TIVA is one way of achieving this, as the avoidance of volatile agents during general anaesthesia is associated with a more rapid emergence and less side effects. TIVA may be achieved with a single agent such as propofol for shorter procedures, or can be combined with other agents.
The specific combination of medications to achieve TIVA will be dependent on many factors, and should take into account individual patient needs including surgical requirements to reflect the individual needs of patients and the planned surgical procedure. A sufficient plane of anaesthesia can be achieved through either continuous infusion or bolus dosing, depending on the length of the procedure to be performed.
In comparison to inhaled volatile agents, TIVA has the advantages of:
These benefits of TIVA, particularly with the utilisation of propofol, have enhanced the options available for general anaesthesia. Patients who are undergoing short procedures or investigations as day only patients are often able to be discharged home faster, as the side effects are reduced.
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References:
Chokshi, T., Channabasappa, S., Vergheese, D. C., Bajwa, S., Gupta, B., & Mehdiratta, L. (2020). Re-emergence of TIVA in COVID times. Indian journal of anaesthesia, 64(Suppl 2), S125–S131. https://doi.org/10.4103/ija.IJA_554_20.
Jin, Z., Gan, T. J., & Bergese, S. D. (2020). Prevention and Treatment of Postoperative Nausea and Vomiting (PONV): A Review of Current Recommendations and Emerging Therapies. Therapeutics and clinical risk management, 16, 1305–1317. https://doi.org/10.2147/TCRM.S256234.
Miller D, Lewis SR, Pritchard MW, Schofield-Robinson OJ, Shelton CL, Alderson P, Smith AF. (2018). Intravenous versus inhalational maintenance of anaesthesia for postoperative cognitive outcomes in elderly people undergoing non-cardiac surgery. Cochrane Database Syst Rev. Aug 21; 8(8):CD012317. doi: 10.1002/14651858.CD012317.pub2. PMID: 30129968; PMCID: PMC6513211.
Nimmo, A.F., Absalom, A.R., Bagshaw, O., Biswas, A., Cook, T.M., Costello, A., Grimes, S., Mulvey, D., Shinde, S., Whitehouse, T. and Wiles, M.D. (2019), Guidelines for the safe practice of total intravenous anaesthesia (TIVA). Anaesthesia, 74: 211-224. doi.org/10.1111/anae.14428.
Stephenson, S. J., Jiwanmall, M., Cherian, N. E., Kamakshi, S., & Williams, A. (2021). Reduction in post-operative nausea and vomiting (PONV) by preoperative risk stratification and adherence to a standardized anti emetic prophylaxis protocol in the day-care surgical population. Journal of family medicine and primary care, 10(2), 865–870. https://doi.org/10.4103/jfmpc.jfmpc_1692_20.
Wong, S., Choi, S. W., Lee, Y., Irwin, M. G., & Cheung, C. W. (2018). The analgesic effects of intraoperative total intravenous anesthesia (TIVA) with propofol versus sevoflurane after colorectal surgery. Medicine, 97(31), e11615. https://doi.org/10.1097/MD.0000000000011615.
Crystal Smith is a Senior Education Consultant for Critical Care Education Services (part of the Medcast Group). She has a clinical background in critical care, paediatrics and education.
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