AnestAssist PK/PD

I've been using this for almost a year, and it is fantastic. I teach residents and I use this to show the difference that solubility coefficients make in short vs long cases, how WHEN you give fentanyl has a profound effect on plasma level and Ce, how to plan sufentanil infusions, TIVA, neuromuscular blockade. Very easy to use, and now I have a library of real cases and simulated cases to review with my residents.

I had this app since it was newly released, and have used it almost daily since then. I just modeled cisatracurium infusion and glanced at the PK/PD (T1 50%) to help with our understanding of the dosing. Then, with my resident, we plotted the sevoflurane/fentanyl and looked at the interaction model by Manyam. If you are administering anesthesia, buy it! If you are using TIVA as your technique, you should have bought it when it came out!

response required

Idea is great. Data entry is cumbersome. Time hard to track; you must enter in clock hours but is displayed from time 0. Graphs truncate at seemingly random times from time zero, even if curve has not decayed to baseline. Graph scale doesn't change if you use larger doses than the software designer anticipated (as many may do with fentanyl, for example.) It doesn't take long to regret making the purchase price.

response required

It should have been a red flag that this app has not been updated since 2010.

In the past I have used several very good PC based PK simulators, TIVA-Trainer and GasMan, both of which cost well over $100 each. This application compares very favorably in terms of functionality, but at a fraction of the cost, and it's practical to bring this on my iPod into the OR for teaching and review purposes. The user interface is pretty good and I didn't have too many problems figuring out how to use it. Actually the data entry and display is quite clever considering that with the small screen (compared to a PC) some operations need to be spread out over several screens. I expect the iPad version is better in this respect. The app comes with PK/PD models for quite a few IV and volatile agents, and also allows you to add additional drugs and PK models if you wish (but beware, adding models is a bit complex and only for knowledgeable users). Many aspects of the PK display are configurable, including scaling of the concentration axis and a choice of "real-time" time axis and drug entry (to record an actual case as opposed to experimenting with the simulator). I found this especially useful for teaching purposes in the OR. Also there is the ability to set "reference concentration" lines for drugs for students to use to visualize target concentrations. Questions to the developer were answered almost immediately, and he seems sincerely interested in feedback and suggestions. My own suggestion to the developer is to add some way for me to export "cases" to my PC. I'd like to be able to add them to a presentation, or forward as examples to students. As a side note, the idea of 'cases' is this app is not as useful as it could be. This is one area that could use more work, for example to be able to search and sort. Kind of cumbersome now beyond a few cases. There's a lot more to this app than I have time to write about. It's certainly worth having a look at, especially at the bargain price.