Apprenticeship Learning for a Predictive State Representation of Anesthesia.

Objective: In this paper, we present an original decision support algorithm to assist the anesthesiologists delivery of drugs to maintain the optimal Depth of Anesthesia (DoA).

Methods: Derived from a Transform Predictive State Representation algorithm (TPSR), our model learned by observing anesthesiologists in practice. This framework, known as apprenticeship learning, is particularly useful in the medical field as it is not based on an exploratory process - a prohibitive behavior in healthcare. The model only relied on the four commonly monitored variables: Heart Rate (HR), the Mean Blood Pressure (MBP), the Respiratory Rate (RR) and the concentration of anesthetic drug (AAFi).

Results: Thirty-one patients have been included. The performances of the model is analyzed with metrics derived from the Hamming distance and cross entropy. They demonstrated that low rank dynamical system had the best performances on both predictions and simulations. Then, a confrontation of our agent to a panel of six real anesthesiologists demonstrated that 95.7% of the actions were valid.

Conclusion: These results strongly support the hypothesis that TPSR based models convincingly embed the behavior of anesthesiologists including only four variables that are commonly assessed to predict the DoA.

Significance: The proposed novel approach could be of great help for clinicians by improving the fine tuning of the DoA. Furthermore, the possibility to predict the evolutions of the variables would help preventing side effects such as low blood pressure. A tool that could autonomously help the anesthesiologist would thus improve safety-level in the surgical room.