We describe an anaesthesia simulator capable of simulating all possible situations during anaesthesia. The Leiden anaesthesia simulator (LAS) may be used with most commercially available anaesthesia equipment and monitors, which are connected to the simulated patient as they are to a patient. A commercially available intubation manikin attached to an electromechanical lung model represents the patient. The lung allows both spontaneous and mechanical ventilation. Compliance, resistance, tidal volume and ventilatory frequency may be altered by a controlling computer. Carbon dioxide production and oxygen uptake are simulated. Physiological signals (ECG, arterial, pulmonary arterial and central venous pressure waveforms) generated by a signal generator under software control provide input to the monitors. All types of ECG disturbances may be simulated. There are facilities for simulating non-invasive arterial pressure measurement and pulse oximetry. A series of physiological models is being developed to control interactions between the cardiovascular and respiratory variables. During a simulation session, a pre-defined scenario is presented to the trainee. The task of the trainee is to diagnose and treat the problem as if in real life. The simulator experiences on the LAS were judged as highly realistic by 28 subjects. This simulator is currently being used for teaching and training of anaesthetists, trainees and anaesthesia personnel and for research.
We have studied the pulmonary uptake of sufentanil in patients during and after a short infusion of the drug. We studied 10 patients undergoing elective coronary artery bypass surgery during anaesthesia with 0.4-0.8% enflurane, before surgery. Sufentanil 50 micrograms min-1 was given over 10 min by a constant rate infusion. During infusion and for 20 min thereafter, blood samples were obtained from the distal port of the pulmonary artery catheter and from a radial artery catheter. Uptake and release of sufentanil into and from the lungs were examined by mass balance and compartmental analyses. At the end of the infusion a mean of 48.9 (SD 18.6)% of the dose was retained in the lungs, and 20 min after infusion retention was 18.4 (22.4)%. Smokers had significantly higher pulmonary retention of sufentanil. The pulmonary volume of distribution of sufentanil, estimated from the two-compartment model, was 20.9 (7.7) litre. We conclude that pulmonary uptake of sufentanil is significant, if the drug is given as an infusion.
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