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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.

Dr Nick Sutcliffe is a UK trained senior clinician with more than 30 years of experience in the fields of Medicine and Anaesthesia. His clinical interests include Intensive Care Medicine (ICM) and Total Intravenous Anaesthesia (TIVA). He is a recognised specialist in TIVA and regularly gives lectures and workshops, both nationally and internationally. He is currently a board member of the European Society of Intravenous Anaesthesia (EuroSIVA). He initially trained in Renal Medicine, before switching to Anaesthesia to pursue his interest in Intensive Care Medicine. His most recent position was Deputy Chairman of Anaesthesia in Doha Qatar; a role including clinical duties as well as a leading position in e-health and clinical governance for the state healthcare system.

Not surprisingly, Luc Barvais from the Erasme University in Bruxelles was the initiator of the development of a local Target Controlled Infusion (TCI) system.  He made a major contribution to the teaching of TCI with the very frequently cited and downloaded publication. We encourage you to take notice from this downloadable publication. Tips-and-Tricks-Acta-2013 From TCI Luc went on to other interesting aspects connected to intravenous anaesthesia: measuring the analgesic component of IV anaesthesia. You can here download a yet unpublished manuscript on the Nociception-Antinociception balance. The-NAN-balance-manuscript-EuroSiva1 The clinical evaluation and validation of the Nociception Level Index was done in the following  publication. EJA_predicting_remifentanil Some further enlightments on the topic can be downloaded here where the effect of Dexmedetomidine on the requirements for remifentanil and propofol is investigated using the Nociception Level Index EJA_Dexmedetomidine_and_NAN Possibly the next development in anaesthesia for the next decade is the development of closeloop anaesthesia. The team at the Erasme Hospital from the Universite Libre in

Until my retirement, just before the Covid pandemic, I was clinically working as a cardio-thoracic anaesthesiologist at the Leiden University Medical Centre with a special interest in paediatric anaesthesia for children with congenital heart disease(CHD). The interest in anaesthesia for CHD was certainly fuelled by the many CHD missions to Surinam. Another clinical highlight and challenge was the re-establishment of the Crawford programme (surgical repair of the thoraco-abdominal aneurysma aortae). Both patient groups have in common that early ectubation ‘on the table’ is preferable. In Surinam because of the limited time postoperative care is available, for the Crawford procedure it allows early assessment of the spinal cord function. Multi modal  intraveneus anaesthesia with Target Controlled Infusion is a great help to accomplish this ‘fast tracking’ or maybe better called ‘early return of patient maintained homeostasis’. Going home with her parents, 5 days after open heart surgery I have not turned my back to clinical work completely. This year I will