Pharmaokinetic/dynamic TCI Model: StanPumpR

[Soparklion]

Does anyone use StanPumpR by Steve Shafer to analyze and adjust propofol infusions? We don't have PCI in the US, so we need to use other simulations if we want guidance. It gives overestimates wakeup time for TIVA cases; for a standard sized 50 yo patient after 5 hours or propofol at 150 mcg/kg/min the time to wakeup is 220 min, after 6 hours it calculates 370 min. This is obviously not consistent with clinical reality... does anyone have an alternative or a way to adjust the site to give accurate information?

Link: https://steveshafer.shinyapps.io/

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[deleted697535]

Itiva app on your phone can use marsh or scheider 3 compartment models. Works fine. Wakeup is whatever you want it to be. They just tell you Ce, you choose what you want it to be

 

[Soparklion]

Itiva app on your phone can use marsh or scheider 3 compartment models. Works fine. Wakeup is whatever you want it to be. They just tell you Ce, you choose what you want it to be

I agree that Ce is the question, eg at what concentration will the pt awaken? for anyone who is not familiar.

So how do you set Ce? StanPumpR uses a Ce = 1.0. After a 5 hour infusion, it takes ~70 min to fall from 1.2 to 1.0. Patients awaken sometime between 1.2 and 1.0, which in this case is sometime over that hour...

 

[deleted697535]

Ce 2 is a sedated but breathing patient, rousable

4 needs an lma

8 needs a tube.

Thats the rough numbers i learned way back. Thats for schneider

I have no idea what a stan pump is. Ive no idea what algorithm it uses.Id have to study the algorithm and the volumes.

It shouldnt take 70 mins to awaken someone with a tci. . Thats what happens with constant infusions. With a properly working tci algorithm the pump literally stops pushing drug for an uncomfortably long time...

I've gotten wakeups down to 7 mins after an 8 hour case with tiva schneider. I dont Feel comfortable gettng faster wakeups than that. And dont need to as i can time it with the sutures for close up. Theyre very light at that stage. Any un toward move by a surgical resident can wake them and make me look stupid. Lol even stupider

 

[GassYous]

I have no idea what you guys are talking about

 

[abolt18]

I have no idea what you guys are talking about

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[deleted162650]

I have no idea what you guys are talking about

In other counties they aren’t smart enough to figure out how to titrate propofol infusions, so they need fancy pumps to do it for them.

 

[GassYous]

In other counties they aren’t smart enough to figure out how to titrate propofol infusions, so they need fancy pumps to do it for them.

I just go up on the numbers on the screen until the patient falls asleep then I go down on the numbers on the screen to wake them up. I'm a simple man.

 

[woopedazz]

You US guys are missing out.

#PumpLife #TCfly #Set&Forget

 

[deleted697535]

In other counties they aren’t smart enough to figure out how to titrate propofol infusions, so they need fancy pumps to do it for them.

Yeah thats it.

Pharmacokinetics/dynamics is really easy if you just ignore it. Like Trump. Drink the lysol, be grand ;-)

The pumps are a surrogate for the knowledge behind BET and multi compartment models, partition coefficients etc. Anesthesia trainees and consultants are facile with these terms for a number of drugs, algorithms in many countries.

To say this pump is not FDA approved therefore im ignoring a very large body of knowledge on my bread and butter medication ie propofol isnt great

If they move, give em more lolol

 

[zizzer]

I use iTiva for ketamine, propofol, and hydromorphone.