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AnestAssist PK/PD app for iPhone and iPad


4.6 ( 7136 ratings )
Education Medical
Developer: Palma Healthcare Systems LLC
4.99 USD
Current version: 1.9, last update: 7 years ago
First release : 05 Aug 2009
App size: 3.38 Mb

AnestAssist PK/PD is an educational tool used for understanding and visualizing the pharmacokinetics, pharmacodynamics, and interactions of commonly used anesthetic drugs.

Anesthesiologists, CRNA’s, veterinarians, and other clinicians involved with anesthesiology, from residents to the very experienced, will find AnestAssist a valuable tool for understanding rational dosing strategies tailored to individual patients.

Mathematical models, published in peer reviewed anesthesia journals (see www.palmamhealthcare.com), which take into account patient weight, age, and gender, are used to estimate and chart:
Plasma Concentration (IV drugs)
Alveolar Concentration (Inhaled agents)
Effect Site Concentration
Probability of Effect (individual and combined drug interactions)
Analgesia: No response to laryngoscopy
Sedation: OAA/S < 2
NMB: T1/T0=50%

IV drugs included: Propofol, Remifentanil, Fentanyl, Alfentanil, Sufentanil, Dexmedetomidine, Ketamine, Lidocaine, Morphine, Midazolam, Atracurium, Cisatracurium, Rocuronium, and Vecuronium.

Inhaled agents included: Sevoflurane, Isoflurane, Desflurane, Enflurane, Halothane, and Nitrous Oxide.

Interactions modeled: Propofol, Sevoflurane, or Isoflurane with any combination of Remifentanil, Fentanyl, Alfentanil, or Sufentanil.

Users can add drugs and PK/PD model parameters to the system in addition to those included above.

Real-Time Case Capture: Drug entry system facilitates recording drugs administered real-time or retrospectively from intra-operative record. Save to Case Library for later review.

Case Library: Save actual cases or design and add your own cases to the library to record and demonstrate dosing strategies for a variety of patient types and drugs.

AnestAssist runs an enhanced user interface full screen natively on the iPad and in standard mode on the iPhone/iPod. The core functionality is the same on both.

Please see www.palmahealthcare.com for detailed information.

For Educational Use Only

Pros and cons of AnestAssist PK/PD app for iPhone and iPad

AnestAssist PK/PD app good for

of very little clinical use, huge tool to understand pharmacokinetics at a deeper lever. Strongly suggested
In the past I have used several very good PC based PK simulators, TIVA-Trainer and GasMan, both of which cost well over $100 each. This application compares very favorably in terms of functionality, but at a fraction of the cost, and its practical to bring this on my iPod into the OR for teaching and review purposes. The user interface is pretty good and I didnt have too many problems figuring out how to use it. Actually the data entry and display is quite clever considering that with the small screen (compared to a PC) some operations need to be spread out over several screens. I expect the iPad version is better in this respect. The app comes with PK/PD models for quite a few IV and volatile agents, and also allows you to add additional drugs and PK models if you wish (but beware, adding models is a bit complex and only for knowledgeable users). Many aspects of the PK display are configurable, including scaling of the concentration axis and a choice of "real-time" time axis and drug entry (to record an actual case as opposed to experimenting with the simulator). I found this especially useful for teaching purposes in the OR. Also there is the ability to set "reference concentration" lines for drugs for students to use to visualize target concentrations. Questions to the developer were answered almost immediately, and he seems sincerely interested in feedback and suggestions. My own suggestion to the developer is to add some way for me to export "cases" to my PC. Id like to be able to add them to a presentation, or forward as examples to students. As a side note, the idea of cases is this app is not as useful as it could be. This is one area that could use more work, for example to be able to search and sort. Kind of cumbersome now beyond a few cases. Theres a lot more to this app than I have time to write about. Its certainly worth having a look at, especially at the bargain price.
I had this app since it was newly released, and have used it almost daily since then. I just modeled cisatracurium infusion and glanced at the PK/PD (T1 50%) to help with our understanding of the dosing. Then, with my resident, we plotted the sevoflurane/fentanyl and looked at the interaction model by Manyam. If you are administering anesthesia, buy it! If you are using TIVA as your technique, you should have bought it when it came out!
After practicing anesthesia for 17 years I learned a lot about how various infusion rates and boluses will effect my anesthetic by using this software. For a US based anesthesiologist who does not have access to target controlled infusion pumps this is the best option to calculate plasma levels that I am aware of. As a Mac user I could never get StanPump to work and this comes at a fraction of a cost of the TIVA trainer from Eurosiva.org with an interface that is way more user friendly. AnestAssist uses the same published algorithms as TCIs and the other programs. I have used it for a year or more on iPhone and iPad and the only rare glitch I have seen was the program quitting suddenly but I was able to resume where I left off by opening up the application again. To be able to interpret the data properly you will have to know what plasma or effect site concentrations you are aiming for and we think in terms of doses and know little about plasma concentrations. For starters try to simulate various regimens to achieve a propofol plasma concentration of 3 or 4 mcg/ml (common target for TCIs) then set the infusion to 0 mcg/kg/min and see how soon will plasma concentrations reach 1-1.4 mcg/ml where most patients will wake up. Try infusion rate changes versus boluses and look at how long it takes for plasma concentrations to change. Then do the same for dexmedetomidine. You will be surprised at what you learn. In summary: excellent, easy to use tool you just have to learn what to do with the results.
Ive been using this for almost a year, and it is fantastic. I teach residents and I use this to show the difference that solubility coefficients make in short vs long cases, how WHEN you give fentanyl has a profound effect on plasma level and Ce, how to plan sufentanil infusions, TIVA, neuromuscular blockade. Very easy to use, and now I have a library of real cases and simulated cases to review with my residents.

Some bad moments

It doesnt work!!! It conks out after the first run Dont buy it!!
Idea is great. Data entry is cumbersome. Time hard to track; you must enter in clock hours but is displayed from time 0. Graphs truncate at seemingly random times from time zero, even if curve has not decayed to baseline. Graph scale doesnt change if you use larger doses than the software designer anticipated (as many may do with fentanyl, for example.) It doesnt take long to regret making the purchase price.
It should have been a red flag that this app has not been updated since 2010.