Guidelines for the safe practice of total intravenous anaesthesia (TIVA)

Abstract

Summary Guidelines are presented for safe practice in the use of intravenous drug infusions for general anaesthesia. When maintenance of general anaesthesia is by intravenous infusion, this is referred to as total intravenous anaesthesia. Although total intravenous anaesthesia has advantages for some patients, the commonest technique used for maintenance of anaesthesia in the UK and Ireland remains the administration of an inhaled volatile anaesthetic. However, the use of an inhalational technique is sometimes not possible, and in some situations, inhalational anaesthesia is contraindicated. Therefore, all anaesthetists should be able to deliver total intravenous anaesthesia competently and safely. For the purposes of simplicity, these guidelines will use the term total intravenous anaesthesia but also encompass techniques involving a combination of intravenous infusion and inhalational anaesthesia. This document is intended as a guideline for safe practice when total intravenous anaesthesia is being used, and not as a review of the pros and cons of total intravenous anaesthesia vs. inhalational anaesthesia in situations where both techniques are possible.

Future directions in regional anaesthesia: not just for the cognoscenti

“…But how can we increase access and equity in the provision of regional anaesthesia to the wider population? How do we cement basic regional anaesthesia skills as a core competency for all anaesthetists, similar to that of airway management, monitoring of fluid status or the newly recommended core competency of total intravenous anaesthesia ?…”

An approach to using pharmacokinetics and electroencephalography for propofol anesthesia for surgery in infants

“…EEG, electroencephalography, infant, neonate, propofol, remifentanil, total intravenous anesthesia, total intravenous anesthesia neurosurgery) or manipulation of the airway (microlaryngoscopy, bronchoscopy, laryngotracheal repairs). [1][2][3][4][5] Despite the growing popularity and utilization, safe and effective techniques for TIVA are not well imbedded into pediatric anesthesia practice or training programs. 2 TIVA is frequently conducted by rote with manual infusion pumps or faith in target-controlled infusion (TCI) devices, potentially resulting in over-and under-dosing and adverse events.…”

“…[1][2][3][4][5] Despite the growing popularity and utilization, safe and effective techniques for TIVA are not well imbedded into pediatric anesthesia practice or training programs. 2 TIVA is frequently conducted by rote with manual infusion pumps or faith in target-controlled infusion (TCI) devices, potentially resulting in over-and under-dosing and adverse events. 2,[6][7][8] In our experience during organization of an international multi-center study, 9 pediatric anesthesiologists worldwide are generally uncomfortable using TIVA in infants and for good reason.…”

“…2 TIVA is frequently conducted by rote with manual infusion pumps or faith in target-controlled infusion (TCI) devices, potentially resulting in over-and under-dosing and adverse events. 2,[6][7][8] In our experience during organization of an international multi-center study, 9 pediatric anesthesiologists worldwide are generally uncomfortable using TIVA in infants and for good reason. Pharmacokinetic models for propofol dosing in infants display substantial biological variability between individuals, and using proprietary EEG indices, such as BIS, to guide propofol dosing in infants remains uncertain and not recommended for this population.…”

A Prototype Patient-Maintained Propofol Sedation System Using Target Controlled Infusion for Primary Lower-Limb Arthroplasty

“…These include the incorrect input of patient demographics resulting in inaccurate drug dosing, or the incorrect selection of TCI model for the drug to be infused i.e. placing a syringe containing a different drug into a device programmed for propofol delivery, or vice versa [13]. Additionally, the required effect-site concentration for an individual patient can be difficult to determine, as anaesthetists can often misjudge the patients’ anxiety levels [14].…”