to the AnestAssist PK/PD 1.1 Tutorial page. Here you will find an
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.
After starting AnestAssist, the Patient Info window appears. The
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
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.
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:
on the keyboard to hide the keyboard and uncover the complete screen as shown above.
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.
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
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.
wheel will default to the current time but you can select whichever
time the drug was actually given. This screen also provides
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.
'. You are automatically taken to the Amount Given window shown below.
Here you can select whether to
the drug as a Bolus, Contiuous Infusion, or Short Infusion, and then input the given amount.
our current example, we will choose an infusion of remifentanil.
the 'Cont. Infusion'
button. The buttons below the Amount data
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.
Enter '.25' in the Amount data field. Touch
'Save' to complete this drug given entry and return to the Drug Given list screen.
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
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.
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
process of adding a drug, please refer back to the previous detailed
adding an infusion of remifentanil.
the PK/PD Graphs
To view the PK/PD graph of your case, touch the 'View PK/PD' button on
the bottom toolbar.
is the View PK/PD screen. The first drug added to the case
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
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.
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
AnestAssist makes it easy to manipulate the PK/PD graphs to see the
information you desire.
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").
Using the pinch gesture, the graph here was zoomed in from a
timeline to a 20 minute timeline.
Scrolling (Panning) -
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.
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.
To access the Settings menu, touch the "Settings' button on the bottom
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
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
about AnestAssist. If
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.