Control of muscle relaxation during anesthesia: a novel approach for clinical routine

During general anesthesia drugs are administered to provide hypnosis, ensure analgesia, and skeletal muscle relaxation. In this paper, the main components of a newly developed controller for skeletal muscle relaxation are described. Muscle relaxation is controlled by administration of neuromuscular blocking agents. The degree of relaxation is assessed by supramaximal train-of-four stimulation of the ulnar nerve and measuring the electromyogram response of the adductor pollicis muscle. For closed-loop control purposes, a physiologically based pharmacokinetic and pharmacodynamic model of the neuromuscular blocking agent mivacurium is derived. The model is used to design an observer-based state feedback controller. Contrary to similar automatic systems described in the literature this controller makes use of two different measures obtained in the train-of-four measurement to maintain the desired level of relaxation. The controller is validated in a clinical study comparing the performance of the controller to the performance of the anesthesiologist. As presented, the controller was able to maintain a preselected degree of muscle relaxation with excellent precision while minimizing drug administration. The controller performed at least equally well as the anesthesiologist.

Neurally adjusted ventilatory assist in patients with critical illness-associated polyneuromyopathy

Diaphragmatic electrical activity (EA(di)), reflecting respiratory drive, and its feedback control might be impaired in critical illness-associated polyneuromyopathy (CIPM). We aimed to evaluate whether titration and prolonged application of neurally adjusted ventilatory assist (NAVA), which delivers pressure (P (aw)) in proportion to EA(di), is feasible in CIPM patients.

A robust reference signal generator for synchronized ventricular assist devices

Ventricular assist devices (VADs) are blood pumps that offer an option to support the circulation of patients with severe heart failure. Since a failing heart has a remaining pump function, its interaction with the VAD influences the hemodynamics. Ideally, the heart's action is taken into account for actuating the device such that the device is synchronized to the natural cardiac cycle. To realize this in practice, a reliable real-time algorithm for the automatic synchronization of the VAD to the heart rate is required. This paper defines the tasks such an algorithm needs to fulfill: the automatic detection of irregular heart beats and the feedback control of the phase shift between the systolic phases of the heart and the assist device. We demonstrate a possible solution to these problems and analyze its performance in two steps. First, the algorithm is tested using the MIT-BIH arrhythmia database. Second, the algorithm is implemented in a controller for a pulsatile and a continuous-flow VAD. These devices are connected to a hybrid mock circulation where three test scenarios are evaluated. The proposed algorithm ensures a reliable synchronization of the VAD to the heart cycle, while being insensitive to irregularities in the heart rate.

Momentan verfügbare Selbstkontrollkraft: Vorstellung eines Messinstruments und erste Befunde aus pädagogisch-psychologischen Kontexten

Selbstkontrolle spielt in pädagogischen Kontexten oft eine entscheidende Rolle, beispielsweise wenn Lernende attraktiven Handlungsalternativen widerstehen müssen. Etliche Studien zeigen, dass die erfolgreiche Ausübung von Selbstkontrolle von der momentanen Verfügbarkeit an Selbstkontrollkraft abhängt. Zur Erfassung der momentanen Selbstkontrollkraft in deutschsprachigen Stichproben, wurde die State Self-Control Capacity Scale ins Deutsche adaptiert. In der vorliegenden Arbeit wird über fünf Teilstudien berichtet, in denen die psychometrische Güte dieser Skala überprüft wurde. Über alle Studien hinweg erwies sich die eindimensionale Skala als sehr reliabel (Cronbachs Alphas ≥ .93). Bezüglich ihrer Validität zeigten sich erwartete Zusammenhänge mit Validitätskriterien (z. B. Angst, Stress, am gegenwärtigen Tag bereits in Lehrveranstaltungen verbrachte Zeit); zusätzlich gelang die empirische Trennung von verschiedenen Stimmungsaspekten. Des Weiteren bildete die neue Skala (quasi-) experimentell im Labor und im Feld (Hochschule) induzierte Unterschiede in der Selbstkontrollkraft ab. Auch eine aus zehn Items bestehende Kurzskala erwies sich als hinreichend reliabel und valide.

Self-control strength in the relation between trait test anxiety and state anxiety

The present research examined whether in a test situation, the relation between trait test anxiety and state anxiety depends on the momentary availability of self-control strength. Since self-control strength is crucial for emotion regulation, we assume that trait test anxiety is more closely related to state anxiety if self-control strength is depleted than if it is not depleted. We conducted an experiment with 119 undergraduates in which we measured trait test anxiety, manipulated availability of self-control strength, and assessed state anxiety after a test announcement. Consistent with the assumption, multiple regression analyses revealed that trait test anxiety and state anxiety were positively related if self-control strength was depleted, but were not related if self-control strength was intact.

The role of self-control strength in the development of state anxiety in test situations

Self-control strength may affect state anxiety because emotion regulation is impaired in individuals whose self-control strength has been temporarily depleted. Increases in state anxiety were expected to be larger for participants with depleted compared to nondepleted self-control strength, and trait test anxiety should predict increases in state anxiety more strongly if self-control strength is depleted. In a sample of 76 university students, trait test anxiety was assessed, self-control strength experimentally manipulated, and state anxiety measured before and after the announcement of a test. State anxiety increased after the announcement. Trait test anxiety predicted increases in state anxiety only in students with depleted self-control strength, suggesting that increased self-control strength may be useful for coping with anxiety.