). It can also act as the integrated interface engine for an electronic health record (EHR) or as an extract, transform, and load (ETL) tool.

Claims (9)

WE CLAIM

1. Our invention "Fuzzy Logic Based Automatic Intravenous Anesthesia Delivery and Monitoring System" is a improved automatic anaesthesia delivery , monitoring system comprising: (a) at least one of a bispectral index monitor and an anaesthesia vital sign monitor interfaced with a computer to receive input from patient; (b) at least one pump for controlling delivery of drug based on the feedback from patient; (c) said computer having specific software for controlling said pump(s) and for fine tuning the dosage based on patient's response and requirements. The invention is also a apparatus for total intravenous anesthesia includes at least one supply and infusion pump for an intravenous anesthesia agent carried by the apparatus housing and at least one monitor for monitoring the characteristics of the patient during the total intravenous anesthesia. The invention also includes the at least one intravenous anesthesia agent preferably includes a first intravenous anesthesia agent, and more preferably, an analgesic, having a relatively quick offset so that the effects wears off relatively quickly upon stopping intravenous infusion. At the time of monitoring the patient the apparatus preferably includes at least one of an electrocardiogram: 1: blood oxygen monitor 2: blood carbon dioxide monitors 3: inspiration/expiration oxygen 4: inspiration/expiration carbon dioxide 5 blood pressure monitor 6: pulse rate monitor 7: respiration rate monitor 8: patient temperature monitor. Example: The first intravenous anesthesia agent may be an esterase metabolized opioid, such as remifentanil. A second supply of a second intravenous anesthesia agent carried by the housing may also be included and the second supply may be another anesthesia agent, such as propofol etc.

2. According to claims# the invention is to a improved automatic anaesthesia delivery, monitoring system comprising: (a) at least one of a bispectral index monitor and an anaesthesia vital sign monitor interfaced with a computer to receive input from patient; (b) at least one pump for controlling delivery of drug based on the feedback from patient; (c) said computer having specific software for controlling said pump(s) and for fine tuning the dosage based on patient's response and requirements.

3. According to claim,2# the invention is to a apparatus for total intravenous anesthesia includes at least one supply and infusion pump for an intravenous anesthesia agent carried by the apparatus housing and at least one monitor for monitoring the characteristics of the patient during the total intravenous anesthesia.

4. According to claim,2,3# the invention is to a intravenous anesthesia agent preferably includes a first intravenous anesthesia agent, and more preferably, an analgesic, having a relatively quick offset so that the effects wears off relatively quickly upon stopping intravenous infusion.

5. According to claim,2# the invention is to a apparatus preferably includes at least one of an electrocardiogra: 1: blood oxygen monitor 2: blood carbon dioxide monitors 3: inspiration/expiration oxygen 4: inspiration/expiration carbon dioxide 5 blood pressure monitor 6: pulse rate monitor 7: respiration rate monitor 8: patient temperature monitor.

6. According to claim,2,5# the invention is to a first intravenous anesthesia agent may be an esterase metabolized opioid, such as remifentanil and a second supply of a second intravenous anesthesia agent carried by the housing may also be included and the second supply may be another anesthesia agent, such as propofol etc.

7. According to claim,2,5,6# the invention is to a Can be use in those places where there is unavailability of patient monitor or similar products.

8. According to claim,2,5,7# the invention is to the output of sensors (vital parameters) can directly process and display on display unit. Intermediate steps of decoding the received data are eliminated here.

9. According to claiml,2,5,6# the invention is to a no dependency on third party software (Mirth connect)

FIGURE1. PROCESS OF GENERAL ANAESTHESIA

FIGURE. 2-A. THE OPEN SYSTEMS INTERCONNECTION (OSI) MODEL OF HL7

FIG. 2 IS A SCHEMATIC BLOCK DIAGRAM ILLUSTRATING PORTIONS OF THE APPARATUS (PRIOR ART)

FIG.3: STRUCTURE

FIG4: ARDUINO

FIG.5: PROCESSOR

FIG. 6: INTERFACE

FIG.7: FLOW CHART

FIG.8: TRACK