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

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

"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.

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

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

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.

SimTIVA.app is fully capable of offline support. The app can be run offline. Internet connection can be unstable sometimes, but rest assured you can still run SimTIVA normally. Also, minor changes to the mcg/kg/min default rate unit display (manual mode) for Propofol, the bug is fixed. #ansky

You've been meaning to get around to reading about the differences between adult TCI models for propofol? On the to do list for .... ever?? Listen to this to get you warmed up, and check out the references in the show notes for the in depth excitement you're desperate to have! #ansky #FOAMed

Minor update to Simtiva.app: propofol concentration options available: 10mg/ml, 20mg/ml, or custom dilution; plus other bug fixes

Feature preview: propofol concentration can be customized (10mg/ml, 20mg/ml, or custom dilution)

The term "TIVA RSI" misrepresents the issue. All RSIs are IV. Whether it's a TIVA anaesthetic depends on whether the subseq maintenance agent is inhaled or IV (& irrelevant to the process of RSI). The question is whether IV induction agents should be administered by an infusion pump during RSI.

Do you use TIVA when you are doing a rapid sequence induction in theatre? #AnSky #AirwaySky #MedSky doi.org/10.1111/anae...

What is your preferred methodology for in-theatre TIVA RSI? #AnSky #AirwaySky #MedSky doi.org/10.1111/anae...

Simtiva.app update: RSI mode to facilitate guidance of TIVA in an RSI situation. Eleveld model. #AnSky

Simtiva.app update: Dexmedetomidine (Hannivoort) model. CET/CPT/Manual mode available. Welcome any feedback

Feature preview: RSI mode coming soon to simtiva.app! How do you do RSI with TIVA? The algorithm suggests a bolus dose based on user-defined CE target at a specified time point (e.g. 60s). It also predicts a CE overshoot & when to resume infusion. Also testing live preview feature... #ansky

Feature preview: testing dexmedetomidine TCI on simtiva.app - coming soon #ansky

Upcoming feature: y-axis (concentration) can be adjusted. User can define the max. concentration on graph display instead of relying on automatic algorithm

Out of the 6500+ simulations performed with simtiva.app in the past 3 months, Eleveld model was the most popular model, accounting for over half of the sessions performed. Schnider and Marsh models were 2nd and 3rd most used models.

🆕The @who.int has announced that the theme of World Patient Safety Day 2025 will be “Safe care for every newborn and every child”, emphasising the need for stronger measures to protect children from preventable harm. Read more below⬇️ www.pslhub.org/learn/organi... #patientsafety

At work, with SimTIVA 😁

2024 Recap (4) Do you prefer to use Schnider or Marsh model in TCI? SimTIVA.app has an “Eleveld emulation tool” that converts a Marsh/Schnider TCI infusion scheme into CP, CE & estimated BIS values as predicted by the Eleveld model. This helps to compare older models with the Eleveld model. #ansky

2024 Recap (3) In March, I have increased the max infusion duration to 6h (previously 2h). This should be adequate for most cases. A warning prompt will appear to suggest the user to continue with usage of SimTIVA. Once a new target is updated, you can run the sim for another six hours.

2024 Recap (2) Time travel: SimTIVA is designed to be run in real-time, in parallel to the time course of an actual clinical case. In addition, SimTIVA also allows you to jump back and forth in time, like skipping to different time points of a video; resetting to time zero; or pause a sim.

2024 Recap (1) SimTIVA.app has introduced a number of features this year. In Jan, we have added a “preview box” to describe the upcoming infusion scheme as you input a new Target, so you can can adjust your pump settings in advance

Of all the nerdy things that I do, I find much joy in troubleshooting the “arrow” problem: the arrow of the trend line of the PTOL index was always a bit off… but why? I finally fixed it

Enjoying the eBIS on @simtiva.app and how it’s comparing to real time values! My Braun pump doesn’t give that number

My entry for the @sivatrainees.bsky.social #SIVA24 infographic competition. Is there one model to rule them all? Well tbh I think it doesn't matter all that much, as long as you know your model well! You can find a more detailed explanation on my website: hibalazs.net/anaesthesia/... #ansky

RCT: Perioperative intravenous lidocaine infusion did not improve the return of gut function after elective minimally invasive colonic resection. ja.ma/4eNDNi7

Working over the weekend to clean up and optimize the code, most of the changes are under the hood, this won't add new features but will minimize the load times and initial file size transferred. As a web app, performance and speed matter. Load times consistently around 1s across the globe.

Simtiva.app TIP: ✨ U may share your simulation via the "share" button (A). U may then choose to share the sim as a picture (B) or a weblink (C) via your favorite apps. U may enter a filename(D). Weblinks can be opened by the SimTIVA viewer which has an interactive interface. manual.simtiva.app?ch=9

Hi, also introducing: Simtiva.vet is a web app developed by me and Enzo Minghella. It helps to guide total intravenous anaesthesia (TIVA) in small animals. The models included are Beths (Propofol), Cattai (Propofol), Cattai (Fentanyl) in dogs and Cattai (Propofol) in cats. #vetsky #vetmed

First post here! Simtiva.app is a web-based simulator for TCI/TIVA. It allows the use of Eleveld model (the latest one!) for propofol in "CE targeting", so you may use the suggested scheme on any syringe pump without TCI Eleveld functionality. Other drugs and models also available for simulation...