AnestAssist Tutorial


AnestAssist PK/PD 1.1 Tutorial

Welcome to the AnestAssist PK/PD 1.1 Tutorial page. Here you will find an easy to follow guide that provides an overview of how to create a new case, input drugs and view the corresponding PK/PD graphs. If further help is needed or you have any questions, please visit Palma Healthcare's support page www.palmahealthcare.com/support.

Creating A Case



After starting AnestAssist, the Patient Info window appears. The most recent case entered will appear at startup.

Touch the New Case button to add a new case.




The Enter Case Start Time window appears. The current time is initially displayed and selected. Adjust the date/time "wheels" by spinning/sliding them with up or down with your finger, and select a starting time for this case. Touch 'Save and Start' to create a new case.



A blank case screen appears. 



Touch each data field to input the case demographics. First touch the blank field next to Case Name. When you touch a data field, a keyboard or number keypad pops up.



Enter 'John Doe'. Next touch the blank field next to Description and enter 'Normal Induction'. Similarly enter the rest of the patient information to match the screen below:




Press Done on the keyboard to hide the keyboard and uncover the complete screen as shown above.

Note that you can enter height and weight in either English or metric units by touching the approriate units button. Likewise select Gender by touching the approriate button.

Press Save and Go to complete. The Drugs Given entry screen appears automatically next.

Drug Entry

The Drugs Given screen, with no entries yet, is shown below. Touch the Add button now to enter a drug given.



The Drug Name screen, shown below, appears first.



The program will default to Propofol but in our case we will use Remifentanil. Adjust the wheel to Remifentanil. Notice that concentration changes to the default concentration for remifentanil (you can change the concentration if needed, and you can set the default value for remifentanil in the Settings window as described later).




Now that we have selected the drug and its concentration, touch the 'Save' button. You are then automatically taken to the Time Given window as shown below.



The wheel will default to the current time but you can select whichever time the drug was actually given. This screen also provides the Case Start time and the Time Since Start which are useful in referencing what time the drug was given. Also, convienience buttons are included to make adding or subtracting 5 and 10 minutes very easy, intuitive and quick. Choose a time 2 minutes after Case Start. Touch 'Save'. You are automatically taken to the Amount Given window shown below.




Here you can select whether to give the drug as a Bolus, Contiuous Infusion, or Short Infusion, and then input the given amount. In our current example, we will choose an infusion of remifentanil.



Touch the 'Cont. Infusion' button. The buttons below the Amount data field are the units the drug is given in. Note that AnestAssist defaulted to 'mcg/kg/min' for remifentanil, and also defaults to the most commonly used units for other drugs also. You can always over-ride AnestAssist's default and choose what you want.

Remi screen .25 mcg/kg/min infusion


Enter '.25' in the Amount data field. Touch 'Save' to complete this drug given entry and return to the Drug Given list screen.



Remi


The infusion of remifentanil appears on the Drugs Given list. Next, in order to demonstrate multiple drug interactions later, we will also enter a propofol bolus. Touch the 'Add' button on the upper right corner to add another drug to the case. NOTE: You may delete any drug you have already entered by touching the Delete button in the upper left corner of the Drugs Given screen, and then selecting the drug entry you wish to delete. Press 'Done' when you are done deleting entries.

 Prop and Remi

We repeated the above process and added a 120mg bolus of Propofol at 9 minutes after case starting time (see entry above) . If there is any confusion about the process of adding a drug, please refer back to the previous detailed explanation of adding an infusion of remifentanil.

Viewing the PK/PD Graphs


To view the PK/PD graph of your case, touch the 'View PK/PD' button on the bottom toolbar.

remi pkpd


This is the View PK/PD screen. The first drug added to the case will show up when the 'View PK/PD' button is pressed. The top graph is pharmacokinetics and shows drug concentrations in the blood and effect site (i.e. brain and nervious system) for the selected drug. The bottom graph shows pharmacodynamics in terms of percent probability of achieving a target clinical effect. The effect probabilty is shown for the drug by itself, and also the total effect probability when taking into account interactions with other drugs administered. In this case we see the synergistic interaction of remifentanil and propofol (the two drugs given in this case).

To view the PK/PD of other drugs given in the case, touch the 'Switch Drug Displayed' button at the top left corner of the screen.

prop pkpd


To add another drug to the case, either touch the 'Drug Input' tab on the bottom toolbar or touch the 'Enter Drug' button on the top of the screen.

Manipulating the PK/PD Graphs

AnestAssist makes it easy to manipulate the PK/PD graphs to see the information you desire.

Zooming - To zoom in and out, simply use the iPhone pinch gestures (i.e. with two fingers on the screen, move them together to  "zoom out", or move them apart to "zoom in").

prop zoomed

Using the pinch gesture, the graph here was zoomed in from a 60 minute timeline to a 20 minute timeline.

Scrolling (Panning) - To scroll (pan) across the graph's timeline, simple drag a single finger across the graph leftward or rightward in the direction you wish to scroll.

scrolled 

By dragging a finger to the left, you can scroll through forward in the case and see PK/PD and drug interactions at a time of interest. Here we have moved forward to place the propofol bolus starting point at the far left start of the graph. NOTE: You may scroll through as much time as you desire, we simply showed a single finger drag motion.

Settings

To access the Settings menu, touch the "Settings' button on the bottom toolbar.



This is the Settings screen. Any option choosen takes effect immediately. Options are stored in a global state file on your iPhone/iPod, and reloaded and used for subsequent cases. You can change options at any time.

Help Screen



To access the help menu, touch the 'Help' tab on the bottom toolbar.

Touch the User Guide button to access the AnestAssist User Guide. This guide provides a quick and easy way to answer questions about AnestAssist. If the User Guide does not answer your question, please feel free to contact Palma Healthcare support personnel at www.palmahealthcare.com.

Touch the PK/PD Models button for a description and references for the PK/PD models used by AnestAssist.

Touch the Disclaimer button for important caution information regarding the use of AnestAssist.