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The Eleveld model dissected Prof. Dr. Hugo Vereecke, University of Groningen, The Netherlands Friday 19 January 9:00-9:30 In 2018, Douglas Eleveld, from the University of Groningen,  published a new PKPD model for propofol based on the “open TCI initiative” database.1 This database, initiated by S. Shafer and C. Minto, combined a large amount of raw data derived from previously published studies on the PKPD of propofol, remifentanil and some other drugs. By combining these  globally acquired data, including several  demographic subgroups of people, Eleveld developed a so called “general purpose” model for propofol,  a single PKPD model that can adjust the propofol administration towards predictable results in all types of patients, including lean and obese adults, elderly and children. As even the largest database may contain limited information on rare demographic characteristics, the model also incorporates mathematical solutions to avoid extreme deviations of drug administration in such patients. The first prospective validation studies reveal promising results.2 However, when switching from one TCI

Patient-Maintained Sedation Smart pharmacologic concepts beyond the OR Gavin NC Kenny Friday 19 January 11:00-11:30 Conscious sedation allows patients to undergo procedures which they would otherwise be unable to tolerate. The sedation must not contribute any morbidity or mortality to the procedure and ideally should be safe when used by surgeons and physicians as well as anaesthetists. Satisfactory sedation has been reported with TCI propofol in patients undergoing upper gastrointestinal endoscopy and surgery under regional blockade. Patient-maintained sedation (PMS) allows the patient to control the target concentration of propofol using a button push. Studies suggest that this provides rapid, safe and effective relief of anxiety. The requirement was to develop a system which cannot allow the patient to overdose. Recent studies demonstrated the feasibility of using degradation in patient reaction time as a control function. The use of reaction time to control the target concentration of propofol may increase the margin of safety during sedation. With more procedures being undertaken using

Multimodal monitoring to guide TIVA:more windows more light? Luc Barvais MD, PhD1 and Sean Coeckelenbergh, MD2 Saturday 20 January 8:30-9:00 Erasme University Hospital, Brussels Paul Brousse Hospital, Paris Improving TIVA by personalizing monitoring TCI titration is very important in the daily clinical anaesthesia practice to decrease the risk of agitation and sometimes delirium in the postoperative period which could be associated with postoperative cognitive dysfunction.  The aim of new TCI techniques is to get perfect recovery with patients walking rapidly after moderate to major surgery without any mental alteration. In an international survey published in 2022, the rate of responses was essentially in Europe with 255 respondents in Western Europe, 96 respondents in Southern Europe and 76 respondents in Eastern Europe (1).  The majority of respondents considered anaesthetic depth monitoring EEG either always or on most occasions important while a majority never or occasionally found antinociception monitoring important with a statistically significant difference.  The respondents use EEG monitoring more often during

Measuring online exhaled propofol: – feasible, useful, the future of TIVA, or a toy from the industry? Johan Raeder1,2 Saturday  9:30- 10:00 Co-Authors: Martin Rygh Braathen1,2,  Ivan Rimstad2, Terje Dybvik2 Ståle Nygård3 1 Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway 2Dept. of Anaesthesiology, Division of Critical Care, Oslo University Hospital, Oslo, Norway 3 Dept. of Informatics, Faculty of Mathematics and Natural Sciences, University of Oslo. Oslo Centre for Biostatistics and Epidemiology, University of Oslo, Oslo, Norway Background/Introduction: Ion Mobility Spectrometry (IMS) allows for online quantification of exhaled propofol concentrations. The concentrations are extremely low (parts per billion!) and the technology has so far been very cumbersome and only used for research purposes. Recently a commercial bedside online IMS device, the Edmon®, were developed for predicting plasma concentrations of propofol in everyday OR practice. We got the opportunity to test this device in a series of gastrosurgical patients (normal weigt and obese) and children, by comparing exhaled propofol with plasma

With a Hammer everything looks like a Nail How to use Tivatrainer Frank Engbers Friday 19 January 9:00-9:30 Initially, pharmacokinetic models were developed in pharmacological research to elucidate and forecast the temporal profile of drug concentrations upon administration to the body. The utilization of these models in Target Controlled Infusion pumps involves reverse engineering them to eliminate the time component in dosing. Throughout the evolution of Target Controlled Infusion techniques, I believe that the significance of the virtual blood or effect site concentration has been somewhat overestimated, leading to chaotic and uncontrolled implementation in commercial infusion pumps. This is evident through various implementations of the same drug model, different models for the same drug, extrapolation of patient data to inexplicable extremes, the ongoing challenge of determining the correct blood brain equilibration delay and its impact on induction dosage, as well as references to publications that cannot be traced. Tivatrainer was developed several years ago to educate healthcare professionals on IV

Dr. Hugo E.M. Vereecke (°04/07/1972) became a medical doctor at the Ghent University, Belgium (1997) and consultant anesthesiologist (2002) at the University Hospital Ghent, Belgium. After finalizing his PhD Thesis (2007) on improving anesthetic drug titration using neuro-physiological monitoring, he proceeded an academic career at the University Medical Center Groningen (UMCG) (2010-current), the Netherlands, where he became an assistant professor in anesthesia (2012-current). He is involved in multiple study-projects related to anesthetic pharmacology, such as: the improvement of pharmacokinetic-dynamic models for anesthetic drugs; using interaction models to predict responsiveness during anesthesia; exploring the use of electroencephalographic derived information to individualize titration of anesthetic drugs. Dr. Hugo E.M. Vereecke currently combines his academic position with a clinical consultancy at the general hospital AZ Sint-Jan Brugge-Oostende AV, Brugge, Belgium (2016-current). He is an experienced lecturer and educator in his domain of expertise. He is co-promotor of several PhD’s and masterthesis. He volunteered in several professional societies and committees: the medical ethical committee

Why are we still talking about volatile anaesthesia? Why do anaesthetists feel comfortable with sticking to old practice and don’t feel the need to progress? And why does the medical literature offer so little to support this change?I remember when I was teaching a trainee during the end of last year. He was fairly advanced in his training and knew about pharmacology the best of what is required for the exam and beyond. We were in cardiac theatre and I was asking him about his consideration regarding the choice of anaesthetic drugs. He knew I was expecting a favourable portrait of TIVA but I asked him to challenge me with anything good he can think of about volatiles. We then talked about almost everything from cardio-protection, organ toxicity, PONV, recovery times to physiologic regulation and effects on the endothelium and the inflammatory response. We discussed the most cited studies and debated the details in each paper until we ended in

Alain Borgeat was clinically working as Head of the Anesthesiology Department, Balgrist University Hospital Zurich, Switzerland with the main focus on Regional Anesthesia and Perioperative Pain Medicine. Since his retirement he works as Senior Research Consultant at the Balgrist Campus, University of Zurich. He was chairman and initiator of the annual EUROSIVA Winter Symposium in Crans-Montana, Switzerland.