J. Kent Garman, M.D.

It is rare today to see an anesthesiology resident or attending without a hand-held computer. Obviously this is because hand-helds provide useful and sometimes critical “real-time” clinical information. In my previous articles in this publication, I have discussed the choices of hand-held computer hardware.¹ In this article, I will discuss hand-held computer software of interest to anesthesiologists. Please note that I have no financial interest in any of these products or companies (although I wish I did).

Memory Requirements
Remember to buy a hand-held with as much memory as possible since many of these programs require large amounts of memory. When I could find it, I have specified the memory requirements for each product mentioned. Do not buy a hand-held using Palm OS^® with less than 16 MB of built-in memory (most high-end models from Palm and Sony now have 16 MB) and an expansion slot to add additional memory. Most “Pocket PC” hand-helds come with at least 32 MB and preferably 64 MB of built-in memory and almost unlimited memory expansion capability. (I have a memory card with 256 MB in my Compaq hand-held.) You can never have too much memory!

It is important to remember to install these high-memory software titles on your expanded memory cards instead of on your limited basic hand-held memory. This will allow you to install multiple titles without running out of room. The other advantage of doing this is that you will not lose your programs in case your hand-held computer crashes since memory cards are usually not erased.

Reference Software
Now for reference software: First, visit Skyscape <www.skyscape.com>. This site has become the premier source for medical hand-held software (both Palm and Pocket PC). I recommend the following Skyscape titles highly, and all are available in both Palm and Pocket PC versions. All Skyscape titles can be delivered by immediate Internet download or by CD-ROM. Of note, all Skyscape titles can “cross-index” together, greatly increasing their search capabilities.

1. Clinical Anesthesia for the PDA. Barash, Cullen, Stoelting. Lippincott Williams & Wilkens; 2002. $60 (Palm 1.0 MB, Pocket PC 1.75 MB). This provides the essential content of the 4th edition of the Handbook of Clinical Anesthesia, including basic principles, preparation, pharmacology, management, specialty topics, critical care, postanesthesia and consultant care. It includes tables and formula lists. Every anesthesiologist should have this reference in his or her pocket.

2. AnesthesiaDrugs™ (Sota Omoigui’s Anesthesia Drugs Handbook), Omoigui, State-of-the-Art Technologies, Inc.; 2002. $65 (Palm 0.6 MB, Pocket PC 1.1 MB). This provides a comprehensive drug reference of those drugs common to anesthesiology and critical care practice.

3. 5MCC™ (2002 Griffith’s 5-Minute Clinical Consult), Dambro, Lippincott Williams & Wilkins; 2002. $65 (Palm 4.0 MB, Pocket PC 7.4 MB). I have found this large program to be invaluable when faced with a disease or syndrome that I have forgotten. It gives a concise summary of the basic details, diagnosis, treatment and medications for many medical and surgical conditions.

4. Wash Mnl™ (The Washington Manual of Medical Therapeutics, 30th Edition), Ahya SN, Flood K, Paranjothi S, Lee H, Schaiff RA, eds. Lippincott Williams & Wilkins; 2001. $60 (Palm 2.4 MB, Pocket PC 3.4 MB). I have used the Washington Manual throughout my medical training and clinical work. It is still a very useful resource for general medical diagnosis and treatment.

Drug Database
Next, get a drug database. There are two excellent, free drug databases, Epocrates and Mobile PDR. I have included Tarascon Pharmacopia even though it is an evolving product still in beta version. All are updated regularly and are easy to use. All include various tables and formula lists.

1. Epocrates Rx™ <www.epocrates.com> (Palm only, 2.5 MB). This is the first, and still excellent, free drug database. Unfortunately, they do not have a Pocket PC version yet. If you wish, you can upgrade to the “Pro” version (Palm only, 3.0 MB) for $50 per year. This offers expanded features and content. Go to the Palm Web site and decide if it is worth the expense.

2. Mobile PDR™ <www.mobilepdr.com> (Palm up to 4.9 MB, Pocket PC up to 6 MB). This is the only free drug database available for both Palm and Pocket PC platforms. Depending on your chosen options for installation, it can be very large. An excellent drug reference.

3. Tarascon Pocket Pharmacopoeia™ <www.tarasconpublishing.com> $25 (Palm only). This is the Palm version of the popular shirt-pocket drug reference. I have used the free beta version and found it to be easy to use and complete with useful tables and references included. It certainly is worth looking at since the final version was released in January.

Medical Calculator
Finally, you will need a medical calculator. There are several useful ones that are hand-held-specific.

1. Archimedes™ <www.skyscape.com> (Palm not available, Pocket PC 0.5 MB). A free medical formula calculator for the Pocket PC only, which has 70 preprogrammed medical formulas that allow entry of known values and calculation of unknowns. Absolutely indispensable for Pocket PC users.

2. MedCalc^® <www.palmgear.com/software/showsoftware.cfm?prodID=6376> (Palm only, 232 KB). A free, Palm-only medical calculator with 75 formulas. The calculator can be individually customized.

3. Infusicalc <www.aetherpalm.com> $15 (Palm only). This is an infusion rate calculator that I find to be extremely valuable. This simple tool will help you to avoid the simple calculation mistakes that we all make. It is customizable.

Due to space limitations, I have only touched on the amazing amount of medical software that is available for hand-held computers. Also, due to rapidly evolving software development, I highly recommend that you look at a Web site that lists and evaluates anesthesia software for hand-held computers (yes, there are at least two such sites). Go to <web.onetel.net.uk/~vills> or <www.aetherpalm.com>. Both sites catalogue and review anesthesia-specific hand-held software. What I have missed, they will have included on their Web sites.

Editor’s Note: The mention of certain brand-name products is not intended to be construed as an endorsement by ASA and is essentially the personal preference of the author.

J. Kent Garman, M.D., is Associate Professor of Anesthesia, Stanford University School of Medicine, Stanford, California.