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1. The pharmacokinetic models included in AnestFusor Series ll Standard Veterinary require some information about the patient in order to calculate the drug concentrations in the plasma You must enter the following basic information SMB Facultad de Medicina Universidad de Chile All rights reserved 2002 2010 Patient s name Enter the patient s name The default value is the case or simulation number Species Enter the patient s species Breed Enter the patient s breed Gender Select the patient s gender male female male neutered female spayed Procedure and details Enter procedures and details that will be relevant to the case Weight Enter the patient s weight in kilograms Age Enter the patient s age in years and months Once the patient s data has been entered AnestFusor Series Il Standard Veterinary will display a summary of the values entered including lean body mass and body surface area It is important to note that the pharmacokinetic constants of the models require accurate patient information Configuration of peripherals The peripherals configuration wizard will prompt you to select the external monitors and pumps to be used In Real Mode the wizard will then connect the system to each of the peripherals selected 1 Pumps 2 Monitors only in Real Mode 3 Open connections only in Real Mode AN WARNING All peripherals must be correctly connected to AnestFusor Series ll Standard Veterinary before any other
2. aft OS ee Universidad de Chile USER MANUAL ANESTFUSOR SERIES II STANDARD VETERINARY Version 2 6 1 DISCHARGE OF RESPONSIBILITY AnestFusor Series I Standard AF is not a program equipment or instrument approved for medical use by any regulatory authority in any country Therefore AF should only be used for experimental purposes and has been designed as an aid for clinical investigation The authors can not be held responsible for any problem or damage that may arise from the use AF The operator of AF is exclusively responsible for the use of the program and the care of the patient Accordingly AF should only be operated under permanent supervision of qualified and trained personnel lt is mandatory that all operators of AF become familiar with its usage and the concepts that underlie the program before attempting its use While using AF the operator should not under any circumstances use another program as this can cause conflicts with AF and critically alter its performance Because of international regulations on medical equipment and software if you agree to install AF you explicitly accept 1 To have a valid Real Mode license for AF extendend by SMB Facultad de Medicina Universidad de Chile This license is for personal use only and not transferable 2 To be authorized in the use of AF exclusively for clinical studies approved by local authorities 3 That in no event will the developers of AF as well as the Universidad
3. 07 50 Total remaining Plasma S 0 56 paml OT 90 SMB Facultad de Medicina Universidad de Chile All rights reserved 2002 2010 32 Instructions for connection and verification of connection between the computer pumps monitors and AnestFusor Series ll Standard Veterinary 1 Verification of drivers Review the number of communication ports associated with the USB RS232 converter Startup gt configuration gt Control Panel gt Hardware gt Device driver in ports COM amp LPT review the port associated with the driver for the USB RS232 interface Device Manager E EHE E Display adapters EL DYDICO ROM drives HA Floppy disk controllers HA IDE ATAJATAPI controllers Es Keyboards A Mice and other pointing devices Z Monitors a Network adapters 2 9 Ports COM amp LPT E Communications Port COM sound video and game controllers E E System devices oe The name of the USB RS232 converter should appear along with the associated COM port without symbols of any type for example a question mark 2 Verify the connection with AnestFusor e Execute AnestFusor e Select option Real Mode e Enter patient data e In configuration of peripherals i Pumps Select the pump model COM port and ID Fresenius DPS according to the system being used ii Monitors Use default configuration iii Open connections Click Continue and confirm in the text box Condition that the connection
4. This warning arises when the perfused volume reported by the pump differs in more than 1 ml from the value calculated by AnestFusor This is just a warning and it does not affect the performance of the program lf this warning appears repeatedly we suggest sending the pump for servicing and calibration JE Rescue bolus Ctrl F5 AnestFusor has the possibility to deliver a rescue bolus This option is only available in the Bolus Perfusion mode graph and icon mode and plasma steering mode graph mode only The default values are 0 25 mg Kg propofol 25 ug remifentanyl and fentanyl For the rest of the drugs the default value is set to 0 These values can be edited If you decide to change the default values please edit them carefully paying extra attention to the units Insert comment Allows the user to insert a comment into the case record For cases in which more than one pump is used the command is applied to the pump in the active window Comments will be displayed in the pump screen as they are entered and they will be saved to the log file for the case Simulation speed Only available in Study and Playback Modes Allows the user to speed up a simulation or playback This command is applied to all pumps used in the case You may increase the speed to 2x 3x 4x 5x or 10x the actual speed You can also increase the speed to your processor s maximum speed F11 To return to actual speed select 1x F12 Alarm silencing F4
5. Only available in Real Mode Silences the alarms on the Fresenius DPS and Fresenius Pilot pumps This command is applied to all pumps in use This command silences all alarms on the Fresenius DPS and Fresenius Pilot pumps except the alarm indicating a physical short in the connection between the PC and the pump Only the alarm sounds will be interrupted the alarms will still be displayed on the pump screens Graph Menu Export time data Executes the Export wizard For cases in which more than one pump is used the command is applied to the pump in the active window Copy to clipboard Copies the data to the Windows clipboard For cases in which more than one pump is used the command is applied to the pump in the active window You can then export the data to other applications using the Paste command Options Displays the Graph Options window This command can be executed only for the active window or for all windows at once See Graph Options for more details Zoom Allows you to increase or decrease the scale of the X and Y axes of graphs For cases in which more than one pump is used the command is applied to the pump in the active window These commands can also be executed from the graph scrollbar Auto scroll Activate deactivate the auto scroll feature For cases in which more than one pump is used the command is applied to the pump in the active window SMB Facultad de Medicina Universidad de Chile All rights reserv
6. be used by AnestFusor Series I Standard Veterinary Change syringe F9 Runs the Configuration wizard for a pump For cases in which more than one pump is used the command is applied to the pump in the active window Always execute this command before changing the syringe The Configuration wizard will guide you through the steps to remove the current syringe and resume infusion with the new syringe Note It is important to execute this command every time you change the syringe regardless of the reason for the change This is the only way to safely maintain control of the infusion and the underlying mathematical model IMPORTANT After a syringe change the program will resume the infusion state found just before the change Therefore if you have paused the infusion just before performing a syringe change the program will return to a paused state after finishing the syringe change Conversely if you issued the change syringe command meanwhile the pump is perfusing icon the program will automatically resume the perfusion according to the underlying model upon finishing the syringe change The same logic applies if you cancel the syringe change Warning on volume inconsistencies The following warning may appear The volume infused reported by the pump differs in XXX ml SMB Facultad de Medicina Universidad de Chile All rights reserved 2002 2010 7 from the value calculated by AnestFusor The consistency of the data cannot be assured
7. operation is initiated Configure peripherals Pumps Hardware Configuration ES E Pumps EHEHEHEH j Select the number of pumps you vish to use Then speci the pump models and COM ports when using Fresenius DES epecity the pump IE also Humber of pumps 4 F Model COM Wh a A RT T men EO O EN a Number of pumps Allows you to select up to 4 pumps to be used simultaneously Model Select the model for each pump You may use Fresenius DPS Fresenius Pilot or Alaris TIVA MK III pumps COM Select the serial ports COM ports to be used with each pump If you are using two Fresenius DPS Base A modules you must select the same COM port for each module ID For Fresenius DPS modules only Enter the ID number of the Base A or Orchestra module The ID number can be found on the front panel of each module SMB Facultad de Medicina Universidad de Chile All rights reserved 2002 2010 10 Note For simulations in Study or Playback Mode you do not have to select the COM ports or enter the Fresenius DPS module ID numbers Configure peripherals Monitors Hardware Configuration A 2000 Enable this option to use the Aspect A 2000 anesthesia monitor version RS232 only CSM Enable this option to use the Danmeter cerebral status monitor Enable the option RS232 according to the link used lo C View Enable this option to use the Morpheus Medical loC View anesthesia monitor version RS232 only COM Enter the
8. serial port COM port to be used with the monitor This COM port should not be the same as the port used for the pumps in the Pumps item Note This applies only to Real Mode Configure peripherals Open communications The wizard will then prepare to connect the system to the peripherals selected in Pumps and Monitors Make sure that the peripherals are turned on and connected to the appropriate serial SMB Facultad de Medicina Universidad de Chile All rights reserved 2002 2010 11 ports When you are ready click Next If AnestFusor Series ll Standard Veterinary detects a faulty connection with any of the peripherals the connection process is aborted You should check all the connections and configurations and then try to connect again Once the connection process has been completed the Finish button will be activated Click on Finish to continue Note This applies only to Real Mode AN WARNING All peripherals must be correctly connected to AnestFusor Series ll Standard Veterinary before any other operation in initiated Syringe configuration AnestFusor Series ll Standard Veterinary automatically detects the pumps installed with the syringe configuration wizard Use this wizard every time you change a syringe The syringe configuration wizard will guide you through the steps to remove the current syringe and resume infusion with the new syringe 1 Confirm syringe 2 Syringe detected Note It is important to execute thi
9. with the AnestFusor with the RS232 port for the workstation was successful and that the connections between the RS232 port and the pumps were SMB Facultad de Medicina Universidad de Chile All rights reserved 2002 2010 33 successful Hardware Configuration Open Communicators HEHHEHE j AnestFuzor ls ready to open soli communication with the chosen pumps Pump J El and monitors Make sure they are on and Ge Opening Con 15 gt connected to the appropriate serial ports Connecting to Be i Press Next when ready and the pumps Cancel Communication state between the pc and the com port Communication state between the pe RS232 com port If the connection failure is under Communication status with the workstation COM port review the installation of the adapter Otherwise continue 3 Electrical verification of port A practical method for verifying the real status of a serial port is short circuiting the 2 and 3 pins of the DB9 connector using a jumper DE male connector Shorted pins Front view Starting a session in Hyper Terminal Startup gt Programs gt Accessories gt Communications gt Hyper Terminal Name XXX Connect using Com associated with USB RS232 converter In port configuration use default options Enter Anestfusor using the workstation keyboard The message Anestfusor should appear on the Hyper Terminal screen If it does not review the previous
10. Series I Standard Veterinary is exclusively responsible for the patient s safety Therefore AnestFusor Series ll Standard Veterinary should only be operated by qualified trained professionals All users of AnestFusor Series ll Standard Veterinary should familiarize themselves with its proper use before attempting to operate the system All other programs should be shut down prior to launching AnestFusor Series ll Standard Veterinary as other programs could interfere with AnestFusor Series Il Standard Veterinary and affect its performance Warnings AN WARNING Use of AnestFusor Series Il Standard Veterinary is subject to local regulations regarding medical equipment AN WARNING All other programs should be shut down prior to launching AnestFusor Series Standard Veterinary AN WARNING When used in Real Mode AnestFusor Series Il Standard Veterinary is the exclusive responsibility of the operator The program should only be used as part of a Clinical trial by qualified and trained personnel The authors cannot be responsible for the performance of AnestFusor Series ll Standard Veterinary on every operating system or in every possible situation Operators are responsible for testing the system several times prior to use to ensure that the peripherals and the system are working properly SMB Facultad de Medicina Universidad de Chile All rights reserved 2002 2010 4 AN WARNING AnestFusor Series ll Standard Veterinary can be connected to
11. an Aspect A 2000 anesthesia monitor Danmeter cerebral status monitor and loC View anesthesia monitor Please refer to the respective user s manual for this monitor to set up these connections as a faulty connection could compromise the patient s safety AN SAFETY e Ensure that the electrical network is stable in order to prevent sudden power loss A rapid succession of brief periods of power loss could cause electrical transients and jeopardize the stability of the peripherals e Never handle the peripherals carelessly or roughly For example it has been found that suddenly pressing and releasing the Fresenius Pilot syringe plunger results in a fatal hardware error Safety Before beginning an AnestFusor Series Il veterinary session e Ensure that the connections are securely attached and cannot be accidentally disconnected e Ensure that the batteries in the peripherals are fully charged e Ensure that all other programs have been shut down This includes antivirus task manager and all other programs If other programs are running save your work and then shut them down e Ensure that all peripherals are turned on and ready to communicate with AnestFusor Series ll Standard Veterinary References Design of AnestFusor Series ll Standard Veterinary is based on the following work 1 A simple analytical solution to the three compartment pharmacokinetic model suitable for computer controlled infusion pumps Bailey J M Shaf
12. an one pump is used the command is applied to the pump in the active window Note This command is irreversible To terminate an infusion you must first stop the infusion with the Pause command Target F5 Bolus F5 Infusion speed F6 Pump speed F7 These commands allow you to edit the parameter values for an infusion pump In cases in which more than one pump is used the command is applied to the pump in the active window When you start a new infusion the system will prompt you to enter the initial target and the maximum pump speed in the Drug and Model wizard When an infusion is already in progress changes to target value are always executed as quickly as possible without exceeding the maximum pump speed In bolus infusion mode the operator enters parameter values for the bolus maximum pump speed infusion rates or pump speed When you start a new infusion the system will prompt you to enter the initial bolus maximum pump speed and rates in the Drug and Model wizard When an infusion is already in progress changes to the bolus value are always executed as quickly as possible without exceeding the maximum pump speed If a bolus is in progress any change to the infusion rate pump speed or maximum pump speed will stop the bolus in order to continue with infusion mode All of these parameters can also be edited from the toolbar of the active pump Max pump speed F8 This command allows you to set the maximum pump speed to
13. ched as quickly as the given pump and syringe combination allows Note The target concentration time can only be specified at the start of an infusion Once an infusion is in progress any change to the target value will be executed as quickly as the pump and syringe will allow Drug model and Effect site mode Maximum pump speed Drug and mode for pump Fresenius Pilot v a e tee fe a a Bs s s a n a n fa ee mn EREHE H POE AnestFusor Series ll Standard Veterinary allows you to specify the maximun pump speed in which the effect site target concentration should be reached You may choose a speed from the drop down list or enter any value between 1 and 1500 expressed in ml h Drug model and Effect site Plasma mode Summary Drug and model for pump Fresenius Pilot on COM O xj This is the final step of the drug and model wizard If you would like to change any of the parameters displayed in the Summary click Back Otherwise click Finish SMB Facultad de Medicina Universidad de Chile All rights reserved 2002 2010 17 Drug and Bolus Infusion mode Plot model Drug and model for pump Fresenius Pilot on COM O 111111 1111111111 HHH In this step the wizard will prompt you to select the model for graphing the infusion process The default option is no graph If the drug selected does not have an associated model this screen will not appear IMPORTANT NOTE Remember that you are in the Bolus Infusion mode and therefore t
14. connected via a 9 or 25 pin cable to the computer and a 9 pin cable to the peripheral The cable for the infusion pumps may be assembled according to the following diagrams Note For a secure data transfer the maximum length of the connecting cable should note exceed 3 meters Note It is essential that the computer that runs the program complies with IEC 950 security specifications for connections mo 07 4or Shield Sub D Connector Sub D Connector 9 pins Male 9 pins fom ale DE 9 P DES Shield Sa D Corrector Sub D Convector J pias maja 9 pins formate DE 9 P HESS SMB Facultad de Medicina Universidad de Chile All rights reserved 2002 2010 28 Graph options Apply to all windows This option is only available for cases in which two pumps are used simultaneously If this option is selected the graph options will apply to all windows If it is not selected graph options will apply only to the active window Always use this configuration Select this option if you wish to continue using the same graph options the next time you use AnestFusor Series Standard Veterinary Restore default settings Click this button to restore the factory settings Monitor graph options A 2000 Graph Settings SMB Facultad de Medicina Universidad de Chile All rights reserved 2002 2010 29 Always use this configuration Select this option if you wish to continue using the same graph options the next time you us
15. de Chile be liable for direct indirect incidental or consequential damage or damages on patients resulting from the use of AF even if it has been advised of the possibility of such damage GENERAL WARNING Pumps infuse at ml h and have a resolution of one decimal place 10 of a milliliter Therefore AnestFusor rounds all values to one decimal place Please be aware that under certain clinical settings very low weight and the use of highly concentrated drug solutions you should infuse using ml hr pump speed instead of infusion rate to avoid errors in the amount of drug delivered that may pose significant clinical impact SMB Facultad de Medicina Universidad de Chile All rights reserved 2002 2010 2 Table of Contents Welcome to AnestFusor Series ll Standard Veterinary eee eee ee 4 CONGCINONS OF USC a eo an e is 4 e A A eo eeautes 4 A 5 A 5 COMA D sorena es ede 5 A e ECO O O Ce te a eee 6 A eects ene et ees ee eee nee ne eee ee eee ae 7 SF A Mi NS ENR id acosa 8 Window 9 0 T A sacesameuvindancudeiGesemada 9 REPNOG 9 Patient IRTORMANO Missean e a Ee ae ea Eades i 9 GContiguration OF pDenpaeralS asia iia 10 SVMINGS COMME UNA OM ci di 12 PUG modeland ModE st e a e lat e an seta de dao O A DO 14 Dated ina 23 Sel ar tan 26 Serial POMS CONMGUPAUON aiii dia 26 A A A A er eee eR 28 GrP GS LO y e A O rt cE CO ne cee 29 MONIKO grap ODON SS di 29 ICOM MOQO TTT 30 Grap MMO dE erun a a A NNE ne 32 Instructions for connection and
16. e AnestFusor Series Standard Veterinary Restore default settings Click this button to restore the factory settings Icon Mode This mode displays a minimum amount of data and thanks to the small character size allows for rapid detection of critical values Within Icon Mode you may choose from two options depending on the workspace available e Reduced display This mode displays only two values at a time You will be asked to select one each from the following a Pump speed ml hr Total infusion mass Total infusion volume b Plasma concentration Effect site concentration Solution concentration Target SMB Facultad de Medicina Universidad de Chile All rights reserved 2002 2010 30 Expanded display Displays four values at a time You will be asked to select two each from the following a Pump speed ml hr Total infusion mass Total infusion volume b Plasma concentration Effect site concentration Solution concentration Target SMB Facultad de Medicina Universidad de Chile All rights reserved 2002 2010 31 Graph Mode This mode displays the plasma and effect site concentrations as a function of time which is ideal for reviewing the data E Propofol Fresenius Pilot Plasma 0 56 ej ml Site Effect 0 57 ye ml Infusion rate 15 qa ac y O da Ys TE Am Jo Ac Jo qo Speed S mg Ka h Solution concentration 10 mom OT 10 Total infused Site S U 97 paml
17. e Pump speed in the Infusion item you must enter the initial rate in ml hr The mass of the drug infused will depend on the concentration of the solution Note The type of infusion rate entered in this step only applies to the initial rate Once the infusion is in progress you will be able to specify the rate of infusion in both ways Drug Bolus Infusion mode Summary Drug and model for pump Fresenius Pilot on COM 15 This is the final step of the drug model and mode wizard If you would like to change any of the parameters displayed in the Summary click Back Otherwise click Finish SMB Facultad de Medicina Universidad de Chile All rights reserved 2002 2010 22 Data export The export wizard allows you to save the infusion variables in a format recognizable by other Windows applications All variables are exported as a function of time You may save the data as a text file Excel file or in the Windows clipboard 1 Columns to export 2 Time interval 3 Export format Data export Columns to export Time Data Export E r CE lurnrnz Lp export A AAA AAA A A A A PA Mark the columns to export i Include headers Extend selection to all pumps The export data wizard will create a column for each variable selected from this list Include header row If you select this option the first row of the table exported will contain the names of the variables See the examples below Select all pumps If you select th
18. ed 2002 2010 When this option is activated the graph will always display the most recent events This command can be also executed from the graph scrollbar Lock Displays all values for models simultaneously click on the icon Show concentrations Active Inactive concentrations expressed in numerical format located in the upper right hand portion of the graph window Show projections Generates a time projection forecast of the model derived values assuming null infusion rate Window Menu Cascade Arranges the pump windows in a cascade Tile horizontal Arranges the pump windows horizontally Tile vertical Arranges the pump windows vertically Arrange icons Arranges the minimized pump windows in the lower left hand corner of the screen Change to Icon Mode Changes all the windows currently in Graph Mode to Icon Mode except for the monitor windows Change to Graph Mode Changes all the windows currently in Icon Mode to Icon Mode except for the monitor windows Status bar Hides displays the status bar Help Menu Help topics for AnestFusor Series Il Standard Veterinary F1 Displays the Help topics AnestFusor on the web Opens AnestFusor website in your browser You must be connected to the Internet to use this command About AnestFusor Series Il Standard Veterinary Displays the welcome window for AnestFusor Series ll Standard Veterinary Includes the version number and copyright notice Patient information
19. er S L IEEE Transactions on Biomedical Engineering 38 6 522 525 1991 2 Algorithms to rapidly achieve and maintain stable drug concentrations at the site of drug effect with a computer controlled infusion pump Shafer S L Gregg K M Journal of Pharmacokinetics and Biopharmaceutics 20 2 147 169 1992 3 Using the time of maximum effect site concentration to combine pharmacokinetics and pharmacodynamics Minto C F Schnider T W Gregg K M Henthorn T K Shafer S L Anesthesiology 99 324 333 2003 Contact Us AnestFusor Series Il Standard Veterinary team welcomes your comments and suggestions You may contact us at infotec smb cl SMB Facultad de Medicina Universidad de Chile All rights reserved 2002 2010 5 File Menu New Ctrl N Opens a new case Real Mode or a simulation Study Mode and Playback If another file is open when you create a new file AnestFusor Series Il Standard Veterinary will ask whether you want to save your work A new case or simulation will begin with the following wizards 1 Patient data 2 Configuration of peripherals 3 Syringe configuration in Real Mode only 4 Drug and model Playback Ctrl R Only available in Study and Playback Modes Opens a previously saved case or simulation If another file is open when you open a file for playback AnestFusor Series Standard Veterinary will ask whether you want to save your work To play back real cases use file extension AnestF
20. f you exit the syringe configuration wizard but have not removed the syringe from the pump simply complete the configuration with the original syringe AN WARNING Certain syringes may not be correctly detected by the pumps For example the Fresenius Pilot pump is not designed to work with 10 ml syringes In these cases the volume infused and volume remaining values displayed may be incorrect However this will not affect AnestFusor Series ll Standard Veterinary s control of the pumps Configure syringe Syringe detected Syringe configuration for pump Fresenius Pilot on COM 15 AnestFusor has detected the following conditions Model Dispomed tipe F Capacity ml 50 8 Volume remaning ml 29 7 asirio pump speed 1500 0 allowed frlth o Back Once a syringe has been detected and confirmed the wizard will display the following parameters Model Capacity in milliliters Remaining volume in milliliters Maximum pump speed with the selected syringe in milliliters hour Solution concentration At the beginning of the case first syringe this option is disabled However upon performing a syringe change second syringe and so on this option will be enabled Therefore please note that you must indicate in each syringe change the concentration of the solution Be careful and pay attention to what you are doing If these data are correct click Finish to resume infusion with the new syr
21. for the pharmacokinetic model to be used to control a pump The wizard should be used for each pump selected Drug model and mode Infusion mode Drug and mode for pump Fresenius Pilot q huso mode o i Next choose the infusion made T Plasma steering tC BalusAnfusiorn Effect site controlled In this infusion mode the control parameter is the target concentration of the drug in the effect site Infusion is controlled so that a given target of drug concentration is maintained in the effect site Plasma controlled In this infusion mode the control parameter is the target concentration of the drug in the plasma Infusion is controlled so that a given target of drug concentration is maintained in the blood plasma Bolus infusion This is the manual infusion mode The control parameters are the boluses the infusion rates and the pump speed In this mode AnestFusor Series ll Standard Veterinary functions similarly to a system without computer controlled infusion pumps SMB Facultad de Medicina Universidad de Chile All rights reserved 2002 2010 14 Drug model and Effect site Plasma mode Drug Drug and model for pump Fresenius Pilot on COM 15 sees A a In this step you will specify the drug and concentration to be used with the infusion mode selected in Infusion Mode item Drugs without site effect models cannot be selected if you chose a target effect site controlled infusion mode Drug model and Effect si
22. guration of the serial ports will result in a communication error creating malfunctions in AnestFusor Series Il Standard Veterinary The values in these tables are the default factory configurations If this is not the case for your equipment please refer to the documentation that came with the equipment Fresenius Modular DPS pump connected to a Fresenius Base A Baud rate 19 200 Start bit 1 Data bits T Bit parity Even Stop bit 1 Fresenius Vial Pilot Anesthesia 2 Baud rate 19 200 Start bit 1 Data bits T Parity Even Stop bit 1 Alaris Asena Tiva MK IlI Baud rate 38 400 Start bit 1 Data bits 8 Parity No Parity Stop bit 1 SMB Facultad de Medicina Universidad de Chile All rights reserved 2002 2010 26 Aspect 2000 Baud rate 9600 Start bit 1 Data bits T Parity No Parity Stop bit 1 Danmeter CSM Baud rate v USB 460 800 Baud rate v RS232 115 200 Start bit 1 Data bits 8 Parity No Parity Stop bit 1 Morpheus Medical loC View Baud rate 115 200 Start bit 1 Data bits 8 Parity No Parity Stop bit 1 SMB Facultad de Medicina Universidad de Chile All rights reserved 2002 2010 27 Cables The connection between the workstation computer and pumps Alaris Asena TivaMK IIl Aspect 2000 monitor Danmeter CSM version RS232 and Morpheus Medical loC View uses a standard RS232 serial cable Fresenius Vial pump cables The workstation computer and Fresenius Vial pump are
23. he model and graph selected are displayed for indicative purposes only The pump is NOT controlled by the model selected Drug and Bolus Infusion mode Units Drug and model for pump Fresenius Pilot on COM 15 The physical units selected in this window will be used throughout the case All boluses and infusion rates specified later must be entered in these units For example if you enter a bolus of remifentanyl in ug the pump will deliver this exact quantity of the drug to the patient If you enter a bolus of remifentanyl in yg kg on the other hand the pump will deliver that quantity of the drug per kilogram of the patient s weight This also applies to SMB Facultad de Medicina Universidad de Chile All rights reserved 2002 2010 18 infusion rates and any other drug Example Suppose you have a patient weighting 25 kg If you infuse one bolus of 1 wg the pump will infuse that exact amount On the other hand if you infuse one bolus of 1 ug kg the pump will infuse 1 ug kg x 75 kg or one bolus of 25 wg Drug and Bolus Infusion mode Bolus Drug and model for pump Fresenius Pilot on COM 15 A AAA n bolus infusion mode you can initiate an infusion with or without an induction bolus Yes The infusion will begin with an induction bolus and the it will continue with the speed indicated in the Pump Speed item No You will be taken to the wizard where you have to define the mode of infusion In this case the system will
24. ill not be erased if the program shuts down unexpectedly for example if there is an electrical outage that causes a short Exit Closes the case or simulation that is currently open and shuts down the program If there is another file open AnestFusor Series ll Standard Veterinary will ask whether you want to save your work Note For safety reasons AnestFusor Series ll Standard Veterinary will not allow you to exit during a real case In order to exit you must first abort all infusions in progress External programs Calculator Ctrl F1 Runs the Windows calculator accessory program To run this application you must have it installed in your machine If it is not installed you may do so using the Add Remove Programs feature on the Control Panel SMB Facultad de Medicina Universidad de Chile All rights reserved 2002 2010 6 Notepad Ctrl F2 Runs the Windows Notepad accessory program If this application is not installed in your machine you may do so using the Add Remove Programs feature on the Control Panel Infusion Menu E Start Pause Resume F2 When a new case is opened this command will cause the pump to begin infusion For cases in which more than one pump is used the command is applied to the pump in the active window When a case is in progress this command allows you to pause and resume infusion E Terminate Terminates AnestFusor Series Il Standard Veterinary s control over a pump For cases in which more th
25. inge If the data are not correct check that the correct syringe has been selected You may click Back to correct the entries and re confirm the new syringe You may modify the remaining volume value that the system automatically detects However this value is for reference purposes only AnestFusor Series ll Standard Veterinary will use the remaining volume indicated by the pump for its internal operations Note In Study and Playback Modes AnestFusor Series ll Standard Veterinary simulates a syringe with infinite capacity and remaining volume SMB Facultad de Medicina Universidad de Chile All rights reserved 2002 2010 13 AN WARNING You may exit the syringe configuration wizard at any time However AnestFusor Series ll Standard Veterinary will treat this event as a critical error and will not resume infusion until the syringe configuration has been correctly completed If you exit the syringe configuration wizard but have not removed the syringe from pump simply complete the configuration with the original syringe AN WARNING Certain syringes may not be correctly detected by the pumps For example the Fresenius Pilot pump is not designed to work with 10 ml syringes In these cases the volume infused and volume remaining values displayed may be incorrect However this will not affect AnestFusor Series ll Standard Veterinary s control of the pumps Drug model and mode The drug and model wizard will configure the initial parameters
26. is option the variables selected will be exported for all the pumps Example of table with header rows Time se Effect site Plasma c concentration ng ml concentration ng ml 0 0 0 10 0 23 2 72 20 0 47 2 36 Example of table without header rows 0 0 0 10 0 23 2 72 20 0 47 2 36 Note For the variable syringe changes a value of 1 represents the moment in which the syringe was removed and a value of 1 represents the moment that infusion was resumed with the new syringe SMB Facultad de Medicina Universidad de Chile All rights reserved 2002 2010 23 Data export Time interval Time Data Export E Time miera DTH i Choose the time interval to store the data The export data wizard will create a file for the interval entered here The smallest interval that can be selected is 0 1 seconds Insert event logs If you select this option an additional file listing every event that occurred during infusion will be created These events include changes in target values infusion rates boluses syringe changes comments inserted and hardware alarms See the examples below Preserve intervals This option is only available for files with event logs added If you choose to preserve the intervals the event will not interrupt the rhythm of the time data intervals no matter when the events occur See the following examples Examples In these examples the time data is exported at intervals of 10 seconds An event
27. l be executed as quickly as the pump and syringe combination allows SMB Facultad de Medicina Universidad de Chile All rights reserved 2002 2010 20 Drug Bolus Infusion mode Infusion ug and model for pump Fresenius Pilot on C IIIZ gt nfusion rate Infusion rate Use this option to specify an initial infusion rate in the units specified the Units item The infusion rate always refers to the mass of the drug to be infused The pump will adjust the speed according to the concentration of the solution Pump speed Use this option to express the initial speed in ml nr The pump speed always refers to the volume of the solution to be infused The mass of the drug infused will depend on the concentration of the solution Note The infusion type entered in this step only applies to the initial rate Once the infusion is in progress you will be able to specify the rate of infusion in both ways Drug Bolus Infusion mode Speed Infusion rate Drug and model for pump Fresenius Pilot on COM 15 SMB Facultad de Medicina Universidad de Chile All rights reserved 2002 2010 21 If you chose Infusion rate in the Infusion item you must enter the initial rate in the units specified in the Units item The infusion rate always refers to the mass of the drug to be infused The pump will adjust the infusion rate according to the concentration of the solution Pump speed Drug and model for pump Fresenius Pilot on COM 15 lf you chos
28. occurred at 13 7 seconds after infusion was initiated Example 1 Table without event log Time Effect site Plasma sec concentration ng ml concentration ng ml 0 0 0 10 0 23 2 12 Event occurred at 1 7 seconds no event logged 20 0 47 2 36 30 0 65 2 06 Example 2 Table with event log preserved interval rhythm Time Effect site Plasma sec concentration ng ml concentration ng ml 0 0 0 10 0 23 2 72 13 7 0 31 2 59 Event occurred at 13 7 seconds 20 0 47 2 36 event logged However the 30 0 65 2 06 following record is logged at 20 seconds E S E to preserve the rhythm interval SMB Facultad de Medicina Universidad de Chile All rights reserved 2002 2010 24 Example 3 Table with event log interval rhythm not preserved Time Effect site Plasma sec concentration ng ml concentration ng ml 0 0 0 10 0 23 2 72 13 7 0 31 2 59 Event occurred at 13 7 seconds 23 7 0 53 2 24 event logged The rhythm is not 30 7 0 70 1 96 preserved so the following record is logged at 23 7 seconds Data export Export format Text file file with extension txt The variables are comma delimited The decimal separator is always a period regardless of the regional configuration of your operating system Excel file with extension xls The variables are tab delimited The decimal separator depends on the regional configuration of your operating system These file can be opened directly in Microsoft Excel Copy to clipboard co
29. pies the data to the Windows clipboard You can then export the data to other applications using the Paste command When you export data as a text file or an Excel file the system will ask you to enter the name of the file to be exported When you are finished exporting data select Finish SMB Facultad de Medicina Universidad de Chile All rights reserved 2002 2010 25 Peripherals Peripherals refer to the infusion pumps and monitors used for anesthesia AnestFusor Series Standard Veterinary is designed to work with the following peripherals Fresenius Vial Pilot Anesthesia 2 infusion pump Fresenius Vial Modular DPS infusion pump connected to Base A or Orchestra Asena Tiva MK Ill infusion pump Aspect A 2000 or XP BIS anesthesia monitor Danmeter cerebral status monitor Morpheus Medical loC View anesthesia monitor AN Multiple serial ports RS 232 If your computer has a physical serial port you will only be able to use two infusion pumps simultaneously if you use the Fresenius Modular DPS Infusion Pump connected to a Fresenius Base A with two modules If you wish to add other monitors or manage other pumps you must add one more physical serial ports The following are two alternative suggestions for setting up such a system Serial ports configuration AnestFusor Series ll Standard Veterinary has been internally configured to work with peripherals configured to the specifications shown in the following tables Any other confi
30. s command every time you change the syringe regardless of the reason for the change This is the only way to safely maintain control of the infusion and the underlying mathematical model Configure syringe Confirm syringe Syringe configuration for pump Fresenius Pilot on COM 15 fs Acknowledge simge FEEFEE Install the syringe on the pump Check model and capacity and acknowledge by pressing the green disk button on the pump Click Nest when teady AnestFusor Series Standard Veterinary automatically detects the syringes in the pumps You must confirm that the syringe is in the pump to continue To confirm a syringe follow the instructions displayed in this window then click Next Check that the pump and drug displayed in the syringe configuration wizard are correct because for cases in which more than one pump is used the command is applied to the pump in the active window Note It is important to execute this command every time you change the syringe regardless of the reason for the change This is the only way to safely maintain control of the infusion and the underlying mathematical model SMB Facultad de Medicina Universidad de Chile All rights reserved 2002 2010 12 AN WARNING You may exit the syringe configuration wizard at any time However AnestFusor Series ll Standard Veterinary will treat this event as a critical error and will not resume infusion until the syringe configuration has been correctly completed I
31. skip the the wizards for bolus mass and perfusion time for the bolus Drug Bolus Infusion mode Bolus mass Drug and model for pump Fresenius Pilot on COM 15 SMB Facultad de Medicina Universidad de Chile All rights reserved 2002 2010 19 In this step the wizard will prompt you to enter the mass of the induction bolus The bolus must be entered in the units selected in the Units item If you do not wish to use an induction bolus click Back to return to Bolus item and select No Drug Bolus Infusion mode Time for bolus infusion Drug and model for Tier any time longer than flash expressed rey EEE ert ere ete C al a 9 Ep AnestFusor Series ll Standard Veterinary allows you to specify the time in which the bolus mass AnestFusor Series ll Standard allows you to specify the time in which the bolus specified should be infused You may choose a time from the drop down list or enter any value expressed in seconds The most commonly selected option is the minimum time also erroneously called flash or instantaneous bolus If you select this option the target will be reached as quickly as the pump and syringe will allow IMPORTANT NOTE In the case of remifentanyl the program automatically adjusts the minimum time possible for an induction bolus to a rate of 0 5 wg kg min Note The bolus infusion time can only be specified for the initial induction bolus Once an infusion is in progress any change to the target value wil
32. steps 4 Verification of connection with pump In the AnestFusor Help menu Hardware gt Peripheral cables You will find a diagram of the connection to be used with Fresenius pumps pumps and monitors use a standard one to one RS232 cable SMB Facultad de Medicina Universidad de Chile All rights reserved 2002 2010 The other 34
33. te Plasma mode Pharmacokinetic model Drug and model for pump Fresenius Pilot on You may use this window to select pharmacokinetic model and review the constants associated with the model SMB Facultad de Medicina Universidad de Chile All rights reserved 2002 2010 15 Drug model and Effect site Plasma mode Target effect site concentration Drug and model for pump Fresenius Pilot on COM 15 In this step the wizard will prompt you to enter the target effect site concentration It is important to enter the target in the units that are displayed on the screen Remifentanyl Units for the target effect site concentration ng ml Propofol Units for the target effect site concentration ug ml In effect site mode infusion is controlled according to the kinetic parameters of the drug being used Keep in mind that using an effect site concentration target means overshooting the plasma concentration Drug model and Plasma mode Time to target Drug and model for AnestFusor Series ll Standard Veterinary allows you to specify the time in which the target concentration in the plasma should be reached You may choose a time from the drop down list SMB Facultad de Medicina Universidad de Chile All rights reserved 2002 2010 16 or enter any value expressed in seconds The most commonly selected option is the minimum time also erroneously called flash or instantaneous bolus If you select this option the target will be rea
34. usor Cases afc in the Playback dialog window To play back simulations use file extension AnestFusor Simulations afs Note All files saved by AnestFusor Series Il Standard Veterinary are read only Files cannot be modified in Playback Mode This is true for both simulations and real cases Add Pump Ctrl P Allows user to add a pump to a case or simulation The total number of pumps allowed per case or simulation is 4 Add Monitor Ctrl M Allows user to add a monitor to a case AnestFusor Series ll Standard Veterinary is compatible with the following models of monitor e Danmeter CSM versions USB and RS232 e Aspect A 2000 and XP BIS Monitor version RS232 e Morpheus Medical loC View Monitor version RS232 Save Ctrl G Save As Saves the open case or simulation This option is deactivated for playback cases as these are read only Simulations are saved with extension afs and real cases with the extension afc When a case or simulation is saved AnestFusor Series ll Standard Veterinary also saves a log file in the same directory with the extension txt The bit core file contains a summary of the properties of the case or simulation as well as an event log Note In Real Mode AnestFusor Series Il Standard Veterinary automatically saves your work in a file called Backup afc located in the case directory This backup is erased once the case is closed therefore you should also save your work yourself However the backup w
35. verification of connection between the computer pumps monitors and AnestFusor Series ll Standard Veterinary eee eee e ee 33 SMB Facultad de Medicina Universidad de Chile All rights reserved 2002 2010 3 Welcome to AnestFusor Series ll Standard Veterinary Welcome to AnestFusor Series ll Standard Veterinary a program developed by the University of Chile School of Medicine AnestFusor Series ll Standard Veterinary is an automated system for administering intravenous anesthesia drugs If this is your first time using the system we encourage you to spent a few moments to read this manual This chapter contains essential information regarding the system as well as important warnings regarding its use This manual also provides an overview of the main operating components of AnestFusor Series ll Standard Veterinary Please note that by installing AnestFusor Series ll Standard Veterinary you are agreeing to the conditions stipulated in the Conditions of Use Conditions of use AnestFusor Series ll Standard Veterinary has not been approved for use as a system piece of equipment or instrument by any regulatory body in any country Therefore AnestFusor Series II Standard Veterinary should only be used as part of a clinical trial and has been designed as a tool for clinical research The authors are not responsible nor liable for any problems resulting from use of AnestFusor Series ll Standard Veterinary The individual operating AnestFusor

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