BIS Titration SimulatOR / SimulatOR InstructionBooklet 087-1042 2_00

							User Guide
	BIS Index Information	Customer Service				BISTitration SimulatORtm
	1-888-BIS-INDEX	1-800-442-7688
	Clinical Information	Technical Support				Version 2.0
	1-800-442-8655	1-800-442-2051
Aspect Medical Systems, Inc.		Aspect Medical Systems
World Headquarters		International B.V.

Phone: [phone]		Phone:
Fax:	1-617-559-7400	FAX:
Email:	[e-mail]	email:

+31.30.662.9140

+31.30.662.9150

[e-mail]

education

www.BISeducation.com

© 2009, Aspect Medical Systems, Inc. 087-1042 2.00

Aspect, BIS, the BIS logo and Bispectral Index are trademarks of Aspect Medical Systems, Inc., and are registered in the USA, EU, and other countries. All other trademarks or registered trademarks are property of their respective owners.

Produced by Moberg Multimedia

education

Contents

This manual is designed to help you

install and use the BIS Titration SimulatORTM. It contains six sections:

Installation...............................................................	1
Overview............................................................................	1
Navigation...................................................................	2
Starting a Case...................................................	6
Managing a Case............................................	7
Finishing a Case..............................................	12

Minimum Computer Requirements:

•Processor: Pentium 4 CPU 2.4 GHz

•Operating System:Windows XP/Vista (32-bit)

•Memory/RAM:Windows XP – 512MB,

Windows Vista – 2GB

•Free hard disk space: 50MB

•Color Display Resolution: 1024x768

•Sound capabilities and speaker or headset

•CD-ROM drive

installation

To install the BIS Titration SimulatOR™:

•Insert the CD into the computer’s CD-ROM drive

•Using Windows Explorer or My Computer, go to the CD-ROM drive

•Double-click on “Setup.exe” and follow the instructions on the screen

To run the BIS Titration SimulatOR:

Upon a successful installation, there will be a shortcut placed on your

desktop and under the Start Menu for BIS Titration SimulatOR.

• Double-click on the BIS Titration SimulatOR shortcut on the desktop1 OR

• Go to Start Menu >> All Programs >> BIS Education >> BIS Titration SimulatOR

1When launching the program, you may get the following warning: “Open File – Security Warning,” stating that the software is from an unknown publisher. Click on “Run” to ignore this warning and proceed with the simulation.

overview

Goals and Desired Ranges

The BIS Titration SimulatOR lets you explore BIS guided titration in a simulated environment.

Goals of the simulated anesthetic management:

•Keep BIS in range 80% of the time

•Maintain patient hemodynamic vital signs (Heart Rate and Mean Arterial Pressure) within range at least 80% of the time

•Refrain from using cardiovascular drug interventions (Ephedrine & Labetalol) to treat hypotension or hypertension

The desired ranges are as follows:

•BIS 45-60

•HR 50-95

•MAP 70-100

1

navigation

The SimulatOR has various components to help you navigate through a case:

• The BIS monitor	• Stimulation meter
• Vital signs monitor	• Tabs with various controls and
• Animated patient	patient information
• Playback controls	• System messages
• Clock	• Surgeon’s comments
• Progress indicator	• Options menu
• Performance evaluation

Monitors

Simulated monitors are provided as the primary means for assessing the patient’s physiological state and responses to surgery and anesthesia.

These displays can be enlarged by clicking on them.

2

The Patient

Throughout the case, be sure to pay attention to the patient, who may exhibit signs of pain, stress, or awareness.

Speed Control

The SimulatOR lets you

control the speed at which you progress through the case.

•Click “PLAY” to move at regular speed, in normal time.

•Click “FAST” to fast-forward the simulation and put it into accelerated time.1, 2, 3 Use this feature to get simulation results faster.

(Speed depends on individual computer capabilities. Use this feature to get simulation results up to 12 times faster.)

•Click “PAUSE” to temporarily pause the case, and “PLAY” or “FAST” when you are ready to resume.

•Click “STOP” to restart the case, select another case, or exit the SimulatOR.

1 The speed will depend on the capabilities of your computer.
2 In fast-forward mode, the waveforms are not displayed on the patient monitor.
3 During a case, occurrence of certain events will cause the case to resume to real-time to alert you of important
changes. These events are:The BIS Sensor guide messages, surgeon’s comments, administration of drugs.	3

navigation Continued

Clock

The clock shows the actual time in the operating room, which is helpful since some parts of the case use accelerated time.

When you begin a surgical case, the clock will be paused.

Once you start the case and begin driving the SimulatOR, the clock will advance as fast as the speed you choose.

Progress Bar

The progress bar indicates where you are in the case from induction through emergence.

Surgical events are marked with longer lines.The details of some of the events are shown directly on the bar with the name of the event and the time it occurred. Other events are marked with just a line that can be clicked on to get more information.

Performance Meters

Three meters monitor and display your performance throughout the simulation:

•BIS IN RANGE displays the percentage of time BIS is kept between 45-60.

•VITALS IN RANGE displays the percentage of time heart rate is maintained at 50-95, and mean arterial pressure is maintained at 70-100.

•BP DRUG INTERVENTIONS displays the number of times Ephedrine or Labetalol was administered.

Together, these meters help you monitor how well you are achieving the goals of the simulated anesthetic management.

Stimulation Meter

The stimulation meter is in the upper left corner of the screen.

Throughout the case, it measures the intensity of the surgery and displays a value between 0 and 10. 10 indicates the highest level of surgical stimulation.

Expandable Tabs

On the left of the screen are four tabs:

•AGENTS AND DRUGS

•STRATEGIES

•PATIENT CHART

•ANESTHESIA RECORD

Clicking on any of the tabs expands them across the screen to give you access to their functions and information.

Tabs are covered in detail in the section “Managing a Case.”

NAVIGATION: BIS Sensor Icon and Surgeon

Throughout the simulation, the BIS Sensor icon may alert you of system related

events, and also provide you with various instructions and options.

The BIS Sensor icon helps guide you through the simulation with messages, which appear in the top

center of the screen.

Throughout the case, the

surgeon may make comments to alert you to surgery related events, such as the start or end of a particular surgical procedure.

The surgeon’s comments, like the BIS Sensor icon, appear in the top center of the screen.

4

5

navigation Continued

Options Menu

The OPTIONS MENU is in the upper left corner of the screen. Click the “OPTIONS MENU” to expand it. From there you can restart the same case, select another case, browse

this tutorial, adjust the volume, contact Aspect Medical Systems, or exit the simulation.

When you restart a case, the previously chosen anesthesia technique will be used.

starting a case

When you start the simulation, you will be presented with several surgical cases to choose from.

Selecting Patient & Technique

ÅSelect a patient by clicking on the patient details on the main board. The patient chart below the board displays pre-anesthesia evaluation and the anesthesia plan depending on the selected technique.

ÇSelect a technique from the board on the right by clicking on the one you would like to use for anesthesia.

ÉBegin the simulation with chosen settings by clicking on the “START CASE” button next to the BIS sensor icon.

When You Begin

The case starts in Pause mode.

•Clock and playback controls in the top right of the screen, as well as

the progress bar at the bottom indicate what is happening with the case.

•AGENTS & DRUGS tab is expanded to show you the primary anesthesia controls available to you.

•When you are ready to begin, click “PLAY” or simply begin administering drugs and anesthetic agents.

•The clock and the monitors will immediately reflect that the case has started.

•Performance meter for the vital signs and interventions will start reflecting the state of the patient right away. And the BIS evaluation will start after intubation or when BIS goes below 60.

managing a case

AGENTS & DRUGS Tab

The AGENTS & DRUGS tab contains the following controls:

•Vaporizer with a pre-programmed drug if “Volatile” technique is chosen

•IV Infusion Pumps if “TIVA” or “TIVA-TCI” technique is chosen

•Ventilator

•Fresh Gas Flow

•“PLACE ETT/LMA” button for intubating the patient

•Lactated Ringer bag

•Syringes for Labetalol, Ephedrine, Rocuronium, Fentanyl and

•Propofol and an associated refill button

		AGENTS & DRUGS Tab contains various controls to help you
		manage anesthesia.
	6		7

managing a case Continued

Vaporizer Control

When “Volatile” is chosen as the technique, the vaporizer control will be present.The drug in the vaporizer is pre-programmed into the scenario.

To adjust the vaporizer drug, click and drag the knob to a desired dosage.

Infusion Pumps

If “TIVA” or “TIVA-TCI” is chosen as the anesthesia technique, two infusion pumps will be present: Propofol and Remifentanil.

Click the associated “INFUSE” button to start the infusion. You can then click the “PAUSE” button to stop infusion.

In TIVA mode, the knob on the pump controls the rate of the infusion. In TIVA-TCI mode, it controls the target concentration and rate is dynamically calculated.

To adjust the knob setting, click and drag the knob

indicator to the desired position along the arc. When the desired number is shown on the knob, click the center of the knob to confirm the setting.

Ventilator Controls

To turn ventilator on or off, click the “ON/OFF” button.

To change the Tidal Volume and Respiration Rate settings on the ventilator, click and drag the knob indicator to the desired position along the arc.When the desired number is shown on the knob, click the center of the knob to confirm the setting.

Fresh Gas Flow Setting

To change the Fresh Gas Flow setting, click and drag the

knob indicator to the desired position along the arc.When the desired number is shown on the knob, click the center

of the knob to confirm the setting.

Intubation

Click the “PLACE ETT/LMA” button when ready to insert designated airway.

System will fast-forward through this procedure and will resume in real-time mode when completed.

If patient is not intubated

within 15 minutes from the start, case will time out giving you a chance to try the same case again or select another.

8

9

managing a case Continued

IV Solution

To change the rate of the IV solution (Lactated Ringers), adjust the fluids controller by dragging the blue knob up and down.

To give a bolus of the fluid, click the “INITIATE BOLUS” button.

NOTE: Infusion bags do not need to be changed. Anesthesia record reflects total volume infused.

Syringe Control

Regardless of the chosen anesthesia technique, the following drugs may be administered via syringe injection:

•Labetalol

•Ephedrine

•Rocuronium

•Fentanyl

•Propofol

To administer a syringe drug, click and drag the plunger to the desired dosage (NOTE: selection will round to nearest 0.5 or 1 ml).

To refill the syringes click the “REFILL SYRINGES” button.

Anesthesia Management Strategies

The STRATEGIES tab shows anesthesia management strategies using the BIS Index.

Depending on the current status of the patient, suggested management strategy is highlighted to guide you through the anesthesia process.

Patient Chart

At any point in the simulation, you can click the PATIENT CHART tab to review the pre-anesthesia evaluation and selected anesthesia plan.

10

11

managing a case Continued

Anesthesia Record

The ANESTHESIA RECORD tab can be expanded to review the history of the drugs administered and patient’s physiological responses, which are charted periodically from the beginning of the case.

To print the record1, click the PRINT RECORD button shown.

1You can print the record to your local printer, or print to file if such an option is available on your computer. You can also print with a PDF writer (such as Adobe Distiller or Cute PDF), if the appropriate software is installed.

finishing a case

Case ends when one of the following occurs:

ÅPatient becomes responsive within the provided timeframe

ÇCase times out because:

a.Patient was not intubated within the provided timeframe

b.Patient did not emerge within the provided timeframe

c.Patient’s clinical situation reached a state requiring advanced interventions beyond simulator capabilities

Performance Summary

After you successfully complete the simulation, you can view the summary of your performance and print the anesthesia record.

The summary section provides an overview of your performance as compared to the goals of

the simulation: BIS in range 45-60 at least 80% of the time, vitals in range at least 80% of the time, and no use of BP interventional drugs.

You can also compare how long your patient took to emerge with the predicted wake-up time for that particular case and mix of administered agents.

12

13