title: Using screen-based simulation of inhaled anaesthetic delivery to improve patient care.
abstract: Screen-based simulation can improve patient care by giving novices and experienced clinicians insight into drug behaviour. Gas Man(®) is a screen-based simulation program that depicts pictorially and graphically the anaesthetic gas and vapour tension from the vaporizer to the site of action, namely the brain and spinal cord. The gases and vapours depicted are desflurane, enflurane, ether, halothane, isoflurane, nitrogen, nitrous oxide, sevoflurane, and xenon. Multiple agents can be administered simultaneously or individually and the results shown on an overlay graph. Practice exercises provide in-depth knowledge of the subject matter. Experienced clinicians can simulate anaesthesia occurrences and practices for application to their clinical practice, and publish the results to benefit others to improve patient care. Published studies using this screen-based simulation have led to a number of findings, as follows: changing from isoflurane to desflurane toward the end of anaesthesia does not accelerate recovery in humans; vital capacity induction can produce loss of consciousness in 45 s; simulated context-sensitive decrement times explain recovery profiles; hyperventilation does not dramatically speed emergence; high fresh gas flow is wasteful; fresh gas flow and not the vaporizer setting should be reduced during intubation; re-anaesthetization can occur with severe hypoventilation after extubation; and in re-anaesthetization, the anaesthetic redistributes from skeletal muscle. Researchers using screen-based simulations can study fewer subjects to reach valid conclusions that impact clinical care.
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA jphilip@partners.org.
authors.forename: J H
authors.initials: JH
authors.lastname: Philip
mesh_terms: D000769:Anesthesia, Inhalation / Q000379:methods / Q000592:standards*; D000776:Anesthesiology / Q000193:education; D018685:Anesthetics, Inhalation / Q000008:administration & dosage* / Q000493:pharmacokinetics; D003196:Computer Graphics; D003198:Computer Simulation; D004503:Education, Medical, Graduate / Q000379:methods; D006801:Humans; D058996:Quality Improvement
chemical_list: D018685:Anesthetics, Inhalation
keywords: anaesthesia, general; anaesthetic techniques, inhalation; anaesthetics, gases; anaesthetics, volatile atmospheric pollution