AnestAssist Version History

Version 1.8 Released 07-Dec-2010

- Custom PK Models can be specified for pediatric and veterinary use
      o Weight, height, and age limits may be specified for user entered custom PK/PD models. In previous versions of AnestAssist these values were hard-coded to "adult human" appropriate values. You may now over-ride these with values for pediatric or veterinary use.
      o PK models included/delivered with AnestAssist were generally developed (by their authors) for adult use. For these models, if you specify patient values outside of "normal adult" ranges (age 18-90yr, weight 40-180kg, height 150-200cm) you will be warned when viewing model results. Previously AnestAssist did not allow entry of patient values outside these ranges.

- Bug fixes

      o When creating new "cases", duplicate cases were sometimes added to the Case List. Fixed this. As a side note we expect to do a major update to "case management" in version 2.0, expected in first half of 2011.
      o Button graphics fixed (again). On the iPad and on some iPhone screens the button graphics were drawn wrong. The buttons did function properly, but looked awful. It's actually quite embarassing for such a blatant problem to appear in the released app. However this was not seen in testing, but somehow appears during the creation of the app "distribution binary" that is sent to Apple (which cannot be run to test). We used a different technique for displaying buttons that hopefully is immune to this problem, and the buttons look much better besides.

**Note: Based on user feedback and help (thank you!), AnestAssist has been significantly enhanced since it's initial release 1 year ago. As it's functionality has expanded and settings and customization have become extensive, so has it's "learning curve". So, very soon we are adding updated background information and video tutorials on www.palmahealthcare.com to help you come up to speed quickly, with the information needed to get the most benefit from AnestAssist. 

Version 1.7 Released 14-Sep-2010

- Added Neuromuscular Blockade Drug PK and PD Models
      o Rocuroniun, Vecuronium, Atracurium, Cisatracurium
- User definable Drugs
      o Users can define and add new/custom drugs (and models) to extend the set of drugs modeled by AnestAssist.
- User definable PK/PD Models
      o Users can enter alternate/custom PK/PD models for any drug included with AnestAssist.


Version 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.

Version 1.5 Released 07-Apr-2010

 - iPad specific user interface
      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 devices.
      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 age displayed.
      o Larger/bolder font used to increase readability.
- 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.


Version 1.4 Released 04-Mar-2010

- Additional drugs and models
      o Added dexmedetomidine, ketamine, lidocaine, morphine, and midazolam
      o Added additional/alternative models for many 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 now 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.
- Isoflurane-opioid interactions
      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.
- Units
      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 the drug.
- Workflow
      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)
- Bug fixes
      o Several, including intermittant crash and/or incorrect display after deleting a drug given entry.


Version 1.3.1 Released 26-Jan-2010

- Bug fix:
      o Case times and drug given times were not consistantly being rounded to nearest minute, consequently elapsed times and PK graphs could be incorrectly displayed to as much as 30 seconds.


Version 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 inspired (circuit) concentration, alveolar concentration, and brain tissue concentration.
      o A sevoflurane - opioid interaction model 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 available. 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


Version 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 relevant.

- 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).


Version 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 auto-scaled.
      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 and analysis.
      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.

Version 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 generously offered 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 as covariates.
- 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).