Total Intravenous Anesthesia (TIVA) – An Overview

What is TIVA: Total Intravenous Anesthesia (TIVA) refers to the conservation of an anesthetic plane by a combination of injectable anesthetic, sedative, and tranquilizer drugs most frequently administered by intermittent boluses or CRI.

Total intravenous anesthesia (TIVA) is the use of intravenous agents for induction and protection of anesthesia. The most often used agent is propofol. Furthermore, the Propofol effect is ordinarily augmented with an opioid. Although it,s possible to bring into operation TIVA anesthesia using pumps with the infusion rate controlled manually, Therefore, the advent of pumps programmed with pharmacokinetic knowledge has facilitated use. The important use of published pharmacokinetic parameter sets allows the pump to determine the infusion rates to preserve a certain plasma concentration (Cp) or effect-site concentration (Ce). Covariate knowledge ( such as weight, age) permit individualization of dose. Furthermore, there are limited data in the neonatal and infant populations. The general indications for TIVA anesthesia techniques include children at risk for malignant hyperthermia, procedures with a high risk of postoperative nausea and vomiting, painful procedures, or brief radiologic. therefore, when rapid recovery is needed and repeatedly repeated anesthesia. However, use is spreading to other fields. Furthermore, the fears that children can develop propofol infusion syndrome during routine anesthesia haven’t eventuated.

Volume Replacement Solutions and Infusion Therapy With Fluid

TIVA is a technique of general anesthesia that uses a combination of agents given by the intravenous route without the use of inhalation agents.

There is a solid rationale for the use of TIVA (Total Intravenous Anesthesia) in some patient cases where the delivery of inhaled anesthetics is disadvantageous or impossible, in scenarios where traditional anesthetic delivery systems may be impractical or unavailable. In alternative cases, the use of TIVA (Total Intravenous Anesthesia) could make the process more efficient and advantageous for the patient.

Compared usually to traditional volatile anesthetic techniques, TIVA offers many potential benefits. Furthermore, these include reduced incidence of postoperative nausea and reduced atmospheric pollution, vomiting, a lot of predictable and rapid recovery, preservation of hypoxic pulmonary vasoconstriction, reduced risk of organ toxicity, greater hemodynamic stability, and reduction in intracerebral pressure.

TIVA has become most popular, possible, and practical due to two main reasons – firstly, the pharmacodynamic and pharmacokinetic properties of drugs like newer short-acting opioids and Propofol, which make them suitable for intravenous administration.

Furthermore, the other second reason, the new concepts in pharmacokinetic modeling coupled with the advances in the technology of infusion pumps that the permit use of algorithms like Target TCI (Controlled Infusion).

Therefore, Total IV anesthesia (TIVA) is exclusive an anesthetic technique, when used in cases where postoperative pain management will be required, multimodal pain management methods may well be applied like conducting territorial anesthesia prior to the TIVA anesthesia for post-operative use to improve (progress) the patient recovery.

Pediatric Equipment

Total Intravenous Anesthesia and Vasoactive Medications

If total IV anesthesia (TIVA) or the use of vasoactive medications is compulsory, they are abstractly infused through separate venous access. The speed at which the medication is administered, its depends on the location of the access point in the infusion line, furthermore, how much priming volume is present in the tubing, and therefore, the rate at which the fluids are infusing. A carrier solution on a pump must is infused at an axis of reference rate because most vasoactive medications are piggy-backed into the tubing at slow infusion rates.

The carrier solution should be adjusted to the child’s conservation infusion rate and the other IV fluids reduced. Therefore, the multiple stopcock manifolds allow for the connection of multiple infusions as well as the carrier solution. There are the many multiple-drug infusion (TIVA systems), which has different priming volumes, which in turn affect the speed at which medications are infused. furthermore, the lots of practitioners prime their medications and then initiate the pumps to run the fluids to the end of the manifold. Thus, when they connected directly to an IV line, medications should be delivered without delay provided the carrier fluid rate is maintained at the same rate.

Total IV Anesthesia medical Term Prescription

Total IV Anesthesia (TIVA) can be conducted either with a combination of drugs or with a single drug. The pharmacological synopsis of the drug help clarifies it assists in drug selection and thus clinical implications. The most generally utilized groups of drugs (TCI Drugs) include hypnotics and short-acting opioids. Therefore, the discovery of Propofol in the 70s revolutionized the use of TIVA Anesthesia. the only intravenously active hypnotic agent suitable for the maintenance and induction of anesthesia. Furthermore, Propofol-based TIVA anesthesia techniques offer more advantages including rapid recovery of psychomotor and anti-emetic effect, consciousness function, enhanced recovery speed, and a lower incidence of postoperative nausea and vomiting. Furthermore, the Propofol may be coupled with muscle relaxants, opioids, NSAIDs, etc. Furthermore, it depends on the type of procedure to be performed or in the patient’s case. When using TIVA via TCI, short-acting opioids like Remifentanil is preferred. TIVA via a TCI combining Remifentanil and Propofol collrcted intra-operative responses, therefore, while the permit for a rapid highlight from anesthesia in elective inpatient surgery. it has also been noted in outpatient surgeries.

What Form of Anesthetic Was Used For Field Surgery

Application: As with patient access and drug preparation, the drug application device is also indicated by the choice of drugs used in the TIVA and the choice of method. For induction or the injection of analgesic prior to the induction of anesthesia, a syringe may be used. For the anesthesia conducted via a TCI algorithm, Therefore, a smart syringe pump could be used. Furthermore, the sophistication of syringe infusion pumps has developed rapidly in the recent past. Furthermore, the current pumps offer an inbuilt TCI algorithm functionality with general algorithms for the most widely used TIVA drugs. The pumps also have dedicated the Anesthesia syringe pump and extension lines allowing more than one drug to be infused cumulatively. A three-way stopcock may also is used in order to combine or split.
Prepration: The methodology of performing a TIVA via TCI depends extremely on the selection or regimen of drugs selected which also additionally influences the drug preparation process. The chosen drugs may or may not be available in ready-to-use plastic/glass vials, or plastic/glass ampoules. Ready-to-use medicine can be drawn up into syringes directly or through a filter. For drugs that require mixing, needle-free mixing devices, and therefore, the mixing bags could be used. In some cases, process-specific procedure kits might be made available which include all the required devices, drapes, and dressings, based on the choice of technique or drug combination. Furthermore, these procedures kits might support in making the entire process safer and more efficient.

Anesthesia Drugs: Drugs Used for Anesthesia

Pharmacodynamic Drug Interactions: Propofol and Opioids drugs are used for anesthesia. this is the foremost commonly used drug combination for intravenous induction of anesthesia and total intravenous anesthesia, therefore, it is also used in low doses for procedural sedation. Furthermore, at anesthesia induction, small doses of opioids, like fentanyl 1 µg/kg, have a low effect on the hypnotic dose of propofol, reducing dose requirements by 20%, but a large effect on propofol dose to suppress movement to pain, reduction dose requirements by 50%. Therefore, there have been five detailed studies of combined propofol and remifentanil infusion using response surface models. The combination is synergistic at all clinical endpoints and therefore it is strongest at concentrations of remifentanil up to 4 ng/mL (equivalent to the effect of a steady-state infusion rate of approximately 0.15 µg/kg per minute in a young adult), where there is a sixty-six percent (66%) reduction in expected dose with little synergy shown by higher doses of remifentanil. Furthermore, the bispectral index is additive in this concentration range, presumably because therefore, remifentanil causes little sedation when it is used as a sole agent in low doses, studies using high concentrations of remifentanil have shown the synergy.
IVA medical abbreviation or anesthesiologist abbreviation: Response surface models have been used for the purpose to optimize drug-dose ratios for useful clinical endpoints. Therefore, Optimal combinations for early wake-up times show that using relatively more remifentanil to propofol is benefits, Therefore, when compared with using fentanyl with propofol. Thus, the equipotent optimal dose ratios were approx propofol 2 µg/mL: remifentanil 5 ng/mL compared with propofol 3.5 µg/mL: fentanyl 1.5 ng/mL. Therefore, a study of respiratory effects showed the marked synergy for this undesirable side effect and that it is not possible to reliably suppress the response to noxious stimuli with the conjugation without inducing valued respiratory depression in most patients. Important Note here, blood pressure changes in response to sustained noxious stimuli such surgical incision have not been studied. Furthermore, these recommendations might also need to be improved depending on the degree of hemodynamic suppression allowed. Therefore, for clinical purposes, equivalent doses of the phenylpiperidine opioids fentanyl, sufentanil, alfentanil, and remifentanil can be used interchangeably as the degree of interaction with propofol is thought to be the same.

Important Point: TIVA (Total Intravenous Anesthesia)

• Co-administration of propofol and remifentanil by TCI (target-controlled infusion) is extremely effective for an obtunding response to noxious stimuli and constitutes ‘ideal’ total I .v. anesthesia (TIVA).
• The use one propofol TCI (target-controlled infusion) model over another and all have proved reliable in clinical practice.
• Titration of effect-site concentration to patient response is important throughout the induction and conservation phases of TIVA.
• TIVA typically achieves a deep plane of anesthesia—Therefore, a processed EEG device is indicated theory for the prevention of excessive hypnosis.
• Awareness that happens with TIVA once technical failure prevents the administration of appropriate drugs—vigilance for like errors is essential.

REFERENCES

1. Total intravenous anesthesial From B. Braun Sharing Expertise
2. Science Direct Article taken from the Intravenous Anaesthesia
3. Timothy G. Short, Jacqueline A. Hannam, in Pharmacology and Physiology for Anesthesia (Second Edition), 2019
4. Brian J.Anderson, James Houghton, in Practice of Anesthesia for Infants and Children (6th Edition), 2019
5. Principles of total intravenous anaesthesia: practical aspects of using total intravenous anaesthesia
6. Drug concentrations, pumps, models and syringes from Wiley Online Library