1.6 Released 20-May-2010- Reference Concentration Lines
o Users can now specify "reference concentration
lines" to be be displayed within the PK graphs. Reference lines are
configured specific to individual drugs, and can be given any values and labels the
user wishes. A reference line definition consists of a concentration
value, a text label, and a color (and a on/off display switch).
Possible uses are to indicate MEC's (minimum effect concentrations:
EC50, EC95, MAC, etc), average LOR, ROR, LOC, ROC values, target
post-op opioid concentrations, etc). Reference lines can be defined for individual drugs in
"Settings". - Added Simulation Time Base
o The "time base" for a case can now be optionally
be set at case creation to either "simulation time" or "clock/real-time". In
previous versions of AnestAssist "clock/real-time" was the only time base. In
"simulation time" drug given times are entered as hours and minutes
relative to start of the simulated case (i.e. start time = "zero
minutes"). This is useful for constructing "hypothetical" cases for
experimenting and planning. The "clock/real-time" time base is useful
for recording and analyzing actual cases for instructional/educational
purposes.- Previous Session View Restored at Start-up
o At startup time the view is (optionally)
restored to what was being viewed when AnestAssist was last exited.
This is useful if you have to exit AnestAssist temporarily to do
something else (phone call, browse web, run other app, etc). When you
restart AnestAssist you see what you were viewing when you exited (i.e.
if you viewing the PK graph at exit, then the PK graph will be shown at
startup, viewing the same drug at the same time position. If you had a
cursor visible in the graph, then it is restored also).
o Restore previous view mode can be configured (in Settings) to "Always", "Never", or "Ask".- Performance
o Simulation calculation speed is improved by
about 25% for IV drugs, and 10% for inhaled agents. Added information
to the "Recalculating" screen to help diagnose unexpected situations.- Stability
o Bug fixes
o Underlying software code simpler and more fault-tolerant.
1.5 Released 07-Apr-2010 - iPad specific user
o AnestAssist PK/PD 1.5 will run on
both the iPod/iPhone and the new iPad (i.e. it is a "Universal App").
AnestAssist detects which device
it is running on at run-time and provides a user interface which is
optimized for that device. In general, when run on an iPad AnestAssist
makes use of the increased screen size to consolidate operations and
views which require several screens on the iPod/iPhone into single
screens. Otherwise functionality and features are the same for all
o Drug Given entry is one screen on
iPad (as opposed to 3 on the iPod/iPhone)
o Current Case/Patient Info and Case
Library are one screen on the iPad
o Settings for drugs are consolidated
into one screen on the iPad.
o PK Concentrations, Bolus Given,
Infusion Given, and Interaction/Effects graphs display simultaneously
on the iPad.-
Drug Given Graphs
o Added "drug given" graphs showing
timing and amounts of infusions and boluses.- Tap to display PK values
o Tapping a point in the PK graph
displays a cursor and numerical readout of the PK concentrations at
that time.- PK Graph Display
o Patient gender, weight, height, and
o Larger/bolder font used to increase
Workflow and Configurability
o After completing entry or edit of a
drug given, the PK graph screen for the drug is immediately displayed.
o Default bolus and infusion units for
each drug can now be selected in Settings.
o Units and graph limit/increment
parameters for bolus given and infusion given graphs for each drug can
be defined in Settings.
o The "secondary" graph on the PK
screen can be selected in Settings to default to either
Interations/Effects or Drug Given.
1.4 Released 04-Mar-2010-
Additional drugs and models
o Added dexmedetomidine, ketamine,
lidocaine, morphine, and midazolam
o Added additional/alternative models
supported drugs. You may view and select the model used for a drug from
"Settings" -> "Individual Drug Setup". The individual drug setup
screen shows the author and journal reference for each model and also
the patient covariates used by the model. Most (but not all) supported
drugs have a model with at least one patient covariate. The PK/PD
graphs are now subtitled with the model selected.
o Because of the large number of drugs
supported, we have added another option in "Individual Drug Setup" to
select whether the drug should appear or not in the Add Drug Given
display. With this you can restrict the drug choices to only the ones
you are interested in.-
o Isoflurane-opioid interaction effect
probabilities are now modeled and displayed (in addition to existing
propofol-opioid and sevoflurane-opioid interactions). See the "Models"
screen under the "Help" tab for more information.-
o Additional units mg/hr, mg/min,
mcg/hr, mcg/min, mg/kg/hr
o The units selectable for a drug
given are now
drug specific, either "milligram" or "microgram" based, depending on
o Add Drug Given defaults to selecting
the drug currently being viewed
o The PK/PD graphs default to the last
drug given, centered at the time of the last drug given.
o Remifentanil defaults to infusion in
Add Drug Given.
o Inhaled agent defaults to
sevoflurane in Add Drug Given (if no other agent selected yet).-
PK/PD GraphTime Axis
o Zoomed in fine resolution now
labeled in 15 or 30 second intervals
o Always display at least two labeled
tic marks in order to see scale.
o Start of Case time labeled in
"Clock" mode (when on tic mark boundry)-
o Several, including intermittant
crash and/or incorrect display after deleting a drug given entry.
1.3.1 Released 26-Jan-2010
- Bug fix:
o Case times and drug given times were
consistantly being rounded to nearest minute, consequently elapsed
times and PK graphs could be incorrectly displayed to as much as 30
1.3 - Released 16-Jan-2010
- Inhaled agent modeling expanded and enhanced
o Sevoflurane, Isoflurane, Desfluane,
Enflurane, Halothane, and Nitrous Oxide
o Model control/input (from user) is
vaporizer setting (%) and fresh gas flow (FGF)
o Model output displayed includes
(circuit) concentration, alveolar concentration, and brain tissue
o A sevoflurane - opioid interaction
provides estimated probabilities of adequate sedation and analgesia for
combinations of these drugs.
- PK/PD graphs enhanced
o PK graph is larger (75% of screen in
vertical (portrait) orientation)
o Horizontal (landscape) view is now
Appears automatically when the iPhone/iPod is rotated to a horizontal
orientation. Provides a FULL SCREEN wide view of the PK graph.
- User interface improvements
o Improved error handling
o Fonts, colors, buttons modified for
readability and aesthetics
o Settings grouped and reorganized
1.2 - Released 15-Dec-2009
- PK Graphs: concentration axis upper limit and
tic mark/line increment values for each drug are user
configurable (see 'Settings' -> Drug Setup). This allows users
to optimize graphs for concentration ranges they deem clinically
- Drugs Given: entries are now editable. This
facilitates tuning dosing scenarios, as well as studying dosing from a
"what if" perspective.
- Default Drug Concentrations: for each drug may
be configured by user (see 'Settings' -> Drug Setup).
1.1.1 - Released 01-Dec-2009
- Fixed error in sevoflurane model PK calculation.
Note the inhaled model is still quite simple (perhaps too simple). A
future release (target is version 1.3) will add the breathing circuit
to the model with user input of fresh gas flow.
Version 1.1 - Released 21-Nov-2009
- Added simple sevofluane PK model, and also a PD
model which includes sevofluane - opioid interactions.
- PK/PD Screen Improvements
o Combined plasma and effect site
concentrations into one graph.
o Time axis can be optionally
displayed as clock time or elapsed time.
o Concentration axis can be optionally
o Help button: instructions for
panning and zooming the graphs.
- Drug Entry Improvements
o Drug entry is automated making the
process much faster and more intuitive.
o Oriented to entering drugs given
real-time, facilitating the capture of actual cases for later review
o Added additional units for boluses:
mcg/kg and mg/kg.
o Added 'Short Infusion" entry - for a
specific amount of a drug over a fixed time period.
- Starting New Case: A 'New Case' button added to
the Patient Info window/startup screen, making starting a new case
direct and more obvious than in version 1.0
- Options/Settings: Added options for PK/PD graph
axes and scaling, also default remifentanil concentration.
1.0 - Released 27-Jul-2009
- Baseline Version/First Release
- Below we list the main features. The first
release was well received, described by pioneering users as a
"great idea but needing clinical and usability improvements". PalmaHealthcare is
indebted and grateful to these pioneering users who kindly and
their time and clinical expertise
to help make AnestAssist
a much more useful tool in subsequent releases.
- PK models for propofol, remifentanil, fentanyl,
sufentanil, alfentanil. Models incorporate patient weight, age, gender
- Interaction model for propofol - opioids.
- User can build list of drugs given with time
given and amount given.
- PK/PD graphs, including interactions. User can
pan and zoom graphs.
- Users can design and save 'cases' in a Case
Library for later review and demonstration. A 'case' includes patient
informations such as weight, height, age, and gender, and all the drugs
given (names, times, amounts).