GA vs TIVA

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  • To understand the difference between a routine general anesthetic (GA) and TIVA.To understand the variety/combinations of drugs used in TIVA.To appreciate the indications for using TIVA.To be aware of the intraoperative advantages/disadvantages of TIVA.To acknowledge the advantages/disadvantages of TIVA in the PACU.

  • Same induction of anesthesia

    Markedly different maintentance phases:Routine anesthetic is volatile based (ie Sevoflurane)A TIVA is Propofol and Remifentanil based

  • Propofol: Hypnosis + AmnesiaLong half lifeshort duration of action?

    Remi:Provides analgesia and CVS stabilityVery short half life and duration of action (10 minutes)

  • MH patientsTriggers include ALL volatiles, and suxxHistory of severe Post-operative Nausea and Vomiting (PONV)ENT SurgeryShared Airway casesEg. Microlaryngoscopy, Rigid Bronchoscopy

  • Specific Drug Effect Elimination Half-life

    Total Body Distribution

    Obesity, increase TBM, blood volume, cardiac output and regional blood flow affect the quality of TIVA administered to these patients.

    (Chidambaran et al., 2013)

  • (Mani & Morton, 2010; Chandler et al., 2013; Akkurt et al., 2009)

  • Short term for patientsIncreases patients comfort.Increases parental satisfaction in the pediatric population.Improves overall patient satisfaction.

    Short term for nursesDecreases workload. Environmentally friendly.

    Long term for everyoneMore pleasant memorable patient experience for future hospital visits.

    (Mani & Morton, 2010)

  • Intra-operative:Increased incidence of awarenessTechnically demandingHyperalgesia

  • Is becoming more widely used with improved infusion pump design, more appropriate pediatric software and more clinical experience.

    Refinement of tools to measure propofol concentrations in both blood and exhaled breath is a work in progress.

    ( Wong & Norton, 2011)

  • Akkurt, B., Temiz, M., Inanoglu, K., Aslan, A., Turhanoglu, S., Asfuroglu, Z. et al (2009). Comparison of Recovery Characteristics, Postoperative Nausea and Vomiting, and Gastrointestinal Motility With Total Intravenous Anesthesia With Propofol Versus Inhalation Anesthesia With Desflurane for Laparoscopic Cholecystectomy: A Randomized Controlled Study. Current Therapeutic Research, 70(2).Chandler, J., Myers, D., Mehta, D., Whyte, E., Groberman, M., Montgomery, C. et al. (2013). Pediatric Anesthesia, 23, 309-315.Chidambaran, V., Sadhasivam, S., Diepstraten, J., Esslinger, H., Cos, S., Schnell, B., et al (2013). Evaluation of propofol anesthesia in morbidly obese children and adolescents, BMC anesthesiology, 13(8),.Lerman,J., Johr, M. (2009). Inhalational anesthesia vs total intravenous anesthesia (TIVA) for pediatric anesthesia. Pediatric Anesthesia, 19, 521-534.Ozkose, Z., Cok, O., Tuncer, B., Tufekcioglu, S., & Yardim, S. (2002). Comparison of hemodynamics, recovery profile, and early postoperative pain control and costs of remifentanil versus alfentanil-based total intravenous anesthesia (TIVA), Journal of Clinical Anesthesia , 14, 161-168.Rohm, K., Piper , S., Suttner, S., Schuler, S., & Boldt, J. (2006). Early recovery, cognitive function and costs of a desflurane inhalational vs a total intravenous anaesthesis regimen in long term surgery. Acta Anesthesiologica Scandinavica, 50, 14-18.Wong, G., & Morton, N. (2011). Total intravenous anesthesia (TIVA) in pediatric cardiac anesthesia. Pediatric Anesthesia, 21, 560-566.