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New App Simulates OR Decision Making, Measures Outcomes in Dollars actions throughout the simulated case. This tool allows clinicians to go back he development of a simulated in time and undo mid-case events, and anesthesia app may help anestheeven make a different decision without siologists save both time and money in restarting the scenario. The models then their practice in the near future. forecast relevant parameters for each new Researchers at the University of Floruser interaction for up to three hours. ida College of Medicine, in Gainesville, Finally, a scrolling time line gives users said the panoramic, screen-based simuthe opportunity to jump forward and lator is particularly adept at assessing the backward in time, either to skip periods cost of neuromuscular blockade admin- The simulated anesthesia app could of inactivity or to undo a previous action. istration, monitoring and reversal, while save both time and money for anesthesia It is this kind of functionality, Dr. Lamalso considering drug costs and the cost practices. potang explained, that allows users to see of associated OR time. the potential costs and savings inherent “Given the continued incidence of residual postoperative neu- in using a particular neuromuscular blockade reversal strategy. romuscular blockade, along with the fairly recent FDA approvUsing an innovation the researchers call a “taxi meter,” the app al of sugammadex, there is renewed interest in fine-tuning the also displays the cost of the procedure on a minute-by-minute monitoring and reversal of neuromuscular blockade,” said Sam- basis. Using a baseline OR cost of $100 per minute, it illustrates sun Lampotang, PhD, the Joachim S. Gravenstein Professor the financial impacts of clinicians’ decisions, such as the time to of Anesthesiology and a professor of urology at the institu- complete recovery from deep neuromuscular blockade. tion. With this in mind, Dr. Lampotang, senior author Nikolaus “This is where sugammadex shines,” Dr. Lampotang said. Gravenstein, MD, and their colleagues developed the interactive “Using a typical simulated patient, we assume that a drug like app, which he said was specifically designed to enable users to rocuronium will take considerably more than 40 minutes to clear practice the administration, monitoring and reversal of neuro- out of the patient’s system on its own. Using neostigmine or glymuscular blockade. copyrrolate, that drops to approximately 20 minutes. But if you The app was built in Adobe Director, a now-discontinued use sugammadex, you’re going to reverse the patient in a minauthoring platform for multimedia applications, to simulate vari- ute or two. So you’ve saved 18 minutes, which we calculate as an ous anesthesia activities in the OR. Although the app uses only immediate savings of $1,800.” one computer screen to simulate the entire OR environment, The app, which was presented at the 2022 annual meetusers can pan around the entire room. ing of the Society for Technology in Anesthesia, is ultimately A range of simulated activities and equipment are represented, much more focused on helping clinicians practice neuromuscuincluding video clips of intubation and laparoscopy. The app also lar blockade and its reversal than on optimizing practice patterns. simulates such equipment as a neuromuscular blockade moni- The researchers verified the app by comparing the output of each tor, an anesthesia machine with user-adjustable flow meters and model with its source material, such as the package insert. It was vaporizers, gas analysis (which models breathing circuit dynamics found that drug concentrations, clinical durations and recovery like wash-in and washout), and physiologic monitoring. times on the app matched these materials. Anecdotally, anesthePharmacokinetic and pharmacodynamic parameters from offi- siologists who used the app said its output matched their clinicial package inserts were used by the developers to mimic (via cal practice. compartmental models) a host of related drugs, including sevo“Our goal in developing the app was not to optimize practice flurane, isoflurane, glycopyrrolate, neostigmine, succinylcho- patterns around neuromuscular blockade, but to offer our cliniline, fentanyl, propofol, rocuronium and sugammadex. These cians more experience,” Dr. Lampotang explained. “So in that inserts were included in the app as searchable PDF files. The sense, there was no agenda. Now that we know it mimics actuapp also displays scrolling time plots of drug concentrations and al practice, though, clinicians can use it to see the effects of their circuit gas concentrations, both of which respond to such user decisions.” actions as drug administration, and provide line of sight of future The researchers are exploring the possibility of repurposing the concentrations. app to include the carbon footprint of each item or consumable used during an anesthetic. A six-minute video of the app can be Navigating the Simulation ■ viewed at bit.ly/3LFutj0. To help users assess the clinical and financial effects of their actions, the app incorporates an event log, which captures all user Dr. Lampotang reported no relevant financial disclosures. By MICHAEL VLESSIDES
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OR Management News • Volume 7 • June 2022
