Please note: There is an easy to follow online user tutorial included with the SimulatOR software (above).  However, if you would prefer a PDF of the User Instruction Guide, click here to download.

To Install the Program:  

To Run the Program: 

 

Upon a successful installation, there will be a shortcut placed on your Desktop and
under the Start Menu for BIS Titration SimulatOR.
 

 

The BIS Titration SimulatOR was developed as a creative learning exercise for anesthesia professionals to explore BIS-guided anesthesia titration during an animated simulation of surgery procedure. The simulator assumes that the user has basic knowledge regarding BIS monitoring.

 

For each patient, the user has the option of conducting the simulated anesthetic using either a volatile gas, TIVA, or TIVA-TCI technique. Regardless of technique, for a given scenario the user manages induction, intubation, ventilation, and fluids in addition to drug selection and titration. In conditions of inadequate anesthesia, analgesia, or muscle relaxant effect, surgical stimulation and pain thresholds determine patient somatic response and/or surgeon comments.

 

The data presented in the patient scenarios were derived from computer model simulations that were guided by published literature. For each scenario option, patient simulation software (“Body Simulation for Anesthesia” (BODY)[1]) was used to create data for displaying numeric values and trends on the OR monitors (i.e., cardiovascular and other physiological parameters.) In addition, BODY calculated predicted volatile agent concentrations and predicted blood concentrations of intravenous agents, as well as the pharmacodynamic effects and interactions among the anesthetic agents on the cardiovascular, respiratory, and neuroendocrine systems in the simulated patient[2]^,[3]. Of note, BODY incorporates patient age, weight and co-morbidity in the modeled response

 

Anesthetic effect was calculated by estimating both net analgesic level and net hypnotic level, from drug interaction models[4]^,[5],[6] and Aspect’s extensive clinical database[7]. Mean BIS values were calculated from the net hypnotic level. The time variation of BIS trends stems was modulated by the predicted analgesic level[8]. Intensity of noxious stimulation (e.g., laryngoscopy, skin incision, abdominal surgery) was estimated using the relative anesthetic requirement to prevent movement response to each stimulation[9]. The rise in BIS, EMG and cardiovascular parameters with intraoperative stimulation was modeled from published studies and Aspect’s clinical database. The train-of-four response was estimated from the predicted concentrations of muscle relaxant[10]. The simulated response to “perceived” stimulation (i.e., pain) from intraoperative events was created by infusing epinephrine to achieve a hemodynamic response as guided by the literature[11]. The train-of-four level was estimated from the predicted concentrations of muscle relaxant[12]. Patient recovery times from cessation of volatile agent were extrapolated from published studies on recovery from BIS guided anesthesia care[13]^,[14].   TCI pharmacokinetics of remifentanil are based on the Minto model while the Schneider model is used for propofol infusion[15]^,[16].

 

            The integrated simulation environment (vaporizers, syringes, infusion devices, simulated patient monitors) as well as animations used in the simulator were created by Moberg Multimedia.

 

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Minimum System Requirements: