Until my retirement, just before the Covid pandemic, I was clinically working as a cardio-thoracic anaesthesiologist at the Leiden University Medical Centre with a special interest in paediatric anaesthesia for children with congenital heart disease(CHD). The interest in anaesthesia for CHD was certainly fuelled by the many CHD missions to Surinam. Another clinical highlight and challenge was the re-establishment of the Crawford programme (surgical repair of the thoraco-abdominal aneurysma aortae). Both patient groups have in common that early ectubation ‘on the table’ is preferable. In Surinam because of the limited time postoperative care is available, for the Crawford procedure it allows early assessment of the spinal cord function. Multi modal intraveneus anaesthesia with Target Controlled Infusion is a great help to accomplish this ‘fast tracking’ or maybe better called ‘early return of patient maintained homeostasis’.
I have not turned my back to clinical work completely. This year I will be involved in setting up children heart missions in Ghana, where surgical care for children with CHD in a population of millions at the moment is just not existing.
My alter ego:
Since the moment I built my own computer (based on a Motorola 6802 processor) for controlling the environment in my terrarium full of tropical animals, I have been working with software in my free and professional time. Early access to experimental computer controlled infusion systems in Leiden Anaesthesia department was the spark to develop my own system based on a bulky IBM PC connected to an Imed 929 infusion pump. Miniaturisation to an atari portfolio and later a psion3A made the system clinically usable. Ten of these systems were set out in The Netherlands in preparation of the commercial release of the Diprifusor by Astra Zeneca.
The Diprifusor was based on a similar development of computer controlled infusion in Glasgow led by professor Gavin Kenny. We, together with other IV enthousiasts, then initiated the formation of the European Society for Intraveneus Anaesthesia in 1994.
Education and training always have been the main goal of the Eurosiva. To accommodate that goal I developed the Tivatrainer: a simulation program for explaining the pharmacokinetics, interaction and, were available, the pharmacodynamics of intravenous anaesthetics. It started as a windows application written in turbo pascal a long time ago and is now only available as TivatrainerX for iPhone, iPad and the newest generation of Apple computers. Three master students software engineering from Delft University are now transforming the software to a multiplatform application: windows, linux, macOs, android and iPhone are served using the dart language and flutter framework. With the same group I developed an app to support the preparation of drugs at the site of care: labelSyringe. It helps with the calculations, accommodates double checking and prints labels. At the moment it is in a clinical test phase at the paediatric and neonatal intensive care in the Academic Hospital Paramaribo, Surinam.
Tivatrainer and the Porto meeting
The Beta test version of Tivatrainer is almost ready. All participants in Porto will have access to this version independent of the smartphone you are using so that we all can take part and interact in the relevant sessions. I hope you will enjoy the meeting and if you have questions or want to suggest a specific issue to be discussed please contact us