Well written! Especially agree with the part about how dumb the web interface of Linkedin is with annoying popups to use their app, which takes plenty of storage space...

Thanks to @propofoldreams.bsky.social for suggesting this and his thoughtful guidance.
At the same time, the algorithm for Kamp has been updated with more accurate loading dose and less frequent infusion rate changes by default.

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You may also read more about ke0 and how it affects TCI here (ref3).
References:
Ref1:https://pubmed.ncbi.nlm.nih.gov/39546215/
Ref2:https://pubmed.ncbi.nlm.nih.gov/12883405/
Ref3:https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.12642

Using time-to-peak-effect (Tpeak or TPE) method (ref2), by deriving the TPE of Navarette-Dyck (1.6min), a new ke0 is re-calculated and applied to the Kamp model. TPE method is advantageous because TPE is model-nonspecific. This would result in more accurate CE prediction/targeting.
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I am not an expert but it is a controversial topic. Linassi published in A&A earlier this yr: journals.lww.com/anesthesia-a...

Also its accompanying editorial is interesting: journals.lww.com/anesthesia-a...

In short, a moderate bolus dose of ketamine increases BIS, but with a delayed effect.

Perhaps other Ketamine enthusiasts can enlighten us on their recipes? (TCI or otherwise) . Want to learn from you too

Hi! I haven't tried TCI Ketamine myself. Mark Barley suggested to me to add this to Simtiva, which I think is a great idea. When I use Ketamine for analgesia intraop, I usually do 0.3mg/kg bolus then approx 0.1-0.2mg/kg/h, and I used this for laparotomy cases, and I think it is a good analgesic...

E.g. low dose ketamine infusion regimen described in the literature (0.3mg/kg bolus followed by 0.15mg/kg/h infusion) resulted in stable CP of 100ng/ml for the first 2h. (100-200ng/ml: target range for analgesia). Alternatively, u may use CE or CP targeting in SimTIVA to guide TCI ketamine.

#ansky

Excellent and easy to follow article

Glass bottle?

Thanks for featuring the SimTIVA app!

To further demonstrate the drawback of RSI using 1200ml/h bolusing speed of pump-delivered bolus, in the same patient, CE of 3 cannot be achieved within 60s. It needs 1m23s to deliver that bolus and achieve a CE of 3 according to simtiva.app simulation (picture)