Total Intravenous Anaesthesia (TIVA)

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.

Factors Influencing TIVA Medication Combinations

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.

Advantages of TIVA over Volatile Agents

In comparison to inhaled volatile agents, TIVA has the advantages of:

• Significantly less postoperative nausea and vomiting (PONV) with the use of propofol
• Faster emergence from anaesthesia
• Significant reduction of emergence delirium in paediatric patients
• Reduction of cognitive impairment and delirium in elderly patients
• Reduced airway irritation in all ages, including post extubation cough
• Half the risk of laryngospasm and bronchospasm in paediatric patients
• Maintenance of cardiac functioning, especially notable in elderly patients who are able to maintain lung perfusion and have less cardiac depression
• Suitable for use in patients with a potential/confirmed risk of malignant hyperthermia

Clinical Benefits of TIVA with Propofol

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. 

Further Learning

If you would like to learn more about pharmacological considerations in the perioperative environment, join us for one of the following courses:

• Perioperative Nursing Essentials
• Critical Bytes Malignant Hyperthermia

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.