On-line atracurium dose prediction: a nonparametric approach.

This paper aims at contributing to personalize anesthetic drug administration during surgery. This study devel-ops an online robust model to predict the maintenance dose of atracurium necessary for the resulting effect, i.e. neuromuscular blockade, to attain a target profile. The model is based on the patient's neuromuscular blockade (NMB) response to the initial bolus only, overcoming the need for information on the patient's weight, age, height and Lean Body Mass usually associated to pharmacokinetic and pharmacodynamic models. To achieve this, a statistical analysis of the response of the patient to the initial bolus is carried out and a set of variables is established as predictors of the maintenance dose. The prediction is accomplished using Classification and Regression Trees, CART, which is a supervised learning method. Simulated data from a stochastic model for the NMB induced by atracurium is used as training set. All the 5000 doses predicted by the model lead to NMB level between 5% and 10%, which supports the proposed predictive model since it is clinically required that the steady state NMB level lies between this two values. The methodology is applied both to simulated and to clinical data sets and is found appropriate for online dose prediction.