Total Intravenous Anesthesia and Target-Controlled Infusion

Abstract

© 2019 Elsevier Inc. All rights reserved. Total intravenous anesthesia (TIVA) is the use of intravenous agents for induction and maintenance of anesthesia. The most frequently used agent is propofol. Propofol effect is usually augmented with an opioid (e.g., remifentanil). Although it is possible to implement TIVA using pumps with the infusion rate controlled manually, the advent of pumps programed with pharmacokinetic information has facilitated use. The use of published pharmacokinetic parameter sets (referred to as models and often described by the principle author) allows the pump to determine infusion rates to maintain a certain plasma concentration (Cp) or effect site concentration (Ce). Covariate knowledge (e.g., weight, age) allows individualization of dose. There are limited data in the neonatal and infant populations. Common indications for TIVA techniques include children at risk for malignant hyperthermia, procedures with a high risk of postoperative nausea and vomiting, brief radiologic or painful procedures when rapid recovery is needed and frequent repeated anesthesia. However, use is spreading to other fields. Fears that children may develop propofol infusion syndrome during routine anesthesia have not eventuated.