Total intravenous anesthesia and target-controlled infusion

Abstract

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 programmed with pharmacokinetic information has facilitated use. The use of published pharmacokinetic parameter sets (referred to as models and often described by the principal author) allows the pump to determine infusion rates to maintain a certain plasma concentration (Cp) and the addition of an effect-site equilibration constant (keo) allows effect-site drug concentration prediction. Covariate knowledge (e.g., weight, age) allows individualization of dose. Recommended target concentrations for both propofol and remifentanil depend on the type of surgery, the degree of surgical stimulation, the use of local anesthetic blocks and the ventilation status of the patient. The use of processed EEG monitoring is helpful in pediatric TIVA anesthesia, particularly in the presence of neuromuscular blockade.