1.38 TIVA

Question 1

Outline Advantages of TIVA

Answer 1

1. Reduction in incidence of PONV
2. Trigger free anaesthetic in risk of MH
3. Maintain anaesthesia where volatile delivery unreliable difficult -
   bronchoscopy/ shared airway surgery
4. Ability to instrument airway w/out muscle relaxation
5. Smoother emergence / recovery profile
   minimal or no cough at extubation
6. Maintenance without lung ventilation
   - bypass
7. Neurosurgery to
   Drop ICP
   Decrease CMRO2
8. Decrease atmosphere pollution compared w/ volatiles
   no gaseous by products
9. Potential advantage during one lung surgery
   preservation of HPV
   (volatiles uncouple HPV = worsening V/Q mm

Question 2

Disadvantages TIVA

Answer 2

1. Cost
   more expensive than volatile
   equipment
   controlled drugs (abuse / error)
2. Requires specific training and understanding of PK + PD
3. Depth alteration rapidity
   relies on patients PK
4. Monitor effectiveness accurately
   effect site concentrations calculated w/ complex maths
5. Occasionally difficulty ventilating with remifentanil
6. Increased risk of awareness
   Kinking lines / bock tubing
   loss access
   equipment
7. CVS instability in some patient
   Sepsis CVS disease elderly

Question 3

Recommendations to prevent critical incidents during TIVA

Answer 3

1. Use 1 way valve on IV fluid when multi lumen IV connectors used
2. All packaging 1 way valves clearly labelled
   ensure correct infusion equipment selected use
3. Continual monitoring and vigilance
   regarding IV access site
   infusion pumps
   infusion lines
4. Pumps are maintained working conditions
   regularly serviced
5. Clinicians expected to ensure adequate training all aspects of TIVA
   Competency testing prior to solo TIVA