Anaesthesiology Insights: TIVA, TCI, Pk/Pd, Eleveld | Tivatrainer

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All Pk/Pd models are wrong - but some are more useful.

We have written in previous blogs about the difference between the available models for propofol. Recently, a part of a real clinical case: down-titration using TCI, was shared on LinkedIn, demonstrating some of the consequences of these model differences. We had to make several assumptions regarding the induction phase, but

From Marsh to Eleveld

From Marsh to Eleveld

In previous blogs, we promised to discuss changing models in your TCI devices and their clinical consequences. Having covered the transition 'From Schnider to Eleveld,' it's now time to explore the topic from a different starting point: the Marsh model. Some time has passed since the

From Schnider to Eleveld

From Schnider to Eleveld

From Schnider to Eleveld. This blog is about what to expect if you change the pharmacokinetic model in your TCI device from Schnider to Eleveld and how to prepare for it. If you are using Target Controlled Infusion (TCI) for Propofol you are most likely, and hopefully, aware that there

Mixing remifentanil in a propofol Target Controlled Infusion device: it is not all white!

Mixing remifentanil in a propofol Target Controlled Infusion device: it is not all white!

Mixing remifentanil in a propofol syringe in a Target controlled infusion device is a practice that is employed specifically for TIVA in paediatric anaesthesia. What are the consequences?

The Mixifusor with Tivatrainer: using the Eleveld+opioid model

The Mixifusor with Tivatrainer: using the Eleveld+opioid model

In the preceding blog post, I conducted an analysis of a publication by Absalom et al. focusing on the drawbacks associated with the concurrent administration of propofol and remifentanil, utilising Target Controlled Infusion to regulate propofol levels while making remifentanil dependent on the rate of propofol administration. This 'Mixifusor&

De- mixing the Mixifusor with Tivatrainer

De- mixing the Mixifusor with Tivatrainer

Tivatrainer has been designed not only for educational purposes but also to explore alternative methods of administering Intravenous anesthesia. A key focus in many IV anesthesia workshops has been the practice of combining drugs in a single syringe, such as propofol/ketamine (ketofol), propofol/alfentanil, and more recently, propofol/remifentanil

The keo of Sufentanil: yet another anomaly in commercial Target Controlled Infusion systems

The keo of Sufentanil: yet another anomaly in commercial Target Controlled Infusion systems

-the keo implementation of the Gepts model for sufentanil differs between the brands of pumps due to a mis-interpretation -input weight range in one pump is 1-250 kg but the Gepts model has a fixed weight so all patients get the same amount of Sufentanil

Important information for Tivatrainer(X) users

Important information for Tivatrainer(X) users

TivatrainerX is the iOS successor to the Tivatrainer for Windows. We have made significant efforts to convert the software into a platform-independent version, which has recently been released for iOS, Android, MacOS, and Windows. The app's framework has been modified to centrally store drug records and, in the

Remimazolam Pk for children

Remimazolam Pk for children

Pharmacokinetics of remimazolam after intravenous infusion inanaesthetised childrenYu-Qing Gao Harald Ihmsen , Zhi-Yan Hu, Wei Sun , Yu-Bo Fang, Zhen Wang, Jürgen Schüttler, Christian Jeleazcov and Hua-Cheng Liu From analysis of the use of the latest version of Tivatrainer we know that many simulations are done with the relative new sedative Remimazolam.

Tranexamic Acid(Grassin-Delyle) validation

Tranexamic Acid(Grassin-Delyle) validation

The anti-fibrinolytic drug tranexamine acid(TA) is a useful drug for limiting bloodloss in major surgical operations like cardiac surgery. Grassin-Delyle and co-authors promote the use of a relative high dose, aiming at a concentration of 150 µg/ml. This concentration should be maintained during the whole surgical procedure. They

Remimazolam

Remimazolam: a benzodiazepine like midazolam with engineered pharmacokinetic properties like remifentanil:metabolized by hydrolysis by non specific tissue and plasma esterases. However it seems that a carboxylesterase in the liver is the main responsible for the metabolization. The pharmacokinetics have been described in multiple publication but only recent a population

Validation Eleveld propofol in Tivatrainer

Validation Eleveld propofol in Tivatrainer

Pharmacokinetic-pharmacodynamic model for propofol for broad application in anaesthesia and sedationD. J. Eleveld, P. Colin, A. R. Absalom and M. M. R. F. Struys Pump manufacturers have implemented, or are considering implementation, of the above model. The parameterisation of the model is rather complex but is available in TivatrainerX (and

Models, models and more models

Models, models and more models

After the era where Target Controlled Infusion was finally called Totally Confused Infusion because of the turmoil of models that were offered by the different pump manufactures for propofol: Marsh, Marsh with short keo, Schnider with fixed time to peak effect, Schnider with fixed keo, and Paedfusor,Kataria for children.

TivatrainerX: validation Remifentanil Kim-Obara-Egan

Disposition of Remifentanil in Obesity A New Pharmacokinetic Model Incorporating the Influence of Body Mass Tae Kyun Kim, M.D., Shinju Obara, M.D., Talmage D. Egan, M.D., and the Remifentanil Pharmacokinetics in Obesity Investigators (Anesthesiology 2017; 126:1019-32) When a pharmacokinetic or pharmacodynamic model is implemented in simulation