Eleveld TCI model is useful for patient with extreme BW, & avoids BW adjustment problems w/Marsh or Schneider. But most hospitals are not equipped with an Eleveld TCI pump yet. SimTIVA.app bridges this technological gap. It enables Eleveld TCI using any syringe pump.

Cross-validation: Our Eleveld engine vs SimTIVA (open-source TCI simulator) We ran SimTIVA's pharmacology.js directly to compare. Results across 6 patient profiles: Eleveld implementation accuracy: - Max Ce deviation: 0.03-0.3% - Root cause: FFM formula difference (Al-Sallami full vs simplified) - Clinically identical Model comparison (Eleveld vs Marsh vs Schnider) reproduced in SimTIVA: - 50y 70kg M: M/E=0.810, S/E=0.886 - 75y 65kg M: M/E=0.737, S/E=0.782 - 90y 52kg M: M/E=0.730, S/E=0.706 These ratios match our independent calculation within 0.1-0.3%. The 27-31% Ce underestimation by Marsh/Schnider in the elderly is NOT a software artifact — it's inherent to the model mathematics. Note: SimTIVA Marsh uses ke0=1.21 (fast), unlike Excel_PkPd ke0=0.26. This affects induction Ce dynamics but not steady-state ratios. #Propofol #TCI #TIVA #SimTIVA #Eleveld #Validation

クロスバリデーション: 我々のEleveldエンジン vs SimTIVA SimTIVAのpharmacology.jsを直接実行して照合しました。 実装精度: - 全6プロファイルでCe偏差 0.03-0.3% - 原因: FFM計算式の差(Al-Sallami完全版 vs 簡略版)のみ モデル間乖離もSimTIVA内で再現: - 50y 70kg M: Marsh/Eleveld=0.810 - 75y 65kg M: M/E=0.737 - 90y 52kg M: M/E=0.730 高齢者でMarsh/Schniderが27-31%低く予測するのはソフトウェアの問題ではなく、モデルの数学的構造に内在する乖離です。 SimTIVA, Excel_PkPd, 我々のアプリ、いずれで計算しても同じ結論が得られます。 注: SimTIVA Marshはke0=1.21(fast)、Excel_PkPdはke0=0.26。導入直後のCe動態は異なりますが定常状態の比には影響しません。 #プロポフォール #TCI #TIVA #SimTIVA #Eleveld #麻酔科

As for the "infusulator", it can be accessed through "research mode". Click on the "Labs" button on the initial screen and the research mode can be activated. This mode also offers an easy export feature for a CSV file containing CP/CE/vol infused over time.

The live preview feature can help to decide the induction dosing. As you enter the initial bolus, the graph will be updated simultaneously. Similarly, you can try and change the bolus and infusion input after simulation has started and the predicted curves (dotted lines) will automatically appear

Upcoming feature: live preview of bolus/infusion rate change in manual mode. Sometimes, we need to change our infusion rate or give an extra bolus, SimTIVA now plots the curve for the predicted effects of such change dynamically as you enter your values. Below examples show the "live preview feature" of: reduction of propofol inf rate, and giving a bolus of fentanyl. Will be released soon.

Conversely: you can also enter a series of manual bolus infusion regimen to see the PKPD response over time. The below is the Roberts regimen, simulated based on Eleveld model, with resultant CE/CP values

The future of target-controlled infusion and new... : Current Opinion in Anesthesiology journals.lww.com/co-anesthes…

"... 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." #anaesthesia #MedTwitter doi.org/10.1111/anae.70003

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.

iOS 26 has broken the interface of Simtiva quite badly… will try to fix it soon

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. Using time-to-peak-effect (Tpeak or TPE) method (ref2), by deriving the TPE of Navarette-Dyck (1.6min), a new ke0 is re-calculated and applied to the Kamp model. TPE method is advantageous because TPE is model-nonspecific. This would result in more accurate CE prediction/targeting. You may also read more about ke0 and how it affects TCI here (ref3) At the same time, the algorithm for Kamp will be updated with more accurate loading dose and less frequent infusion rate changes by default. Thanks to @propofoldream for suggesting this and his thoughtful guidance. Ref1:pubmed.ncbi.nlm.nih.gov/3954… Ref2:pubmed.ncbi.nlm.nih.gov/1288… Ref3:associationofanaesthetists-p…

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 ref: pubmed.ncbi.nlm.nih.gov/3299… In the following example, a low dose ketamine infusion regimen described in the literature (0.3mg/kg bolus followed by 0.15mg/kg/h infusion) resulted in stable CP of 100ng/ml for the first 2h. (100-200ng/ml: target range for analgesia). Alternatively, u may use CE or CP targeting in SimTIVA to guide TCI ketamine.

The future of target-controlled infusion and new... : Current Opinion in Anesthesiology journals.lww.com/co-anesthes…