TIVA Flashcards
An anesthetic including intravenous agents only
can be combined with nitrous oxide and regional.
TIVA
what has brought back the emphasis on the IV technique.
Propofol (hypnotic) and remifentanil (analgesic)
Advantages of TIVA (6)
- smooth induction
- easier control of depth
- rapid, predictable emergence
- decrease ED
- lower PONV
- non triggering MH
why are TIVAs Ideal for neurosurgery
reduced cerebral blood flow and decreased cerebral metabolic rate for oxygen; allow intraoperative neuromonitoring
why is TIVA is often used for cystic fibrosis patients
improved mucociliary transport
lung function is decreased with any anesthetic, will you have more or less of a decrease with TIVAs vs volatiles?
less of a decrease in function with TIVA
Indications for TIVA (6 things)
- Malignant hyperthermia-susceptible patients
- Cystic fibrous patients
- Airway endoscopies, laryngeal and tracheal surgery
- Remote locations (ECT), during transportation
- May be preferable in patients with intracranial hypertension
- Emergence delirium prevention
why should technique be continuous infusion over intermittent bolus when using TIVA?
Minimize swings in levels of drugs seen with intermittent bolus (under- and over-dosing)
Can reduce the total drug requirements by 25 to 30%
Fewer side effects (respiratory depression)
Shorter recovery times (rapid awakening)
Decreased drug costs
Provide stable depth of anesthesia
most commonly used agent in tiva
propofol
why is prop most commonly used?
Rapid onset (pain on injection)
Myocardial effect – don’t use with hypovolemia
Apnea – 25 to 30 % (higher with opioids)
No analgesia provided
Induction dose reduced with midazolam, opioids
No accumulation unlike theopental
cool thing about propofol?
antiemetic
ONLY IV anesthetic that can be used as the sole agent for maintenance of TIVA and why
Ketamine - Hypnosis, analgesia, amnesia
Used for pulmonary and cardiovascular disorders, except CAD, pulmonary HTN
K
why Combination of Ketamine with Propofol
Offsetting hemodynamic effects
Offsetting respiratory effects – maintain spon vent
Propofol offsets PONV and hallucinations
Allows high-dose opioids without delayed recovery, no matter the length of infusion time
remifent- beware hyperalgesia
Dexmedetomidine advantages
- decreased ED
- decreased pain
- anxiolysis
the most reliable sign of inadequate anesthesia.
movement
the time required for the concentration in the central compartment to decrease by 50%
Half-time
meant to serve as guides for emergence from anesthesia to help determine when infusions should be discontinued
Context-sensitive half-time (CSHT)
Propofol – CSHT
up to 3 hours is 10 minutes
after 3 hours is 25 minutes
after 8 hours is 40 minutes
Ketamine – CSHT after 8 hrs
50 minutes
Thiopental - CSHT
40 to 300 minutes
Remifentanil - CSHT
4 mins
sufent CSHT after 4 hrs
30 minutes
Program with patient’s weight, height, age
Target-controlled infusion (TCI) systems
