Clinical Aspects of Total Intravenous Anaesthesia: Discussion Paper

Abstract

One may wish to use total intravenous anaesthesia to reduce the pollution hazard in the operating theatre, to avoid repeating the administration of potentially toxic drugs, or for specific indications where the inhalational technique is unsuitable. It may eventually become the method of choice where sophisticated modern equipment is not available, but as yet we have not progressed sufficiently with our understanding or our investigation of the technique to recommend it as a routine outside major centres. To most anaesthetists total intravenous anaesthesia means the administration of barbiturates or other induction agents throughout the period of anaesthesia, supplemented by a myoneural blocking drug and possibly with a potent narcotic and combining these with the continuous use of nitrous oxide/oxygen. Our knowledge of potent narcotics has increased dramatically in the last few years and, while we include high doses of analgesics under this heading, it is not always appreciated that nitrous oxide can be dispensed with while the patient is breathing oxygen-enriched air. This simplifies the method. For more than three decades anaesthetists have been using balanced anaesthesia, based on a drug which will induce sleep, one which will produce muscular paralysis and an analgesic or other means of suppressing reflex response to the operation. This has certainly achieved worldwide acceptance and there is no reason why the same principles should not apply to total intravenous anaesthesia.

Comparison of alfaxalone and propofol administered as total intravenous anaesthesia for ovariohysterectomy in dogs

“…Total intravenous anaesthesia is a technique of general anaesthesia involving the induction and maintenance of the anaesthesia with drugs given solely by the intravenous (IV) route. Desirable characteristics of drugs used in this technique include, short duration of action and rapid clearance from the body so that there are no cumulative effects (Dundee & McMurray 1984; Campbell et al. 2001).…”

Intravenous anaesthesia in goats: A review

“…These advantages include rapid onset of action independent of ventilation status, reduction of adverse effects of other anaesthetic drugs if used in balanced anaesthesia protocols, allowing for provision of continuous analgesia if needed, smoother recovery from anaesthesia, low costs considering that the minimum requirement is a needle and a syringe, and reduction of the hazards of occupational health and atmospheric pollution (Dundee & McMurray 1984;Hasley 1991;Mani & Morton 2010;Waelbers et al 2009). It must be noted that TIVA anaesthesia also contributes to decreased environmental pollution, to a largely unaccounted extent, through disposal of surplus drugs and excreted metabolites into the environment (Briggs 2003).…”

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“…Anaesthesia was maintained with a ketamine 2 or methohexitone infusion 204 with an Oximetrix pump or a Terumo STC-521 syringe driver. When using methohexitone a plasma concentration of 4-5 mg/l was aimed at.…”