Using screen-based simulation of inhaled anaesthetic delivery to improve patient care

Abstract

Screen-based simulation can improve patient care by giving novices and experienced clinicians insight into drug behaviour. Gas Man(®) is a screen-based simulation program that depicts pictorially and graphically the anaesthetic gas and vapour tension from the vaporizer to the site of action, namely the brain and spinal cord. The gases and vapours depicted are desflurane, enflurane, ether, halothane, isoflurane, nitrogen, nitrous oxide, sevoflurane, and xenon. Multiple agents can be administered simultaneously or individually and the results shown on an overlay graph. Practice exercises provide in-depth knowledge of the subject matter. Experienced clinicians can simulate anaesthesia occurrences and practices for application to their clinical practice, and publish the results to benefit others to improve patient care. Published studies using this screen-based simulation have led to a number of findings, as follows: changing from isoflurane to desflurane toward the end of anaesthesia does not accelerate recovery in humans; vital capacity induction can produce loss of consciousness in 45 s; simulated context-sensitive decrement times explain recovery profiles; hyperventilation does not dramatically speed emergence; high fresh gas flow is wasteful; fresh gas flow and not the vaporizer setting should be reduced during intubation; re-anaesthetization can occur with severe hypoventilation after extubation; and in re-anaesthetization, the anaesthetic redistributes from skeletal muscle. Researchers using screen-based simulations can study fewer subjects to reach valid conclusions that impact clinical care.

Context-sensitive decrement times for inhaled anesthetics in obese patients explored with Gas Man®

“…10 h) are limited and there are no clinical investigations comparing the recovery of obese and morbidly obese patients after longer durations of volatile anesthesia. Further, Table 3 Awakening times for desflurane, sevoflurane and isoflurane after a duration of anesthesia of 1, 5 and 10 h for the four different simulation models Decrement times are displayed in min:s. Since one simulation model only has one decrement time for one specific volatile agent and duration of administration, no further statistical analysis can be performed [5] and sevoflurane group 41 [6] kg m 2 ) after volatile anesthesia combined with a target controlled infusion of remifentanil (duration of administration in desflurane group of 112 [28] and sevoflurane group 112 [33] minutes) after laparoscopic gastric banding [42]. In this clinical investigation, postoperative recovery was assessed with the Aldrete score [43].…”

“…To study uptake, distribution and elimination of inhalational anesthetics, the Gas Man simulation software has been used extensively [24][25][26][27][28]. This research report is based on simulation data and does not involve human subjects, either directly or indirectly.…”

“…Gas Man is a physiology-based computer simulation software for simulating uptake, distribution, and elimination of inhalational anesthetics. It predicts expired partial pressure during induction and awakening with high accuracy and can improve patient care [28,29]. It contains a flow-limited four-compartment mammillary model (alveolar gas, the vessel-rich group, muscle group and fat group) of tissues, connected with the circle system.…”

Development and Testing of Screen-Based and Psychometric Instruments for Assessing Resident Performance in an Operating Room Simulator

“…Screen-based simulation has had an important role in the field of anesthesiology [ 16 ] including recent reports that address its impact in education [ 17 ] and in patient care [ 18 ]. The methodology we report here promotes a role for screen-based simulation in the conduct of randomized controlled experiments in which blinded assessment of subjects is required.…”

2015 BJA/PGA Special Issue: a selection of nine educational reviews

“…A review in the Obstetric Anaesthesia section by Katz and Beilin 8 discusses the major acquired and inherited disorders in coagulation that can complicate labour and delivery. Finally, in the Education section, Philip 9 discusses a computer simulation approach to teaching anaesthetic uptake and distribution.…”