Method and apparatus for simulating neuromuscular stimulation during medical surgery

• US 5,391,081 A
• Filed: 05/13/1992
• Issued: 02/21/1995
• Est. Priority Date: 05/13/1992
• Status: Expired due to Fees

• Current Assignee: University of Florida Research Foundation, Incorporated (State University System of Florida)
• Original Assignee: University of Florida Research Foundation, Incorporated (State University System of Florida)
• Inventors: Good, Michael S., Lampotang, Samsun, Carovano, Ronald G., Gravenstein, Joachim S.
• Primary Examiner(s): Apley, Richard J.
• Assistant Examiner(s): Leubecker, John P.
• Application Number:
  US07/882,467
• Time in Patent Office: 1,014 Days
• Field of Search: 434/262, 434/272, 434/275, 434/265, 434/267, 434/266, 434/268, 434/366, 128/28, 128/741, 128/782, 128/419 R, 128/421, 128/422, 364/413.03, 364/413.27, 364/413.02, 364/413.04, 395/920, 395/924, 623/25, 607/48, 607/54, 607/56, 607/120
• US Class Current: 434/262
• CPC Class Codes: A61B 5/00 Measuring for diagnostic purposes radiation diagnosis A61B6/00; diagnosis by ultrasonic, sonic or infrasonic waves A61B8/00; Identification of persons
• CPC Class Codes: A61B 5/0215 by means inserted into the body catheters A61M25/00
• CPC Class Codes: A61B 5/1106 to assess neuromuscular blockade, e.g. to estimate depth of anaesthesia
• CPC Class Codes: A61B 5/1455 using optical sensors, e.g. spectral photometrical oximeters
• CPC Class Codes: A61B 5/411 Detecting or monitoring allergy or intolerance reactions to an allergenic agent or substance
• CPC Class Codes: A61B 7/003 Detecting lung or respiration noise
• CPC Class Codes: G09B 23/28 for medicine
• CPC Class Codes: G09B 23/285 for injections, endoscopy, bronchoscopy, sigmoidscopy, insertion of contraceptive devices or enemas

Abstract

A method and associated apparatus for simulating neuromuscular stimulation in real time during simulated medical surgery using a manikin, such as ulnar nerve stimulation to detect the degree of neuromuscular blockade and external stimulation of nerves to produce evoked potentials so as to monitor the integrity of nerves during surgery is provided. Such simulation allows for the active participation of trainees with the simulation apparatus to experience real world medical procedures in a setting that closely mimics the real world.

Claims

1. A method of simulating ulnar nerve stimulation in real time in response to a simulated degree of neuromuscular blockade during simulated medical surgery using a manikin, comprising the steps of:

(A) applying at least one electric pulse corresponding to a nerve stimulation protocol selected from the group consisting of single twitch, train of four, tetanic, post tetanic count and double burst, to a means for sensing an electric pulse associated with the manikin, wherein the at least one electric pulse is applied using a nerve stimulator;

(B) detecting the at least one electric pulse and identifying the corresponding nerve stimulation protocol;

(C) computing a simulated response to the identified nerve stimulation protocol and the simulated degree of neuromuscular blockade according to a time-and event-based script, a computer model or a combination of a time- and event-based script and a computer model; and

(D) actuating at least one output device associated with the manikin in real time according to the computed simulated response to simulate the neuromuscular stimulation associated with the nerve stimulation protocol and the simulated degree of neuromuscular blockade, wherein the output device is a thumb twitch actuator which moves a thumb on a hand of the manikin relative to the fingers on the hand a distance, time duration and pattern computed according to the nerve stimulation protocol.

2. The method of claim 1, further comprising the steps of:

(A) administering a simulated or real neuromuscular blockade drug to the manikin;

(B) detecting the time at which the neuromuscular blockade drug is administered, detecting the quantity of neuromuscular blockade drug administered, and detecting the kind of neuromuscular blockade drug administered; and

(C) utilizing the time the drug was administered, the quantity of drug administered, and the kind of drug administered in computing a simulated response on the manikin so as to provide a combined simulated response in accordance with both the degree of blockade and the identified nerve stimulation protocol.

19. The method of claim 1, wherein the thumb moves to one of at least 10 preset distances according to the calculated simulated response.

20. The method of claim 1, wherein the thumb is capable of transmitting a force related to the distance computed according to the nerve stimulation protocol when movement of the thumb is impeded.

21. The method of claim 1, further comprising the step of simulating a low battery condition for the nerve stimulator by decreasing the distance the thumb moves according to the computed simulated response upon identification of a nerve stimulation protocol associated with a low battery condition.

3. A method of simulating ulnar nerve stimulation in real time in response to a simulated degree of neuromuscular blockade during simulated medical surgery using a manikin, comprising the steps of:

(A) applying at least one electric pulse corresponding to a nerve stimulation protocol to a means for sensing an electric pulse associated with the manikin, wherein the at least one electric pulse is applied using a nerve stimulator;

(B) detecting the at least one electric pulse and identifying the corresponding nerve stimulation protocol;

(C) computing a simulated response to the identified nerve stimulation protocol and the simulated degree of neuromuscular blockade according to a time-and event-based script, a computer model or a combination of a time- and event-based script and a computer model; and

(D) actuating at least one output device associated with the manikin in real time according to the computed simulated response to simlate the neuromuscular stimulation associated with the nerve stimulation protocol and the simulated degree of neuromuscular blockade, wherein the output device is a thumb twitch actuator which moves a thumb on a hand of the manikin relative to the fingers on the hand a distance, time duration and pattern computed according to the nerve stimulation protocol and the simulated degree of neuromuscular blockade, and wherein the thumb moves to one of at least 10 preset distances according to the calculated simulated response.

4. A method of simulating ulnar nerve stimulation in real time in response to a simulated degree of neuromuscular blockade during simulated medical surgery using a manikin, comprising the steps of:

(A) applying at least one electric pulse corresponding to a nerve stimulation protocol to a means for sensing an electric pulse associated with the manikin, wherein the at least one electric pulse is applied using a nerve stimulator;

(B) detecting the at least one electric pulse and identifying the corresponding nerve stimulation protocol;

(C) computing a simulated response to the identified nerve stimulation protocol and the simulated degree of neuromusclar blockade according to a time-and event-based script, a computer model or a combination of a time- and event-based script and a computer model; and

(D) actuating at least one output device associated with the manikin in real time according to the computed simulated response to simulate the neuromuscular stimulation associated with the nerve stimulation protocol and the simulated degree of neuromuscular blockade, wherein the output device is a thumb twitch actuator which moves a thumb on a hand of the manikin relative to the fingers on the hand a distance, time duration and pattern computed according to the nerve stimulation protocol and the simulated degree of neuromuscular blockade, and wherein the thumb is capable of transmitting a force related to the distance computed according to the nerve stimulation protocol and the simulated degree of neuromuscular blockade when movement of the thumb is impeded.

5. A method of simulating ulnar nerve stimulation in real time in response to a simulated degree of neuromuscular blockade during simulated medical surgery using a manikin, comprising the steps of:

(A) applying at least one electric pulse corresponding to a nerve stimulation protocol to a means for sensing an electric pulse associated with the manikin, wherein the at least one electric pulse is applied using a nerve stimulator;

(B) detecting at least one electric pulse and identifying the corresponding nerve stimulation protocol;

(C) computing a simulated response to the identified nerve stimulation protocol and the simulated degree of neuromuscular blockade according to a time-and event-based script, a computer model or a combination of time- and event-based script and a computer model; and

(D) actuating at least one output device associated with the manikin in real time according to the computed simulated response to simulate the neuromuscular stimulation associated with the nerve stimulation protocol and the simulated degree of neuromuscular blockade, wherein the output device is a thumb twitch actuator which moves a thumb on a hand of the manikin relative to the fingers on the hand distance, time duration and pattern computed according to the nerve stimulation protocol and the simulated degree of neuromuscular blockade, further comprising the step of simulating a low battery condition for the nerve stimulator by decreasing the distance the thumb moves according to the computed simulated response upon identification of a nerve stimulation protocol associated with a low battery condition.

6. A method of simulating nerve stimulation, wherein the simulated nerve stimulation is selected from the group consisting of electrical stimulation of the spinal cord or peripheral nerves, auditory stimulation of the cranial nerve and visual stimulation of the optical nerve according to a nerve stimulation protocol, in real time during simulated medical surgery using a manikin, comprising the steps of:

(A) applying at least one electric stimulus, auditory stimulus, or optical stimulus corresponding to a nerve stimulation protocol to a stimulus sensing means associated with the manikin, wherein the at least one electric stimulus, auditory stimulus, or optical stimulus is applied using an evoked potentials monitoring system;

(B) detecting the at least one electric stimulus, auditory stimulus, or optical stimulus and identifying the corresponding nerve stimulation protocol;

(C) computing a simulated response to the identified nerve stimulation protocol according to a time-and event-based script, a computer model or a combination of a time- and event-based script and a computer model; and

(D) actuating at least one output device associated with the manikin in real time according to the computed simulated response to simulate the nerve stimulation associated with the nerve stimulation protocol, wherein the output device comprises a signal capable of being received by an evoked potentials monitoring system.

7. An apparatus for simulating ulnar nerve stimulation in response to a simulated degree of neuromuscular blockade during simulated medical surgery, comprising:

(A) a manikin;

(B) at least one output device associated with the manikin;

(C) means for sensing an electric pulse associated with the manikin, wherein the means for sensing an electric pulse is capable of detecting pulse frequency, pulse current and the time interval between electric pulses;

(D) means for applying at least one electric pulse corresponding to a nerve stimulation protocol to the means for sensing an electric pulse; and

(E) programmed computing means associated wit the means for sensing an electric pulse for identifying the corresponding nerve stimulation protocol and for calculating a simulated response to the identified nerve stimulation protocol and the simulated degree of neuromuscular blockade and for actuating at least one output device associated with the manikin, wherein the output device is a thumb twitch actuator which moves a thumb on a hand of the manikin relative to the fingers on the hand a distance, time duration and pattern computed according to the nerve stimulation protocol and the simulated degree of neuromuscular blockade associated with the manikin, to simulate the neuromuscular stimulation in real time according to a time- and event-based script, a computer model or a combination of a time- and event-based script and a computer model.

8. The apparatus of claim 7, further comprising:

(A) means to the manikin for receiving a simulated or real neuromuscular blockade drug administered thereto;

(B) means for detecting the time at which the neuromuscular blockade drug is administered;

for detecting the quantity of neuromuscular blockade drug administered; and

for detecting the kind of neuromuscular blockade during administered; and

(C) means associated with the programmed computing means for utilizing the time the drug was administered, the quantity of drug administered, and the kind of drug administered so as to provide a combined simulated response in accordance with both the degree of blockade and the identified nerve stimulation protocol.

9. The apparatus of claim 7, wherein the programmed computing means comprises a distributed processing network.

10. The apparatus of claim 7, wherein the means for applying at least one electric pulse is a nerve stimulator, and further comprising means for simulating a low battery condition for the nerve stimulator, wherein the stimulating means decreases the distance the thumb moves according to the computed simulated response upon identification of a nerve stimulation protocol associated with a low battery condition.

22. The apparatus of claim 7, wherein the thumb twitch actuator moves the thumb to one of at least 10 preset distances according to the calculated simulated response.

23. The apparatus of claim 7, wherein the thumb twitch actuator comprises means of transmitting a force related to the distance computed according to the nerve stimulation protocol when movement of the thumb is impeded.

11. An apparatus for simulating ulnar nerve stimulation in response to a simulated degree of neuromuscular blockade during simulated medical surgery, comprising:

(A) a manikin;

(B) at least one output device associated with the manikin;

(C) means for sensing an electric pulse associated with the manikin, wherein the means for sensing an electric pulse is capable of detecting pulse frequency, pulse current and the time interval between electric pulses;

(D) means for applying at least one electric pulse corresponding to a nerve stimulation protocol to the means for sensing an electric pulse; and

(E) programmed computing means associated with the means for sensing an electric pulse for identifying the corresponding nerve stimulation protocol and for calculating a simulated response to the identified nerve stimulation protocol and the simulated degree of neuromuscular blockade and for actuating at least one output device associated with the manikin, wherein the output device is a thumb twitch actuator which moves a thumb on a hand of the manikin relative to the fingers on the hand a distance, time duration and pattern computed according to the nerve stimulation protocol and the simulated degree of neuromuscular blockade associated with the manikin, to simulate the neuromuscular stimulation in real time according to a time- and event-based script, a computer model or a combination of a time- and event-based script and a computer model, and wherein the thumb twitch actuator moves the thumb to one of at least 10 preset distances according to the calculated simulated response.

12. An apparatus for simulating ulnar nerve neuromuscular stimulation in response to a simulated degree of neuromuscular blockade during simulated medical surgery, comprising:

(A) a manikin;

(B) at least one output device associated with the manikin;

(C) means for sensing an electric pulse associated with the manikin, wherein the means for sensing an electric pulse is capable of detecting pulse frequency, pulse current and the time interval between electric pulses;

(D) means for applying at least one electric pulse corresponding to a nerve stimulation protocol to the means for sensing an electric pulse; and

(E) programmed computing means associated with the means for sensing an electric pulse for identifying the corresponding nerve stimulation protocol and for calculating a simulated response to the identified nerve stimulation protocol and the simulated degree of neuromuscular blockade and for actuating at least one output device associated with the manikin, wherein the output device is a thumb twitch actuator which moves a thumb on a hand of the manikin relative to the fingers on the hand a distance, time duration and pattern computed according to the nerve stimulation protocol and the simulated degree of neuromuscular blockade associated with the manikin, to simulate the neuromuscular stimulation in real time according to a time- and event-based script, a computer model or a combination of a time- and event-based script and a computer model, and wherein the thumb twitch actuator comprises means of transmitting a force related to the distance computed according to the nerve stimulation protocol and the simulated degree of neuromuscular blockade when movement of the thumb is impeded.

13. An apparatus for simulating nerve stimulation in response to a simulated degree of integrity of a nervous pathway, wherein the simulated nerve stimulation is selected from the group consisting of electrical stimulation of the spinal cord or peripheral nerves, auditory stimulation of the cranial nerve, and visual stimulation of the optical nerve to produce simulated evoked potentials, during simulated medical surgery, comprising:

(A) a manikin;

(B) at least one output device associated with the manikin;

(C) means for sensing a stimulus associated with the manikin, wherein the means for sensing a stimulus is capable of detecting stimulus frequency, stimulus magnitude, stimulus pattern and the time interval between stimuli;

(D) means for applying at least one electric stimulus, auditory stimulus, or optical stimulus corresponding to a nerve stimulation protocol to the means for sensing a stimulus; and

(E) programmed computing means associated with the means for sensing a stimulus for identifying the corresponding nerve stimulation protocol and for calculating a simulated response to the identified nerve stimulation protocol and the simulated degree of integrity of the nervous pathway being monitored and for actuating at least one output device associated with the manikin to simulate the nerve stimulation in real time according to a time- and event-based script, a computer model or a combination of a time- and event-based script and a computer model, wherein the output device comprises a signal capable of being received by an evoked potentials monitoring system.

14. An anesthesiological training simulator capable of simulating ulnar nerve stimulation in response to a simulated degree of neuromuscular blockade, wherein the simulator comprises a manikin and is capable of simulating spontaneous breathing, controlled mechanical ventilation, breath sounds, heart tones, and palpable radial and carotid artery pulses, comprising:

(A) means for sensing an electric pulse associated with the manikin, wherein the means for sensing an electric pulse is capable of detecting pulse frequency, pulse current and the time interval between electric pulses;

(B) at least one output device associated with the manikin, wherein the at least one output device is selected from the group consisting of a thumb twitch actuator and a means for decreasing the current transmission to the means for sensing an electric pulse to simulate increasing skin resistance of the manikin, and wherein said thumb twitch actuator moves a thumb on a hand of the manikin relative to the fingers on the hand a distance, time duration and pattern computed according to the nerve stimulation protocol and the simulated degree of neuromuscular blockade associated with the manikin;

(C) means for applying at least one electric pulse corresponding to a nerve stimulation protocol to the means for sensing an electric pulse; and

(D) programmed computing means associated with the means for sensing an electric pulse for identifying the corresponding nerve stimulation protocol and for calculating a simulated response to the identified nerve stimulation protocol and the simulated degree of neuromuscular blockade and for actuating at least one output device associated with the manikin to simulate the neuromuscular stimulation in real time according to a time and event-based script, a computer model or a combination of a time and event-based script and a computer model.

15. A method of simulating nerve stimulation in real time in response to a simulated degree of integrity of a nervous pathway during simulated medical surgery using a manikin, comprising the steps of:

(A) applying, according to a nerve stimulation protocol, at least one stimulus selected from the group consisting of electrical stimulation of the spinal cord or peripheral nerves, auditory stimulation of the cranial nerve and visual stimulation of the optical nerve to produce simulated evoked potentials, to a means for sensing a stimulus associated with the manikin, wherein the at least one stimulus is applied using an evoked potentials monitoring system;

(B) detecting the at least one stimulus and identifying the corresponding nerve stimulation protocol;

(C) computing a simulated response to the identified nerve stimulation protocol and the simulated degree of integrity of the nervous pathway being monitored according to a time- and event-based script, a computer model or a combination of a time- and event-based script and a computer model; and

(D) actuating at least one output device associated with the manikin in real time according to the computed simulated response to simulate the nerve stimulation associated with the nerve stimulation protocol and the simulated degree of integrity of the nervous pathway being monitored, wherein the output device comprises a signal capable of being received by an evoked potentials monitoring system.

16. A method of simulating ulnar nerve stimulation in real time in response to a simulated degree of neuromuscular blockade during simulated medical surgery using a manikin, comprising the steps of:

(A) applying at least one electric pulse corresponding to a nerve stimulation protocol selected from the group consisting of single twitch, train of four, tetanic, post tetanic count and double burst, to a means for sensing an electric pulse associated with the manikin, wherein the at least one electric pulse is applied using a nerve stimulator;

(B) detecting the at least one electric pulse and identifying the corresponding nerve stimulation protocol;

(C) computing a simulated response to the identified nerve stimulation protocol and the simulated degree of neuromuscular blockade according to a time- and event-based script, a computer model or a combination of a time- and event-based script and a computer model; and

(D) actuating at least one output device associated with the manikin in real time according to the computed simulated response to simulate the neuromuscular stimulation associated with the nerve stimulation protocol and the simulated degree of neuromuscular blockade, wherein the output device comprises a means for decreasing the current transmission to the means for sensing an electric pulse to simulate increasing skin resistance of the manikin.

17. An apparatus for simulating ulnar nerve stimulation in response to a simulated degree of neuromuscular blockade during simulated medical surgery, comprising:

(A) a manikin;

(B) at least one output device associated with the manikin;

(C) means for sensing an electric pulse associated with the manikin, wherein the means for sensing an electric pulse is capable of detecting pulse frequency, pulse current and the time interval between electric pulses;

(D) means for applying at least one electric pulse corresponding to a nerve stimulation protocol to the means for sensing an electric pulse; and

(E) programmed computing means associated with the means for sensing an electric pulse for identifying the corresponding nerve stimulation protocol and for calculating a simulated response to the identified nerve stimulation protocol and the simulated degree of neuromuscular blockade and for actuating at least one output device associated with the manikin, wherein the output device comprises a means for decreasing the current transmission to the means for sensing an electric pulse to simulate increasing skin resistance of the manikin, to simulate the neuromuscular stimulation in real time according to a time- and event-based script, a computer model or a combination of a time- and event-based script and a computer model.

18. An apparatus for simulating nerve stimulation in response to a simulated degree of integrity of a nervous pathway during simulated medical surgery, wherein the simulated nerve stimulation is selected from the group consisting of electrical stimulation of the spinal cord or peripheral nerves, auditory stimulation of the cranial nerve, and visual stimulation of the optical nerve to produce simulated evoked potentials, comprising:

(A) a manikin;

(B) at least one output device associated with the manikin, wherein the at least one output device comprises a signal capable of being received by an evoked potentials monitoring system;

(C) means for sensing a stimulus associated with the manikin, wherein the means for sensing a stimulus is capable of detecting stimulus frequency, stimulus magnitude, stimulus pattern and the time interval between stimuli;

(D) means for applying at least one electric stimulus, auditory stimulus, or optical stimulus corresponding to a nerve stimulation protocol to the means for sensing a stimulus; and

(E) programmed computing means associated with the means for sensing a stimulus for identifying the corresponding nerve stimulation protocol and for calculating a simulated response to the identified nerve stimulation protocol and the simulated degree of integrity of the nervous pathway being monitored and for actuating at least one output device associated with the manikin to simulate the nerve stimulation in real time according to a time- and event-based script, a computer model or a combination of a time- and event-based script and a computer model.