Total Intravenous Anesthesia (TIVA)

Total intravenous anesthesia (TIVA) is a technique of maintenance of general anesthesia without the use of inhalational anesthetics. A combination of hypnotics with or without analgesics is used to achieve the desired clinical end-point. A clear understanding of the pharmacokinetics of TIVA/TCI (target-controlled infusion) is necessary as improper usage can lead to accidental awareness during anesthesia as reported in the Fifth National Audit Project (NAP) on accidental awareness during general anesthesia (NAP5) report. TIVA has definite advantages in certain scenarios where the use of inhalational anesthetics might not be possible such as non-operating room anesthesia (NORA), during transfer of the patients, airway surgeries, high risk of postoperative nausea and vomiting (PONV), patients with malignant hyperthermia. During TIVA, anesthesia can be induced and maintained by either manual dosing where the provider determines the bolus dose and infusion rate, or by using a TCI pump where the anesthetist enters the desired “target” concentration to be achieved in the patient’s plasma or brain. This chapter provides an overview of practical aspects related to TIVA.