AUTOMATION IN ANAESTHESIOLOGY : CLOSED LOOP ANAESTHESIA
DELIVERY SYSTEMS (CLADS), A STEP TOWARDS THE FUTURE.
Dr.Freddie Flavian Cruz, Dr. Manoj Kamal, Dr. Anita Chouhan, Dr.Goverdhan Dutt Puri
Department of Anaesthesiology and Critical Care, AIIMS Jodhpur
INTRODUCTION
METHODOLGY
In the modern era of automation, robotics and artificial intelligence Closed
Loop Anesthesia Delivery Systems (CLADS) has proved itself as a novel
device [1] The trust, acceptance and proven safe technology made it
acceptable and a safe way to deliver anaesthesia in a personalized manner
[2] To further validate the statement, a series of 5 cases with different
patient profiles, disease pathology and operating scenarios have been
discussed .
• All patients received general anaesthesia using the CLADS system. Monitor
including in built BIS of the machine were attached , from which feedback was
received.
• Target BIS value was kept at 40 and Hemodynamic cutoffs based on patient
baseline values, Propofol and fentanyl infusions were administered via widebore peripheral cannula, Mode used was "Induction and Maintenance" mode.
• Standard induction protocol was followed and patient induced according to
surgical requirement. Drug delivery from induction to maintenance was
titrated automatically based on BIS values and hemodynamic parameters.
• Infusions were stopped 15-30 mins prior to Extubation.
RESULTS
Table 1: Patient Demographics and Intraoperative Parameters
Cases
Surgery
Image 1: CLADs Machine (Clarity)
Time to Induction Time to
VAS
Extubation
Closed L2 Wedge
Mod. Aldrete
Score
Pedicle Screw Fixation at L2
7 Min
3 Min
2
10
Lap Pylorus Resecting
5 Min
12 Min
1
10
4 Min
10 Min
1
10
Compression fracture
with Right Closed Distal
Femur Fracture
Distal
Cholangiocarcinoma s/p Pancreaticoduodenectomy
ERCP Stenting/60/F
Voluntary Live Renal
Laparoscopic Donor
Transplant Donor/44/F
Nephrectomy
Appendicitis /14/M
Laparoscopic Appendectomy
3 Min
9 Min
0
10
Deviated Nasal
Septoplasty
5 Min
13 Min
2
10
Septum/19/M
DISCUSSION
The modern operating theatre is no longer confined to the hands of human expertise alone. With the arrival of Closed-Loop Anaesthesia Delivery Systems
(CLADS), we are witnessing a fusion between technology and medicine—a partnership where algorithms assist the anaesthesiologist in navigating each
patient’s physiology.
What makes CLADS stand out is:
•Adaptability across a wide spectrum of patients and surgical contexts.
•Remarkable consistency through continuous interpretation of BIS feedback and hemodynamic signals to adjust anaesthetic dosage.
•Personalization, offering each patient a tailor-made anaesthetic plan that dynamically adjusts second-by-second based on individual physiology.
•Reduced variability, by eliminating fluctuations often seen with manual titration.
•Contribution to Green Anaesthesia, by avoiding volatile anaesthetic agents.
•Reduction in postoperative cognitive dysfunction (POCD) and PONV, particularly in high-risk or elderly patients.
•Cognitive unloading for anaesthesiologists, allowing them to focus on critical decision-making.
A systematic review and meta-analysis on the clinical performance and safety of closed-loop systems demonstrated that these automated systems result in
better control of target parameters within a defined range [3]. Furthermore, a randomized controlled trial evaluating quality of recovery showed that CLADS,
when used to deliver desflurane in robotic surgeries, was superior to conventional general anaesthesia [4]. These findings bolster confidence in CLADS as a
reliable, safe, and intelligent alternative.
CONCLUSION
These five clinical cases reaffirm the reliability, safety, and innovation of
CLADS. With its evolution into an intelligent, responsive, and increasingly
autonomous system, one can envision a future where anaesthetic care
becomes a seamless collaboration between human expertise and machine
precision.
Therfore this demonstrates that CLADS is a reliable and adaptable system
suitable for diverse surgical procedures and patient populations. Its ability to
maintain anaesthetic depth, minimize postoperative pain, and ensure quick
recovery suggests its valuable role in modern anaesthesia practice.
RESEARCH POSTER PRESENTATION DESIGN © 2022
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