Abnormal drug responses with adrenaline on an educational paediatric simulator: the measurement of the responses and correction of the pharmacological model parameters

A paediatric simulator (PediaSimtrade mark, Medical Education Technologies, Inc (METI), Florida, US) has been in use at the Bristol Medical Simulation Centre since early 2000. It has proved to be a very effective educational tool. The simulator is a full-sized high fidelity model of a healthy six year old child weighing 20 kg. Administration of adrenaline (epinephrine) to the simulator was found to create an unrealistic clinical response. Correction of this abnormal response was considered extremely important to ensure valid teaching material for adult learners. Comprehensive physiological measurements and dose responses for adrenaline were evaluated in the simulator under steady state conditions. The dose responses from the simulator were compared with those responses that were considered clinically appropriate by a cohort of paediatric anaesthetists. Expert opinion was utilized as no published haemodynamic data are available for adrenaline in a healthy population of children in this age group. The drug parameters were modified using the simulator drug editor. Dose responses were repeated using the modified drug model and again compared to the required responses. This process was repeated until acceptable clinical limits were achieved. The baseline responses for the drug differed significantly from the required responses. The drug model parameters were successfully modified to give the appropriate clinical responses. The improved model for the haemodynamic effects of adrenaline now provides realistic clinical responses, enabling the paediatric simulator to be a more effective educational tool.