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Closed loop anaesthesia delivery system (CLADS) and Improved Anaesthetic Agent Delivery System (IAADS) has been in clinical use at PGIMER, Chandigarh since last more than 8 years. This is currently under evaluation in a multicentre trial sponsored by Dept. of Information Technology, Govt. of India. The system comprise of a algorithm based software on computer interfaced to vital sign monitor and syringe pumps containing anaesthetic drugs like propofol, muscle relaxants, analgesics and inhalational anaesthetics. The algorithm designed is based on pharmacokinetic and pharmacodynamic principles of the anaesthetic drugs being controlled. The feedback from the anaesthetic depth monitor and the hemodynamic monitor helps in automatically altering the drug infusions (through syringe pumps). This was the first closed loop system in the world to be used for both inducing as well as maintaining anaesthesia with safety features of hemodynamic controls incorporated. This is also the first system which can be used to provide both intravenous as well as inhalational anaesthesia through closed loop. In addition to its clinical use and evaluation at PGIMER, Chandigarh this system has been evaluated in detail at following centers

Sri Ganga Ram Hospital and Research Centre, New Delhi
Government Medical College and Hospital, Chandigarh
Dayanand Medical College and Hospital, Ludhiana
SNM Hospital , Leh,
Rajindera Hospital , Patiala

A large number of scientific manuscripts related to this system have also been published,

Figure illustrating the configuration of automated Closed Loop anaesthesia delivery system (IAADS). Computer receiving information from monitors and controlling drug infusion pumps using Automated Anaesthesia delivery system IAADS.

Basic logic of the closed loop anaesthesia delivery system and IAADS
Utility Aspects of Automated Anaesthesia Delivery System

This system allows automatic delivery of anaesthetic agent to the patient at the time of induction of anaesthesia using intravenous or inhalational (gaseous anaesthetic agents) anaesthetic agents depending upon the patient’s condition or choice of anaesthetist.
It frees the anaesthetist from the repetitive task of looking at the anesthetic depth and altering the drug delivery manually.
It frees anaesthetist’s hands to allow him/her to do other activities while keeping a watch on the monitor.
Anaesthetist is warned of the abnormal rates of drug delivery as well as abnormal response of the patient through visual and audio warning.
It allows fine-tuning of the drug delivery according to the requirement of the patient as well as the surgical stimulus requirement.
It allows safety of patient by cutting off anaesthetic drug delivery in case of severe drop in blood pressure or heart rate.
It allows the anaesthetist to define the safety limits of blood pressure as well as heart rate and blood gas levels for not only warning the anaesthetist but also stopping delivery of the anaesthetic agents.
It also allows the anaesthetist to define the inspired and expired concentrations of anaesthetic agent beyond which the system stops delivery of anaesthetic agent.

Publications directly related to Closed Loop Anaesthesia Delivery System

Puri GD , Kumar B, Aveek J. Closed-loop anaesthesia delivery system using Bispectral index: a performance assessment study. Anaesth Intensive Care 2007:35: 357-62
Bi-spectral index guided closed-loop anaesthesia delivery system in pheochromocytoma. Hegde HV, Puri GD, Kumar B, Behera A. J Clin Monit Comput. 2009 Aug;23(4):189-96.
Agarwal J, Puri GD, Mathew PJ Comparison of closed loop vs. manual administration of propofol using the Bispectral index in cardiac surgery. Acta Anaesthesiol Scand. 2009 Mar; 53(3) : 390-7.
Puri GD, Mathew PJ Closed-loop control of anesthesia using the bispectral index in open heart surgery.. Acta Anaesthesiol Taiwan. 2009 Sep;47(3):123-7.
Solanki A, Puri GD, Mathew PJ.Bispectral index-controlled postoperative sedation in cardiac surgery patients: a comparative trial between closed loop and manual administration of propofol.Eur J Anaesthesiol. 2010 Aug;27(8):708-13

Presentations related to Closed Loop Anaesthesia Delivery System

“Evaluation of Closed loop anaesthesia delivery system in open heart surgery patients” presented at joint meeting of the International Society of Heart Research, International Academy of Cardiovascular Sciences and the Heart Failure Society of India at the PGI 29^th Feb -2^nd March 2008.
Closed loop anaesthesia at high altitude (3505 metres above sea level): performance characteristics of an indigenously developed Closed Loop Anaesthesia Delivery System at American Society of Anaesthesiologists (ASA) Annual Meeting 2008 at Orlando 18-22^nd Oct 2008. – oral presentation
Closed-Loop Controlled Delivery Of Propofol Is Better Than Manual Control In Cardiac Surgery. at ASA Annual Meeting 2008 at Orlando 18-22^nd Oct 2008. – poster discussion
Bispectral index controlled post operative sedation in cardiac surgery patients :A comparative trial between closed loop administration versus manual administration of propofol. at American Society of Anaesthesiologists Annual Meeting 2008 at Orlando 18-22nd Oct 2008. oral presentation
BIS controlled isoflurane anaesthesia using CLADS versus manually controlled administration in open heart surgery GD Puri, P Joseph, Sethumadhvan at 25^th Annual Meeting of EACTA held in Edinburgh, Scotland, 9-11 June 8, 20112010.