SimTIVA

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.

@IzvlNpzd Great to connect with you too! Honoured to be mentioned and glad that Simtiva is useful to you.

@simtiva_app Thank you! We actually used SimTIVA as a cross-validation reference for our Eleveld engine — great to connect with you. Happy to discuss any findings or differences you spot!

Introducing 3 FREE anesthesia PK/PD simulators. Built by an anesthesiologist, for anesthesiologists. All run offline as PWAs. No login, no ads. Propofol TCI | Remimazolam TCI | Rocuronium PKPD Thread below

@IzvlNpzd Amazing

Two approaches to PK engine computation in TCI simulators: Analytical Exponential (STANPUMP-derived): - Closed-form solution with eigenvalue decomposition - Exact within constant-rate segments - Requires piecewise junction management at rate changes 4th-Order Runge-Kutta (RK4): - Numerical ODE integration (dt=0.01 min) - Uniform accuracy across ALL phases - No special handling at rate changes - Simple extension to N compartments Our Remimazolam TCI app uses RK4 -- validated against Excel_PkPd Ver1.46 Lite (Prof. Nakamura, Hiroshima Univ.) Max deviation: Cp 0.57%, Ce 0.52% At t>=15 min: <0.001% Both methods are valid. RK4 was chosen for its simplicity and uniform accuracy across bolus, rate changes, and steady-state phases. #TCI #TIVA #Anesthesiology #Remimazolam #Pharmacokinetics

@IzvlNpzd Amazing

TCIシミュレータのPKエンジン：2つのアプローチ 解析的指数関数法（STANPUMP由来）： - 固有値分解による閉形式解 - 定速注入区間では厳密解 - 速度変更時に区間接続処理が必要 4次ルンゲ・クッタ法（RK4）： - 数値ODE積分（dt=0.01分） - 全フェーズで均一な精度 - 速度変更時の特別処理不要 - N個のコンパートメントへの拡張が容易 当アプリはRK4を採用。Excel_PkPd Ver1.46 Lite（中村隆治教授・広島大学）との相互検証済み。 最大偏差：Cp 0.57%、Ce 0.52% t>=15分以降：<0.001% どちらも有効な手法です。RK4はボーラス・速度変更・定常状態の全局面で均一な精度を実現できる点で採用しました。 #TCI #TIVA #麻酔科 #レミマゾラム #薬物動態

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

@IzvlNpzd Your page is utterly fascinating! Well done! Let me read through and play with your apps

1/ Propofol TCI Simulator Eleveld 2018 model. Target plasma or effect-site, real-time PK/PD curves. ysuzuki1978.github.io/propofol-tci-s…

You can share the timer via a link, or a QR code. You may also arrange a timetable schedule in advance, and describe each stage of the timetable. The reason why we developed this is that, there is nothing like this on the market. A free, cloud-connected timer, with no ads, that is simple and intuitive. If you are interested, have a play around! May be buggy still. Will continue to improve.

Introducing CloudTimer.app Have you conducted a viva or osce examination? My friend Eric and I wrote this little app to help synchronize the countdown timer - this web app is a cloud-connected timer, so that the host can control the countdown and multiple viewers can connect to the same timer simultaneously. This serves the purpose of syncing the timers across different stations/exam rooms.

@fuma_nama Great achievement

Fumadocs just reached 10k stars on GitHub, a phenomenal journey and life-time milestone to me. Been working hard with passion to make an open source docs framework that's truly flexible & powerful. Kudos to everyone in this wonderful journey 🙌

The December update also includes important bugfixes e.g. dexmedetomidine algorithm, event editing bug, etc

December updates for Simtiva.app: (1) Infusulator, a retrospective time series data entry tool to simulate the infusion data from a list of raw 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

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.

@CannulaTech Great, thanks

@simtiva_app Ah, yes. Had a bit of play around with it. Looks good!

"Infusulator", first created by Dr. Matthew Hart, to be incorporated into 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.

@CannulaTech Hi, thank you for your messages! The "infusulator" will work separately from the main app functions. To access the "infusulator", you can use the "research mode", which is available on the front screen. I shall introduce more about the feature soon

@simtiva_app Would love to play around with these. The app massively helps plan for RSIs that I plan to run on volatile but would love to have information from pk/pd modelling to help plan peri-induction period. Although i hope the current non-infusulator interface will stay as well.

Coming soon to SimTIVA, with a number of bugfixes, in December

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