International Journal of Engineering & Technology, 7 (2.

25) (2018) 48-52

International Journal of Engineering & Technology

Website: www.sciencepubco.com/index.php/IJET

Research paper

Automatic anesthesia regularization system (AARS) with

patient monitoring modules
S.Krishnakumar 1 *, J. Bethanney Janney 1, W. Antony Josephine Snowfy 1, S. Joshin Sharon 1, S. Vinodh Kumar 1
1 Department of Biomedical Engineering, School of Bio and Chemical Engineering, Sathyabama Institute of Science and Technology,
Chen-nai-600119, Tamilnadu, India
*Corresponding author E-mail: [email protected], [email protected]

Abstract

The administration of high/low dose of anesthesia during surgery may cause lethal effect to the patient. To avoid such situation, the anes-
thetist administers few milliliters of anesthesia at regular intervals to the patient. To overcome such tedi-ous problems, this project aims
to design an effective microcontroller based automatically operated anesthesia machine. In the proposed Automatic Anesthesia Regulari-
zation System, anesthesia level is controlled by multi-task feedback and microcontroller system, based on patient’s condition. The Auto-
matic Anesthesia Controller designed using microcontroller aids to control anesthesia levels during the course of surgery. Mechanical
syringe infusion pump is provided to deliver an-esthesia to the patient. The anesthetist can set the keypad to administer the dose of anes-
thesia in terms of milliliters per hour. The keypad transmits the analog signal to the microcontroller to control the required dose of anes-
thesia to be fed into DC motor to operate injection pump. The anesthesia was administered based on patient’s body condition and move-
ment of syringe in the forward or backward direction based on the rotation of DC motor. This module will play a major role in the field
of medicine and useful to the physicians during major surgery to provide the desire amount of anesthesia.

Keywords: Anesthesia; Automatic Regularization System; DC Motor; Infusion Pump; Microcontroller

as body temperature, heart rate and respiration (Manikandan et al

1. Introduction 2013). The system investigates various clinical parameters ob-
tained from the sensors to decide the direction of rotation of the
A patient must be anesthetized before any major surgery by the DC motor. The rotary motion of the DC motor initiate the Infusion
doctors to start their surgical procedure. In case of major surgeries Pump to move in forward and backward direction and the anesthe-
which could take upto 4 or 5 hours, the complete dosage of anes- sia supplied in the syringe is injected to patient’s body. Embedded
thesia could not be administered in single dose to patient. Since based systems are applied in many applications in medical field
excess dose may cause critical condition to the patient which for controlling various biomedical signals, biomedical parameters
could lead to permanent unconsciousness (Misal et al 20016). To and monitoring patient’s health (Durgadevi and Anbananthi, 2014).
overcome this problem, the anesthetist need to designed automatic In the present design, micro-controller is used to control the anes-
direction of anesthesia based on clinical parameters of patient to thesia machine automatically, based upon the diverse biomedical
minimize future side effects. Anesthesia is very much essential to parameters such as heart rate, body temperature, respiration rate
carryout painless surgery so an automatic direction of anesthesia is etc., The main aim of this project is to control the drug injection
essential for a successful surgery (Hanumant Vani et al 2014). At speed depending upon the patient’s state during the surgical pro-
present in clinical practices an anesthetist employs manual system cedure. The main reason for automating is the administration of
of anesthesia administration to the patient. This may originate anesthesia is to relieve the anesthesiologist so that they can dedi-
many complexities such as, dose of anesthesia getting varied and cate their attention to other tasks as well fluid balance, ventilation,
chances of getting adverse side effects in future life. Moreover drug application etc thus to increase the patient's safety. The dos-
anesthetist may fail to administer the accurate dose of anesthesia age given manually by doctors at times may vary from its standard
for the period of the predestined time which might be disturbed value and result in ill effects on the patient. In order to achieve
the patient during surgical procedure. The anesthetic processes are efficient injection of anesthesia by automatic anesthesia controller,
recurring and require keen attention of the anesthetist is always the heart beat sensor plays an important role which takes into ac-
human errors. The incidence of error is drastically reduced due to count the heart rate of the patient and injects anesthesia according-
automatic mechanism of drug administration. In this context there ly reducing the work of the doctors.
is a need to automate the processes related to anesthesia to mini-
mize human error, disturbance from routine repetitive activities 1.1. Embedded system
could be minimized and anesthetist may have more time to take
direct care to patient (Kraft and Lees 1984). Embedded system is a special type of computer system designed
Nowadays embedded system is used in many applications in med- to perform one or few functions, often with real time computing
ical industries to control various biological and biomedical param- constraints. It is usually composed as part of a complete device
eters. Microcontroller is used to regulate the anesthesia machine including hardware and mechanical components. Embedded sys-
automatically depending upon the various clinical parameters such tems read data from input sensors and provide several functions to
Copyright © 2018 S.Krishnakumar et. al. This is an open access article distributed under the Creative Commons Attribution License, which
permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
International Journal of Engineering & Technology 49

monitor the environment. This data finally processed and the out-
come is displayed in digital format to the users. Embedded sys-
tems classically execute applications such as finite state machines,

Fig. 2: Block Diagram of Automatic Anesthesia Regularization System.

2.4. Working technology

Fig. 1: Block Diagram of Embedded System. Anesthetist can determine the dose of anesthesia to be governed to
the patient in terms of milliliter per hour ranging from 1ml to
Control laws, and signal processing algorithms. 1000ml using keypad provided along with the microcontroller.
Block diagram of typical embedded system is displayed in figure After getting the anesthesia level from the keypad regulator, the
1. An embedded system usually. microcontroller set the system to administer anesthesia at the pre-
Contains an embedded processor and digital interface. Some of the viously prescribed level of drugs. This dosage analyses various
embedded system includes operating systems. Others are very based on biomedical parameters received from the sensors to de-
specialized implemented as a single program. These systems are termine the direction of revolution of the DC motor. The revolu-
embedded into some tool for some specific function to provide tion of the DC motor induces the infusion pump to move in for-
general purpose computing. Embedded systems are characterized ward or backward direction. The anesthesia loaded in the syringe
by a unique set of characteristics. Each of these characteristics is injected into the patient’s body.
compulsory have a specific set of design control on embedded
systems designers. The challenge to designing embedded systems
is to conform the specific set of limitation for the application. 3. Hardware requirement
Embedded system designs are characterized for a specific applica-
tion. Many of the performance analysis characteristics are known 3.1. PIC16F877A microcontroller
prior to the hardware is designed. Some embedded systems require
the flexibility of reprogram ability of digital signal processing. Microcontroller integrates a number of components of a micropro-
cessor system onto single chip. It has inbuilt CPU, memory and
peripherals to make it a mini computer. The heart of the microcon-
2. Materials and methods troller is the CPU core. A microcontroller combines onto the same
microchip with CPU, memory (both ROM and RAM) and parallel
2.1. Proposed method digital i/o. Microcontrollers also combine with other devices such
as timer module allow performing tasks for certain time periods.
In the present proposed system, microcontroller based system is Serial I/O ports allow the data to flow between the controller and
used for injecting the drug to maintain the level of anesthesia ad- other devices such as PIC or another microcontroller. An ADC to
ministered to the patient. The dose of anesthesia must be known in allow the microcontroller to accept analogue input data for pro-
advance, as a predefined value is programmed as input for the cessing. The specifications of pin description of PIC 16F877 is
anesthetic control. The actual dose of anesthesia is predetermined presented in Table 1.
based on the body temperature, heart beat and respiration rate of
the patient. The microcontroller is programmed using embedded Table 1: Specification of PIC16F877
system to regulate the dose of anesthesia. PROGRAM DATA DATA
DEVICE
FLASH MEMORY EEPROM
2.2. Sensors PIC 16F877 8K 368 Bytes 256 Bytes

The heart beat sensor, respiration sensor and the thermister (473) 3.2. Memory organization
are used to sense the heart beat, respiration and temperature of an
individual respectively. These sensors give corresponding analog There are three memory blocks in each of the PIC16F87XA de-
values to signal conditioning. Signal conditioning circuit gives the vices. The program memory and data memory have separate buses
binary value to the microcontroller depending on the controller to access concurrently. Additional information on device memory
drives motor. Syringe placed in motor will inject the drug to the is found in the Pismire® Mid-Range MCU Family Reference
patient based on the patient’s body condition. Manual (DS33023).

2.3. Automatic anaesthesia regularization system 3.3. Program memory organization

The PIC16F87XA devices have a 13-bit program counter capable

of addressing 8K word x 14 bits of flash program memory space.
Accessing a location above the physically implemented address
50 International Journal of Engineering & Technology

will cause an envelope around. The reset vector is at 0000h and 3.6. Respiration sensor
the interrupt vector is at 0004h.
Thermistor respiratory monitor is a low cost easy to use device to
3.4. Temperature sensor monitor breathing rates of patients. This portable device was de-
signed for low resource environments and is shown in fig 8. The
LM35 temperature sensor is employed to detect the body tempera- component op-amp (IC 741) is used to amplify the sensed respira-
ture in the present study. The LM35 series are accuracy integrated tory signals and displayed using TTL (transistor to transistor log-
circuit temperature sensor, output voltage is linear proportional to ic) using transistor (BC 547). The device calculates the breathing
the temperature in Celsius (Centigrade). The LM35 devices have rate by detecting changes in temperature when the patient breaths
advantage over linear temperature sensors calibrated in degree through the mask. The device comprises an alarm through a buzz-
Kelvin. The LM35 does not need external calibration to provide er which beeps when the patient stops breathing or has a low
typical accuracies of ± 1⁄4° C at room temperature and ± 3⁄4° C breathing rate (<15bpm) or a high breathing rate (>22bpm). Here
over temperature range of from −55 to +150°C. It can be operated analog to digital conversions of sample readings take place for
by single power supplies. LM35 sensor is appropriate for remote both thermistor and battery for timer to beep the buzzer. The
application and cost effective due to wafer level trimming and thermister used here for respiratory sensor is thermister 473 which
operates from 4 to 30 volts. The LM 35 temperature sensor wired is the NTC (negative temperature coefficient) thermister. NTC
on a circuit board is depicted in fig 6. The white wires go to the thermistors provide the design engineer with desirable sensor per-
power supply. The resistor and the black wire go to the ground. formance which is found advantageous in a variety of applications.
The output voltage would be measured from the middle pin to
ground.

Fig. 8: Thermistor 473.

Two thermistors connected to the resistor bridge network are used

for respiration measurement as displayed in fig 9. The bridge ter-
Fig. 6: Temperature Sensor. minals are connecting with inverting and non-inverting input ter-
minals of the comparator. The LM 741 operational amplifier con-
3.5. Heart beat sensor structs the comparator. The amplified voltage is converted from
+12v to -12v of square wave pulse through the comparator. Then
The heart beat sensor is made to shine an infrared led through square wave pulse is converted from 5v to 0v TTL pulse through-
patient’s finger. The infrared sensor on the other side can pick up out the transistor Q1 (BC 547). Finally, TTL pulse is given to the
slight changes in the light transmittance through finger when microcontroller to monitor the respiration rate.
blood is pumped. The device composts of an infrared (IR) trans-
mitter LED and an infrared sensor phototransistor. The transmitter
sensor is clipped on any one of patient’s finger. The fixing posi-
tion of the heart beat sensor is displayed in fig 7. The LED bom-
bards infrared light to the finger of the patient. The photo-
transistor detects the light rays and calculates the change of blood
volume from the finger artery. The signal in the form of pulses is
amplified, filtered and finally fed to the microcontroller for dis-
play. The microcontroller counts the total number of pulses over a
defined time interval to obtain the heart rate of the patient. Several
readings are received over a specific period of time to get mean
accurate reading of heart rate. The calculated heart rate is dis-
played on LCD in beats per minute using the following format:
Rate is equal to nnn bpm
Where, nnn is an integer between 1 and 999

Fig. 9: Respiration Sensor.

3.7. LCD (liquid crystal display)

A liquid crystal display (LCD) is depicted in fig 10 is a thin, flat

panel used for electronically displaying information such as text,
images, and moving pictures. LCD includes Pin-1 Vss - Ground,
Pin-2 VDD Power 5V, Pin-3 VEE - LCD Contrast Adjustment
Control Signals and RS- Register Select. The enable Pin is used
by the LCD to handle information at its data pins. When the data
Fig. 7: Heart Beat Sensor. is supplied to data pins, high to low pulse must be applied to this
International Journal of Engineering & Technology 51

pin in order to latch the data present in the data pins to display the
LCD.

Fig. 10: LCD Display. Fig. 11: Normal Condition Heart Beat and Respiration.

3.8. Description of MP LAB

The MP LAB Integrated Development Environment (IDE) runs as

a 32-bit application on Microsoft Windows includes several free
software machinery for application development, hardware com-
ponent and debugging. MP LAB IDE also provides as a single,
integrated graphical user interface for additional Microchip, third
party software and hardware development tools. C programming
languages have been used with MP LAB IDE supported through
the use of third party programs. MP LAB IDE does not support
Linux, UNIX and Macintosh based operating system.

4. Results and discussion

4.1. Results
Fig. 12: Abnormal Condition of Heart Beat.
Automatic Anesthesia Regularization System controls drug infu-
sion depending upon the patient’s body state. Temperature sensor,
heartbeat sensor and respiration sensor senses the temperature,
heartbeat and respiration respectively and gives corresponding
analog values to signal conditioning circuit. The Signal condition-
ing circuit then provides the binary value to the microcontroller
depending upon the binary value given to the controller to drive
the syringe pump motor. Syringe placed in motor for injects the
drug to patient based on the patient’s condition. Every 30 seconds
all the parameters were sensed to check the patient’s condition,
which were monitored and intimated in the display whether nor-
mal or abnormal as shown in the fig 11 and fig 12. Infra red heart
beat monitor was kept between the fingers to detect the heart rate.
If the heart beat rate exceeds 40 beats per 30 seconds, it was inti-
mated as abnormal condition and the pump infused according to
the programmed condition. Respiration sensor attached with the
mask kept on the nose sensed the exhalation and the abnormality
Fig. 13: Abnormal Condition of Respiration.
was intimated on the display is shown fig 13 when the respiration
exceeds 12 per 30 seconds. Similarly the temperature sensor
The utilization of Automatic Anesthesia Regularization System
placed between two fingers sensed the patient’s body temperature.
increases patient’s safety and comforts the anesthesiologist by
The abnormal condition was intimated according to the pro-
providing direct attention to other physiological variables under
grammed condition when the temperature reduced to 22°C. The
his control. This helps to protect the environment by using opti-
coding were written in C language, the VB code is compiled and
mum anesthetic agent and cost effective operation. This machine
simulated in MP Lab.
can be fixed along with anesthesia ventilator which will be easier
to control the medicine level to be regularized.
The proposed system is based on Graphical User Interface of static
parameters such as height, weight of the patient undergoing the
surgery by the physician.
The system calculates the initial dose of drugs to be injected to the
subject thereafter the essential parameters of the patient are con-
tinuously monitored by the device. If any parameters deviate from
the normal range at any moment during the surgical procedure the
system recalculates the required dosage of the anesthesia and the
same must be injected by using syringe infusion mechanism. The
52 International Journal of Engineering & Technology

important clinical parameters are stored in real time as database sponse to the intrusions like altering anesthetic drug infusions or
for future reference and analysis. inhaled concentrations.

4.2. Discussion 5. Conclusions

Administration of anesthesia pharmacologically induced tempo-
rary loss of sensation and reversible state of loss of responsiveness, Modern Technologies have developed automation in every sphere
loss of skeletal muscle reflexes provided simultaneously. These of biomedical instrumentation. This project is also based on auto-
conditions allow patient to undergo surgery and other painful pro- mation drug regulation system will be very much useful to sur-
cedures without the sense of pain. Surgical procedure involves geon to check the current position of anesthesia so that the proper
giving anesthetic drugs to patients to induce unconsciousness to anesthesia will be injected to patients. Protection is intelligent than
ensure safe surgery by the surgeon without any untoward inci- prevention and cure. This project on automatic anesthesia regular-
dence (Jung Kim et al 2012). Some of the surgical procedures are ization system is one of the efficient protecting systems in medical
fixed and predetermined whereas some process are based on the industries. This system is very useful to the anaesthesiologists
patient’s response to the interventions like altering anesthetic drug who monitor the particular parameter for the patient and regularize
infusions or inhaled concentrations or to maintain hemodynamic the anesthesia. This module can be connected along with the sy-
etc. The important parameters to be monitored for minor opera- ringe pump or the anesthesia ventilator for future implementation.
tions are ECG, pulse rate, blood pressure, respiration. So with They can also connect with the EEG parameters for major opera-
these parameters the anesthesia can be regulated for either minor tions. Advantages of using the proposed system are physical pres-
or major operations. Collins (1993) reported that anesthesia has to ence of anesthetist is not always required, the required level of
be given to the patient considering the various parameters such as anesthesia is exactly calculated and administered so that future
heart rate, respiratory rate, temperature etc. side effects due to variations in anesthesia levels are eliminated.
Isaka (1993) developed an automatic blood pressure control sys- IR detector is included in the present system for monitoring the
tem has been used in operation theater during major surgery.The total anesthesia level throughout surgery period.
system monitors the blood pressure of patients at low level during
operation using a hypotensive drugs substantially. This deliberate Acknowledgement
hypotension reduces the risk of intra-operative bleeding and also
brought two major desirable effects. First, detailed anatomical The authors are thankful to the Management of Sathyabama Insti-
structures of the patient in the operative field are revealed and thus tute of Science and Technology, School of Bio and Chemical En-
more accurate and speedy operation has been facilitated. Second, gineering, Department of Biomedical Engineering, Chennai, Tam-
blood transfusion is safe, and thus the risk of side effects such as il Nadu, India for providing all the amenities to complete this
sepsis, organ failure and other adverse conditions are decreased. work successfully.
The general anesthesia can be either as gases or vapours or as
injections. It is possible to distribute anesthesia solely by inhala-
tion or injection. The most commonly two forms are combined, References
with an injection given to induce anaesthesia and a gas used to
maintain it. So the infusible medicine can be in liquid form that [1] Collins V.J., “General Anesthesia Fundamental Considerations”,
can be vaporized after being regulated to the vaporizer through 3th Edition, Philadelphia, Lea&Febiger, 1993, 314-359.
[2] Durgadevi S, Anbananthi Embedded System: Patient Life Secure
solenoid pump (Vickers et al 1991). Tavakol et al (2012) devel-
System Based On Microcontroller. International Journal for Ad-
oped a blood pressure sensor to monitor blood pressure using in- vance Research in Engineering and Technology, 2014, 142-147.
vasive technique which has certain disadvantages like arterial [3] Hanumant R.Vani , Pratik V, Makh, Mohanish & Chandurkar.K
obstruction and distal ischaemia. This occurs due to thrombus, Anesthesia Regularization using Heart Beat Sensor International
haematoma, infection when injection of drugs to the patient. So Journal Of Engineering, Education And Technology (ARDIJEET),
the pressure sensor is modified as belt sensor which measures the 2 (1), 2014,1 – 9.
pressure by the movement of the diaphragm. This belt sensor is [4] Isaka, S., “Control Strategies for Arterial Blood Pressure Regula-
also becomes a failure method when the surgery is done on the tion”, IEEE Trans. Biomed. Eng., 40, 1993, 353-363.
Jung Kim, Gina Bledsoe, Steven R Hofstetter, Maureen Fitzpatrick
chest part and hence the functioning and monitoring of pressure
& Maria Fezza, Patient Safety, Practice Management, BJA: British
sensor is replaced by the other important parameter respiration Journal of Anaesthesia, 108(2), 2012, 310–
sensor. 367, https://doi.org/10.1093/bja/aer487.
Prashanth et al (2014) suggested that anesthetist administers regu- [5] Kraft HH & Lees DE., “Closing the loop: How near is automated
lated dose of anesthesia to the patient during surgery. According anesthesia?” Southern Med. J., 77, 1984, 7-12.
to their concept the dose of anesthetic injections are given together [6] Manikandan N, Muruganand S & Vasudevan K, Low Cost Anes-
too closely or too quickly, the patient might suffer from some side thesia Injector Based On Arm Processor, International Journal of
effect due to overdose. On the other hand, suppose the anesthesia Advanced Research in Computer and Communication Engineering,
2(7), 2013, 2810- 2813.
is too less than the optimum dose, then the patient might feel pain
[7] Misal US, SA Joshi, & MM Shaikh, Delayed recovery from anes-
and wake up during the surgery. These result comfortless of pa- thesia: A postgraduate educational review. Anesth Essays Res.
tient due to severe pain and shock leading to unexpected compli- 10(2), 2016, 164–172. doi: 10.4103/0259-1162.165506.
cations. Anesthesia must be administered by correct dosage and [8] Prashanth C, Mohammed Salman, Rohan KR, Govinda Raju M &
time depends on the basis of vital parameters of the patient such as Roopa J, Computerized Anesthesia Infusion SystemInternational
body temperature, heart rate etc. Usually, in current clinical prac- Journal of Electrical, Electronics and Computer Systems (IJEECS)
tices anesthesia is administered manually which may lead to ad- ,2 (3), 2014 , 54 – 59.
verse complications due to overdose or less dose. To reduce the [9] Tavakol M, Salman Ashraf & Sorin J. Brener, Risks and Complica-
tions of Coronary Angiography: A Comprehensive Review, Glob J
risk of such complications, a devise is automatically administers
Health Sci., 4(1), 2012, 65–93. doi: 10.5539/gjhs.v4n1p65.
anesthesia to the patient at regular intervals of patient’s body in- [10] Vickers, MD, Morgan, M & Spencer, PSS, ”General Anaesthetics”,
terest. Vishnoi and Roy (1991) proposed that Closed Circuit Anes- 7th edition, Butterwurth-Heineman Ltd.,Oxford , 1991,118-159.
thesia (CCA) is more safe and economical than open circuit anes- [11] Vishnoi, R & Roy, R.J., “Adaptive control of closed circuit anes-
thesia. However, gas concentrations control regulations are more thesia”, IEEE Trans. Biomed. Eng., 38, 1991, 39-47.
difficult to control. Computer control of CCA has been proposed
for positive efforts to facilitate the control of anesthetic gas con-
centrations have been limited to small group of patients. Some of
these procedures are predetermined based on the patient’s re-