The reason why we developed this is that, there is nothing like this on the market. A free, cloud-connected timer, with no ads, that is simple and intuitive.
If you are interested, have a play around! May be buggy still. Will continue to improve.
This serves the purpose of syncing the timers across different stations/exam rooms.
You can share the timer via a link, or a QR code. You may also arrange a timetable schedule in advance, and describe each stage of the timetable.
Front screen of cloudtimer.app
Introducing CloudTimer.app
Have you conducted a viva or osce examination? My friend Eric and I wrote this app to help synchronize the countdown timer - this web app is a cloud-connected timer, so that the host can control a timer session and multiple viewers can connect to it simultaneously.
🤣
You are absolutely right George, thank you for the observation. Let me add that function in the next update. Thanks a lot! 😄
As for the "infusulator", it can be accessed through "research mode". Click on the "Labs" button on the initial screen and the research mode can be activated. This mode also offers an easy export feature for a CSV file containing CP/CE/vol infused over time.
The live preview feature can help to decide the induction dosing. As you enter the initial bolus, the graph will be updated simultaneously. Similarly, you change the bolus and infusion input values after simulation has started and the predicted curves (dotted lines) will automatically appear
December updates - Simtiva.app:
(1) Infusulator, a retrospective data entry tool to simulate the infusion data from time series of CP/CE target values.
(2) Live preview for manual mode. The graph will be plotted as you type in the bolus or infusion values so you can preview the change in real time
"Live preview" feature: another demo of adding a fentanyl bolus, as u enter "20mcg", the graph updates simultaneously to show the predicted curves of CP/CE.
You may also use this feature to plan your induction (what induction dose to use?) if you are using manual mode.
Coming soon to SimTIVA!
Upcoming feature: live preview of bolus/infusion rate change in manual mode.
Sometimes, we need to change our inf rate or give an extra bolus, SimTIVA now plots the curve for the predicted changes dynamically as you enter your values. Video demo of "live preview" of reducing inf rate from 50 to 30
Coming soon to SimTIVA, with a number of bugfixes, in December
Conversely: you can also enter a series of manual bolus+infusion regimen to see the PKPD response over time. Below is the Roberts manual infusion scheme, simulated based on Eleveld model, with resultant CE/CP values
"Infusulator", first created by Matthew Hart, coming soon to SimTIVA. It allows easy entry of a time series of CE (or CP) targets to generate TCI simulations. The conversion from CET/CPT to dosage (volume infused, or the total dose) over time is made simple. An export module is also provided.
Well written! Especially agree with the part about how dumb the web interface of Linkedin is with annoying popups to use their app, which takes plenty of storage space...
Total intravenous anaesthesia (TIVA) for rapid sequence induction (RSI)
Worried your TIVA infusion is too slow for RSI?
Why not work with your local manufacturer to develop an ‘RSI-TCI’ mode for your target-controlled infusion pumps?
#AnSky #PharmSky
doi.org/10.1111/anae...
"... a ‘RSI–TCI’ mode with a pre-programmed manual bolus offers a pragmatic solution for those who wish to preserve an intact pharmacokinetic model for accurate propofol delivery, while allowing the rapid induction clinicians expect from a manual bolus."
#AnSky #MedSky
doi.org/10.1111/anae...
Today I have updated simtiva.app and simtiva.vet -
The changes are mainly visual, with a refreshed look. Part of the reason is user feedback regarding the new iOS 26 on iPhones partially breaking the user interface with malpositioned top and bottom elements.
Minor bugfixes as well.
#ansky
Thanks to @propofoldreams.bsky.social for suggesting this and his thoughtful guidance.
At the same time, the algorithm for Kamp has been updated with more accurate loading dose and less frequent infusion rate changes by default.
(3/4)
You may also read more about ke0 and how it affects TCI here (ref3).
References:
Ref1:https://pubmed.ncbi.nlm.nih.gov/39546215/
Ref2:https://pubmed.ncbi.nlm.nih.gov/12883405/
Ref3:associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.12642
Using time-to-peak-effect (Tpeak or TPE) method (ref2), by deriving the TPE of Navarette-Dyck (1.6min), a new ke0 is re-calculated and applied to the Kamp model. TPE method is advantageous because TPE is model-nonspecific. This would result in more accurate CE prediction/targeting.
(2/4)
Kamp model for ketamine using different ke0's
Ketamine (Kamp) model will be improved soon. On Simtiva, the Kamp model used a ke0 of 0.238, from Navarette PD study using ANI index (ref1). However, that PD study applies to the Domino PK set, and ke0 is model-specific and should not be naively applied to another PK model...
(1/4)
#ansky
jaj42.github.io/blog/posts/2...
An excellent and interesting read for those interested in TCI and programming! STANPUMP is an amazing piece of software
I am not an expert but it is a controversial topic. Linassi published in A&A earlier this yr: journals.lww.com/anesthesia-a...
Also its accompanying editorial is interesting: journals.lww.com/anesthesia-a...
In short, a moderate bolus dose of ketamine increases BIS, but with a delayed effect.
Perhaps other Ketamine enthusiasts can enlighten us on their recipes? (TCI or otherwise) . Want to learn from you too
Hi! I haven't tried TCI Ketamine myself. Mark Barley suggested to me to add this to Simtiva, which I think is a great idea. When I use Ketamine for analgesia intraop, I usually do 0.3mg/kg bolus then approx 0.1-0.2mg/kg/h, and I used this for laparotomy cases, and I think it is a good analgesic...
E.g. low dose ketamine infusion regimen described in the literature (0.3mg/kg bolus followed by 0.15mg/kg/h infusion) resulted in stable CP of 100ng/ml for the first 2h. (100-200ng/ml: target range for analgesia). Alternatively, u may use CE or CP targeting in SimTIVA to guide TCI ketamine.
#ansky
Low-dose ketamine infusion is an excellent component of multi-modal opioid-sparing analgesia. Kamp model uses meta-analytical technique to facilitate better plasma site targeting for TCI ketamine. This model is now introduced in SimTIVA.app
pubmed.ncbi.nlm.nih.gov/32997732/
(1/2) #ansky
Renewed interest in Ketamine emerged as a result of potentially new indications. Kamp model is an allometric model based on meta-analytical analysis. journals.lww.com/anesthesiolo...
Coming soon to simtiva.app
#ansky
Happy to share that Simtiva (veterinary version), a TIVA simulator for small animals, was successfully used to guide TIVA in prolonged surgery in a cat, and the results were recently published in VAA journal.
Simtiva.vet was co-developed by Enzo Minghella & me 1 yr ago and is actively updated.
