Sedation Simulator, CD-ROM Version 1.0 for Windows,. Edited by Howard Schwid. Anesoft, University of Washington. Price:$99.00.

The Sedation Simulation program uses a CD-ROM format, which costs $99. System requirements are Windows 3.11, Windows 95, or Windows 98 with 4-MB RAM and 12-MB hard disk memory for PCs. The program is not Macintosh compatible. The program was easily installed on my laptop Compaq Presario 1920 and within a few minutes I could begin a “lesson.” Instructions on the general use of the program were minimal, but this was not a problem.

The CD-ROM contains three audiovisual tutorials, each approximately 2.5 min in duration, which provide basic instruction about simple airway management or obtaining peripheral intravenous access. The bulk of the program is the 40 different patients and cases requiring sedation and analgesia. There are four general types of cases the subscriber can choose from: radiologic, dental, endoscopic, and minor surgery. The range of cases in each category is adequately diverse. Both pediatric and adult patients exist.

Critical events can occur at random during each of the 40 cases, or one can choose from a menu of 11 possible adverse events. These critical events are agitation, apnea, aspiration, bronchospasm, cardiac arrest, anaphylaxis, hypertension, tachycardia, bradycardia, hypotension, and myocardial ischemia. However, a quirk in the programming only allows users to choose critical events for the first 4 of the 40 cases. Thus, users cannot focus on the types of cases that may be more relevant to their practice and methodically work their way through the menu of critical events.

Users can take the usual steps involved in providing sedation and analgesia in a manner that simulates clinical conditions. From a top row of menus, patients can be evaluated, examined, and monitored, and airway management and drug administration can be chosen. There is a limited but instructive amount of information available concerning the cardiovascular and respiratory pharmacophysiology of sedation and analgesia under the last menu item in the “help” category. Although the quality of the images in the program is very good, there are not many figures to illustrate educational points throughout the CD-ROM. At any time during a simulation, an individual can pause from the lesson at hand and acquire and explore some of the basic cardiovascular, respiratory, and resuscitative information provided under the help menu. On the other hand, impatient individuals will tend to speed things up through the “accelerate” mode. There is only one fast-forward, and it is rather rapid. This will likely detract from the real-time aspect of the simulation. Fortunately, the program reverts to real time whenever a patient's condition changes.

Other limitations or flaws exist. For example, as simulations proceed into difficult clinical scenarios, not infrequently, patients die. The simulation ends such calamities with the brief comment “the patient has died. Please inform the family.” This can be frustrating, especially when usual and even recommended therapies (found in the help menu) are not always available among the therapeutic options. For example, phenylephrine is not found among drug options for the treatment of hypotension. Other similar problems occurred. In the case of a hypertensive emergency, the recommendations are to use phentolamine or sodium nitroprusside and perhaps an arterial line for monitoring, but, again, these choices are not among the options available during simulation. In the latter case, the recommendations do not seem consistent with what most nonanesthesiologists administering conscious sedation would consider. Minor flaws, such as when the description of a particular patient (e.g. , 45-yr-old obese, anxious smoker with angina) does not match the picture of the patient (young, slim adult male who looks relaxed), are amusing but not problematic.

The presentation of the 40 cases is somewhat interactive in that a “consultant” system can be queried. However, advanced interactivity is limited. For example, if patients improve after an adverse event, one can only assume that this was because initiated therapies were corrective. If a user fails to initiate proper therapies, time will continue to pass until the patient either dies or the user pauses the simulation to seek advice or information from the help menu. Incorrect choices are not highlighted through instructional means during the active phase of the simulation. Although this reviewer thinks such instructional feedback during simulation is of added value and enhances the interactive potential of the format, perhaps “real” simulation (is that an oxymoron?) is better without such added educational components.

A final limitation of the program worth noting is that once the procedure is completed, the patient is left in limbo. There are no prompts questioning the caregiver about patient fitness for discharge from either the procedure area or the facility. If one lets time “accelerate,” even for 30 min, nothing happens. Thus, the entire issue of patient recovery and fitness for discharge is avoided in an awkward manner.

The Sedation Simulation program is advertised as intended for radiologists, endoscopists, dentists, surgeons, and nurses, which seems appropriate. For those seeking a basic introduction to or review of the pharmacology and practice of sedation and analgesia or “conscious sedation,” the Sedation Simulation program can be recommended. Overall, this reviewer found the Sedation Simulation program fun to use. It should prove to be a useful educational tool for clinicians who are either inexperienced or require an update concerning this area of patient care. Additional benefits include an increased awareness of the utility of pulse oximetry and capnometry, because it becomes clear during simulations that critical events are more quickly diagnosed when these monitors are applied. Twenty CME or CNE credits can be obtained by simply mailing in a printed summary of the simulated cases and a nominal accreditation fee.