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You are absolutely right George, thank you for the observation. Let me add that function in the next update. Thanks a lot! 😄

As for the "infusulator", it can be accessed through "research mode". Click on the "Labs" button on the initial screen and the research mode can be activated. This mode also offers an easy export feature for a CSV file containing CP/CE/vol infused over time.

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The live preview feature can help to decide the induction dosing. As you enter the initial bolus, the graph will be updated simultaneously. Similarly, you change the bolus and infusion input values after simulation has started and the predicted curves (dotted lines) will automatically appear

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Terence Luk @simtiva.app · 04/12/2025

December updates - Simtiva.app: (1) Infusulator, a retrospective data entry tool to simulate the infusion data from time series of CP/CE target values. (2) Live preview for manual mode. The graph will be plotted as you type in the bolus or infusion values so you can preview the change in real time

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"Live preview" feature: another demo of adding a fentanyl bolus, as u enter "20mcg", the graph updates simultaneously to show the predicted curves of CP/CE. You may also use this feature to plan your induction (what induction dose to use?) if you are using manual mode. Coming soon to SimTIVA!

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Terence Luk @simtiva.app · 04/12/2025

Upcoming feature: live preview of bolus/infusion rate change in manual mode. Sometimes, we need to change our inf rate or give an extra bolus, SimTIVA now plots the curve for the predicted changes dynamically as you enter your values. Video demo of "live preview" of reducing inf rate from 50 to 30

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Terence Luk @simtiva.app · 21/11/2025

Coming soon to SimTIVA, with a number of bugfixes, in December

Terence Luk @simtiva.app · 21/11/2025

Conversely: you can also enter a series of manual bolus+infusion regimen to see the PKPD response over time. Below is the Roberts manual infusion scheme, simulated based on Eleveld model, with resultant CE/CP values

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Terence Luk @simtiva.app · 21/11/2025

"Infusulator", first created by Matthew Hart, coming soon to SimTIVA. It allows easy entry of a time series of CE (or CP) targets to generate TCI simulations. The conversion from CET/CPT to dosage (volume infused, or the total dose) over time is made simple. An export module is also provided.

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Terence Luk @simtiva.app · 24/10/2025

Well written! Especially agree with the part about how dumb the web interface of Linkedin is with annoying popups to use their app, which takes plenty of storage space...

Anaesthesia @anaesjournal.bsky.social · 01/10/2025

Reposted by Terence Luk

Total intravenous anaesthesia (TIVA) for rapid sequence induction (RSI) Worried your TIVA infusion is too slow for RSI? Why not work with your local manufacturer to develop an ‘RSI-TCI’ mode for your target-controlled infusion pumps? #AnSky #PharmSky doi.org/10.1111/anae...

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Anaesthesia @anaesjournal.bsky.social · 01/10/2025

"... a ‘RSI–TCI’ mode with a pre-programmed manual bolus offers a pragmatic solution for those who wish to preserve an intact pharmacokinetic model for accurate propofol delivery, while allowing the rapid induction clinicians expect from a manual bolus." #AnSky #MedSky doi.org/10.1111/anae...

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Terence Luk @simtiva.app · 20/09/2025

Today I have updated simtiva.app and simtiva.vet - The changes are mainly visual, with a refreshed look. Part of the reason is user feedback regarding the new iOS 26 on iPhones partially breaking the user interface with malpositioned top and bottom elements. Minor bugfixes as well. #ansky

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Thanks to @propofoldreams.bsky.social for suggesting this and his thoughtful guidance. At the same time, the algorithm for Kamp has been updated with more accurate loading dose and less frequent infusion rate changes by default.

(3/4) You may also read more about ke0 and how it affects TCI here (ref3). References: Ref1:https://pubmed.ncbi.nlm.nih.gov/39546215/ Ref2:https://pubmed.ncbi.nlm.nih.gov/12883405/ Ref3:https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.12642

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Using time-to-peak-effect (Tpeak or TPE) method (ref2), by deriving the TPE of Navarette-Dyck (1.6min), a new ke0 is re-calculated and applied to the Kamp model. TPE method is advantageous because TPE is model-nonspecific. This would result in more accurate CE prediction/targeting. (2/4)

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Terence Luk @simtiva.app · 27/08/2025

Ketamine (Kamp) model will be improved soon. On Simtiva, the Kamp model used a ke0 of 0.238, from Navarette PD study using ANI index (ref1). However, that PD study applies to the Domino PK set, and ke0 is model-specific and should not be naively applied to another PK model... (1/4) #ansky

Kamp model for ketamine using different ke0's

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jaj42.github.io/blog/posts/2... An excellent and interesting read for those interested in TCI and programming! STANPUMP is an amazing piece of software

jaj42.github.io

Deep dive into STANPUMP – blog

Terence Luk @simtiva.app · 08/07/2025

I am not an expert but it is a controversial topic. Linassi published in A&A earlier this yr: journals.lww.com/anesthesia-a... Also its accompanying editorial is interesting: journals.lww.com/anesthesia-a... In short, a moderate bolus dose of ketamine increases BIS, but with a delayed effect.

journals.lww.com

Effect of Ketamine on the Bispectral Index, Spectral Edge... : Anesthesia & Analgesia

troencephalogram (EEG)-derived parameters, the BIS and spectral edge frequency (SEF95), after the administration of a ketamine bolus. Secondary aims included investigating the BIS and SEF95 variations...

Perhaps other Ketamine enthusiasts can enlighten us on their recipes? (TCI or otherwise) . Want to learn from you too

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Hi! I haven't tried TCI Ketamine myself. Mark Barley suggested to me to add this to Simtiva, which I think is a great idea. When I use Ketamine for analgesia intraop, I usually do 0.3mg/kg bolus then approx 0.1-0.2mg/kg/h, and I used this for laparotomy cases, and I think it is a good analgesic...

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E.g. low dose ketamine infusion regimen described in the literature (0.3mg/kg bolus followed by 0.15mg/kg/h infusion) resulted in stable CP of 100ng/ml for the first 2h. (100-200ng/ml: target range for analgesia). Alternatively, u may use CE or CP targeting in SimTIVA to guide TCI ketamine. #ansky

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SimTIVA | Free TIVA Simulation App to Simulate Target-Controlled Infusion | Simple TCI Calculator

Low-dose ketamine infusion is an excellent component of multi-modal opioid-sparing analgesia. Kamp model uses meta-analytical technique to facilitate better plasma site targeting for TCI ketamine. This model is now introduced in SimTIVA.app pubmed.ncbi.nlm.nih.gov/32997732/ (1/2) #ansky

simtiva.app

Simple and free TIVA simulator

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Terence Luk @simtiva.app · 28/06/2025

Renewed interest in Ketamine emerged as a result of potentially new indications. Kamp model is an allometric model based on meta-analytical analysis. journals.lww.com/anesthesiolo... Coming soon to simtiva.app #ansky

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Terence Luk @simtiva.app · 12/06/2025

Happy to share that Simtiva (veterinary version), a TIVA simulator for small animals, was successfully used to guide TIVA in prolonged surgery in a cat, and the results were recently published in VAA journal. Simtiva.vet was co-developed by Enzo Minghella & me 1 yr ago and is actively updated.

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Terence Luk @simtiva.app · 13/05/2025

Excellent and easy to follow article

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Terence Luk @simtiva.app · 02/05/2025

SimTIVA.app is fully capable of offline support. The app can be run offline. Internet connection can be unstable sometimes, but rest assured you can still run SimTIVA normally. Also, minor changes to the mcg/kg/min default rate unit display (manual mode) for Propofol, the bug is fixed. #ansky

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Terence Luk @simtiva.app · 25/04/2025

Thanks for featuring the SimTIVA app!

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Reposted by Terence Luk

GasGasGas - The FRCA Primary Exam Podcast @gasgasgaspodcast.bsky.social · 25/04/2025

You've been meaning to get around to reading about the differences between adult TCI models for propofol? On the to do list for .... ever?? Listen to this to get you warmed up, and check out the references in the show notes for the in depth excitement you're desperate to have! #ansky #FOAMed

gasgasgas.uk

TIVA Models for Propofol

TIVA Models for Propofol delivery in anaesthesia. Comparing their pharmacokinetics, clinical use, and pitfalls for the FRCA exam and beyond.

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Terence Luk @simtiva.app · 22/04/2025

Minor update to Simtiva.app: propofol concentration options available: 10mg/ml, 20mg/ml, or custom dilution; plus other bug fixes

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Terence Luk @simtiva.app · 17/04/2025

Feature preview: propofol concentration can be customized (10mg/ml, 20mg/ml, or custom dilution)

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Terence Luk @simtiva.app · 11/04/2025

To further demonstrate the drawback of RSI using 1200ml/h bolusing speed of pump-delivered bolus, in the same patient, CE of 3 cannot be achieved within 60s. It needs 1m23s to deliver that bolus and achieve a CE of 3 according to simtiva.app simulation (picture)

Terence Luk @simtiva.app · 11/04/2025

I agree to an extent. Although the "manual push" bolusing speed was somewhat arbitrarily set at 7200ml/h (2ml/s), it is already 6x as fast as a pump-delivered bolus at 1200ml/h (Fresenius pumps: 1200 is the max). I would argue that one should not use a TCI pump for RSI because it cannot bolus fast!

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Reposted by Terence Luk

Nicholas Chrimes @chrimesy.com · 11/04/2025

The term "TIVA RSI" misrepresents the issue. All RSIs are IV. Whether it's a TIVA anaesthetic depends on whether the subseq maintenance agent is inhaled or IV (& irrelevant to the process of RSI). The question is whether IV induction agents should be administered by an infusion pump during RSI.

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Terence Luk @simtiva.app · 11/04/2025

Interesting! I agree. Simtiva.app has an RSI mode that lets u simulate this scenario, either with a hand bolus or a pump-delivered bolus with max rate of either 1200ml/h or 1500ml/h. Eleveld model was used in the demo. The app lets u set the CE target to be achieved within a specific time, say 60s

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Reposted by Terence Luk

Anaesthesia @anaesjournal.bsky.social · 10/04/2025

Do you use TIVA when you are doing a rapid sequence induction in theatre? #AnSky #AirwaySky #MedSky doi.org/10.1111/anae...

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Reposted by Terence Luk

Anaesthesia @anaesjournal.bsky.social · 10/04/2025

What is your preferred methodology for in-theatre TIVA RSI? #AnSky #AirwaySky #MedSky doi.org/10.1111/anae...

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Terence Luk @simtiva.app · 07/04/2025

Simtiva.app update: RSI mode to facilitate guidance of TIVA in an RSI situation. Eleveld model. #AnSky

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Terence Luk @simtiva.app · 07/04/2025

Simtiva.app update: Dexmedetomidine (Hannivoort) model. CET/CPT/Manual mode available. Welcome any feedback

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Terence Luk @simtiva.app · 04/04/2025

Feature preview: RSI mode coming soon to simtiva.app! How do you do RSI with TIVA? The algorithm suggests a bolus dose based on user-defined CE target at a specified time point (e.g. 60s). It also predicts a CE overshoot & when to resume infusion. Also testing live preview feature... #ansky

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Terence Luk @simtiva.app · 04/04/2025

Feature preview: testing dexmedetomidine TCI on simtiva.app - coming soon #ansky

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Terence Luk @simtiva.app · 01/04/2025

Yes indeed! USA is the top country of users of SimTIVA (around 20% of users)