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Kannabiran, Narmadhalakshmi, and Prasanna Udupi Bidkar. "Total Intravenous Anesthesia in Neurosurgery." Journal of Neuroanaesthesiology and Critical Care 05, no. 03 (2018): 141–49. http://dx.doi.org/10.1055/s-0038-1673544.
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AbstractIn recent years, neurosurgical anesthesia has been rapidly evolving in the fields of pharmacotherapy and techniques to administer safe anesthesia. Intravenous (IV) anesthetic agents reduce both cerebral blood flow and intracranial pressure besides maintaining flow–metabolism coupling in contrast to inhalational agents. In neuroanesthesia, the technique and choice of drugs directly influence the outcome of the patients. The purpose of this review is to provide the updated information of total intravenous anesthesia (TIVA) in neuroanesthesia. Administration of TIVA using target-controlled infusion technique is emerging as a standard method to administer safe anesthesia in neurosurgical patients. The propofol–remifentanil combination has become very popular due to their favorable pharmacokinetic and pharmacodynamic properties for neurosurgery cases. Plasma-effect site concentration monitoring from target TCI devices together with electroencephalogram or bispectral index monitors allows easy titration of anesthetic agents to ensure adequate depth of anesthesia depending upon the nociceptive stimulus. TIVA is associated with smooth induction and rapid emergence with less postoperative nausea and vomiting.
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Anna Abad - Torrent. "Recomendaciones para la práctica segura de la Anestesia Total Intravenosa." Revista Electrónica AnestesiaR 12, no. 6 (2020): 2. http://dx.doi.org/10.30445/rear.v12i6.853.
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Wong, Grace L. S., and Neil S. Morton. "Total intravenous anesthesia (TIVA) in pediatric cardiac anesthesia." Pediatric Anesthesia 21, no. 5 (2011): 560–66. http://dx.doi.org/10.1111/j.1460-9592.2011.03565.x.
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LERMAN, JERROLD, and MARTIN JÖHR. "Inhalational anesthesia vs total intravenous anesthesia (TIVA) for pediatric anesthesia." Pediatric Anesthesia 19, no. 5 (2009): 521–34. http://dx.doi.org/10.1111/j.1460-9592.2009.02962.x.
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Toscano, Fiore V., Angela K.Vick, Hamilton H. Shay, and Ellise S. Delphin. "Total Intravenous Anesthesia (TIVA) for Stiff-Person Syndrome." Open Journal of Anesthesiology 02, no. 04 (2012): 185–87. http://dx.doi.org/10.4236/ojanes.2012.24042.
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Velázquez-Delgado, Perla I., Eduardo Gutierrez-Blanco, Felipe de J. Torres-Acosta, Antonio Ortega-Pacheco, Armando J. Aguilar-Caballero, and Brighton T. Dzikiti. "Comparison of Propofol or Isoflurane Anesthesia Maintenance, Combined with a Fentanyl–Lidocaine–Ketamine Constant-Rate Infusion in Goats Undergoing Abomasotomy." Animals 11, no. 2 (2021): 492. http://dx.doi.org/10.3390/ani11020492.
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This study aimed to compare, first, the anesthetic and cardiopulmonary effects of propofol or isoflurane anesthetic maintenance in goats receiving a fentanyl–lidocaine–ketamine infusion undergoing abomasotomy and, secondly, to compare the quality of the recovery from anesthesia. Two groups were used: propofol (TIVA) and isoflurane (PIVA). Goats were premedicated with fentanyl (10 μg/kg intravenously [IV]), lidocaine (2 mg/kg, IV), and ketamine (1.5 mg/kg, IV). Anesthesia was induced with propofol and maintenance consisted of fentanyl (10 μg/kg/h, IV), lidocaine (50 μg/kg/min, IV), and ketamine (50 μg/kg/min, IV) as constant-rate infusions (CRIs), combined with either CRI of propofol at initial dose of 0.3 mg/kg/min, IV (TIVA), or isoflurane with initial end-tidal (FE’Iso) concentration of 1.2% partial intravenous anesthesia (PIVA). The mean effective propofol dose for maintenance was 0.44 ± 0.07 mg/kg/min, while the mean FE’Iso was 0.81 ± 0.2%. Higher systolic arterial pressure (SAP) values were observed in total intravenous anesthesia (TIVA) during some time points. Recovery was smooth in PIVA, while restlessness, vocalizations, and paddling were observed in TIVA. Both protocols produced a satisfactory quality of anesthesia during surgery, with minimal impact on cardiopulmonary function. Nevertheless, recovery after anesthesia in TIVA might be of poor quality.
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Chokshi, Tushar M. "Infographics in TIVA." Journal of Cardiac Critical Care TSS 05, no. 01 (2021): 033–42. http://dx.doi.org/10.1055/s-0041-1723628.
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AbstractInfographics are a new way of visually communicating information in a colorful and concise manner. They are becoming very popular in medical field since the last decade. Through infographics, one can understand the subjects through text, graphics, and images. Total intravenous anesthesia (TIVA) is a technique of general anesthesia (GA) given via intravenous (IV) route exclusively. In perspective of infographics, TIVA is far more understandable through its simple format. TIVA is also more advantageous than inhalational anesthesia. It avoids the deleterious effects of immunosuppressant and lacks any respiratory irritation, thus providing a good alternative anesthesia technique. Many peripheral surgeries can be done with the patient breathing spontaneously without any airway device, thus avoiding airway instrumentation, leading to droplet and aerosol generation. IV agents can be utilized to provide sedation during regional anesthesia (RA), which can easily be escalated to contain pain due to sparing of blocks or receding neuraxial anesthesia. The present narrative review focuses on the infographics in TIVA technique, providing highlights pertaining to its importance.
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Visser, Klazina, Elly A. Hassink, Gouke J. Bonsel, Jeroen Moen, and Cor J. Kalkman. "Randomized Controlled Trial of Total Intravenous Anesthesia with Propofol versus Inhalation Anesthesia with Isoflurane–Nitrous Oxide." Anesthesiology 95, no. 3 (2001): 616–26. http://dx.doi.org/10.1097/00000542-200109000-00012.
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Background To assess the incidence of postoperative nausea and vomiting after total intravenous anesthesia (TIVA) with propofol versus inhalational anesthesia with isoflurane-nitrous oxide, the authors performed a randomized trial in 2,010 unselected surgical patients in a Dutch academic institution. An economic evaluation was also performed. Methods Elective inpatients (1,447) and outpatients (563) were randomly assigned to inhalational anesthesia with isoflurane-nitrous oxide or TIVA with propofol-air. Cumulative incidence of postoperative nausea and vomiting was recorded for 72 h by blinded observers. Cost data of anesthetics, antiemetics, disposables, and equipment were collected. Cost differences caused by duration of postanesthesia care unit stay and hospitalization were analyzed. Results Total intravenous anesthesia reduced the absolute risk of postoperative nausea and vomiting up to 72 h by 15% among inpatients (from 61% to 46%, P < 0.001) and by 18% among outpatients (from 46% to 28%, P < 0.001). This effect was most pronounced in the early postoperative period. The cost of anesthesia was more than three times greater for propofol TIVA. Median duration of stay in the postanesthesia care unit was 135 min after isoflurane versus 115 min after TIVA for inpatients (P < 0.001) and 160 min after isoflurane versus 150 min after TIVA for outpatients (P = 0.039). Duration of hospitalization was equal in both arms. Conclusion Propofol TIVA results in a clinically relevant reduction of postoperative nausea and vomiting compared with isoflurane-nitrous oxide anesthesia (number needed to treat = 6). Both anesthetic techniques were otherwise similar. Anesthesia costs were more than three times greater for propofol TIVA, without economic gains from shorter stay in the postanesthesia care unit
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Cho, Ho Bum, Mun Gyu Kim, Sun Young Park, et al. "The influence of propofol-based total intravenous anesthesia on postoperative outcomes in end-stage renal disease patients: A retrospective observation study." PLOS ONE 16, no. 7 (2021): e0254014. http://dx.doi.org/10.1371/journal.pone.0254014.
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Background To determine whether the anesthetic method of propofol total intravenous anesthesia (TIVA) is associated with postoperative outcome in ESRD patients, we evaluated the incidence of postoperative major adverse cardiac events (MACE), comparing propofol TIVA versus anesthesia with volatile anesthesia in ESRD patients. Methods Retrospectively, we identified cases with ESRD patients who underwent surgery under general anesthesia. Patients were divided into those who received only volatile anesthesia (volatile group) and those who received only propofol TIVA (TIVA group). The incidence of MACE and potential confounding variables were compared separately in a univariate logistic model and subsequently by multivariate logistic regression. Results Among the 2576 cases in ESRD patients, 1374 were in the TIVA group and 1202 were in the volatile group. The multivariate analysis included 12 factors, including the anesthesia method, of which five factors were significant. Factors that were associated with a significantly lower MACE risk included preoperative chloride concentration (OR: 0.96; 95% CI, 0.92–0.99), baseline SBP (OR: 0.98; 95% CI, 0.98–0.99), and propofol TIVA (OR: 0.37; 95% CI, 0.22–0.60). Conclusions We inferred that the anesthetic method associated with the postoperative outcome in patients with ESRD.
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Şen, Ahmet, Başar Erdivanlı, Abdullah Özdemir, Hızır Kazdal, and Ersagun Tuğcugil. "Efficacy of Continuous Epidural Analgesia versus Total Intravenous Analgesia on Postoperative Pain Control in Endovascular Abdominal Aortic Aneurysm Repair: A Retrospective Case-Control Study." BioMed Research International 2014 (2014): 1–5. http://dx.doi.org/10.1155/2014/205164.
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We reviewed our experience to compare the effectiveness of epidural analgesia and total intravenous analgesia on postoperative pain control in patients undergoing endovascular abdominal aortic aneurysm repair. Records of 32 patients during a 2-year period were retrospectively investigated. TIVA group (n=18) received total intravenous anesthesia, and EA group (n=14) received epidural anesthesia and sedation. Pain assessment was performed on all patients on a daily basis during rest and activity on postoperative days until discharge from ward using the numeric rating scale. Data for demographic variables, required anesthetic level, perioperative hemodynamic variables, postoperative pain, and morbidities were recorded. There were no relevant differences concerning hospital stay (TIVA group: 14.1 ± 7.0, EA group: 13.5 ± 7.1), perioperative blood pressure variability (TIVA group: 15.6 ± 18.1, EA group: 14.8 ± 11.5), and perioperative hemodynamic complication rate (TIVA group: 17%, EA group: 14%). Postoperative pain scores differed significantly (TIVA group: 5.4 ± 0.9, EA group: 1.8 ± 0.8,P<0.001). Epidural anesthesia and postoperative epidural analgesia better reduce postoperative pain better compared with general anesthesia and systemic analgesia, with similar effects on hemodynamic status.
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Hwang, Joon Ku, Seung Joon Lee, Ho Yeong Kil, and Young Joon Yoon. "Clinical Evaluation of One: Syringe Total Intravenous Anesthesia ( TIVA )." Korean Journal of Anesthesiology 32, no. 1 (1997): 67. http://dx.doi.org/10.4097/kjae.1997.32.1.67.
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Ozcan, Ayca Dumanli, Aysun Ersen Yungul, Togay Muderris, et al. "Effects of Total Intravenous Anesthesia and Low- and High-Flow Anesthesia Implementation on Middle Ear Pressure." BioMed Research International 2018 (2018): 1–5. http://dx.doi.org/10.1155/2018/8214651.
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Background. The middle ear is an air-filled lacuna in the temporal bone. Inhaled anesthetic agents increase the pressure of this lacuna. Therefore, attention must be paid in choosing not only anesthetic agents but also anesthetic method. Aim. This study compared the effects of high-flow total intravenous anesthesia (TIVA) and low- and high-flow desflurane anesthesia on middle ear pressure. Study Design. Randomized prospective double-blind study. Methods. In this retrospective double-blind study, 90 patients (20–65 years old) scheduled to undergo elective thyroidectomies were divided into three randomized anesthesia groups: high-flow desflurane (Group I), low-flow desflurane (Group II), and high-flow TIVA (propofol, remifentanil) (Group III). The hemodynamic and respiratory parameters and tympanometry were measured before induction (T1), 10 minutes after intubation (T2), 10 minutes before the end of the operation (T3), and 5 (T4), 10 (T5), 15 (T6), and 30 (T7) minutes after the operation. Results. No statistically significant differences were found in the age, gender, weight, height, body mass index, surgery duration, and anesthetic duration (p>0.05). There were no statistically significant differences at T1, T3, T4, T5, T6, and T7 (p>0.007), but there was a significant difference at T2 (p<0.001), with Groups II and III having lower pressure than Group I (p<0.001). Conclusion. The high-flow desflurane group had higher postinduction middle ear pressure values. Therefore, low-flow anesthesia and TIVA can be used more safely in middle ear surgeries, provided that a well-equipped anesthetic device and appropriate monitoring conditions are available.
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Sandhya, A., R. Mamatha, and Antara Banerjee. "Postoperative Nausea and Vomiting in Day Care Patients: A Comparative Randomized Controlled Trial of Total Intravenous Anesthesia with Propofol, Air, and Oxygen vs Inhalation Anesthesia with Isoflurane and Nitrous Oxide." Journal of Medical Sciences 1, no. 4 (2015): 63–68. http://dx.doi.org/10.5005/jp-journals-10045-0019.
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ABSTRACT Introduction We compared the incidence of postoperative nausea and vomiting (PONV) after total intravenous anesthesia (TIVA) using propofol–air to inhalational anesthesia with isoflurane–nitrous oxide in day care patients at a tertiary care academic institution. Materials and methods We randomized 60 patients and assigned to either group I (inhalational anesthesia with isoflurane– nitrous oxide) or group II (TIVA with propofol–air). Incidence of PONV, use of anti-emetics, and duration of stay in the recovery were recorded for 72 hours by blinded observers. Results Total intravenous anesthesia reduced the PONV up to 72 hours by 27% among our patients (from 37 to 10%, p < 0.001). This effect was seen more in the early postoperative period. Overall, 13.3% of patients in the group I received antiemetic compared to 40% in group II. In our study, patients without PONV were discharged from the recovery room 15 minutes earlier after TIVA than after isoflurane and N2O anesthesia. Conclusion Total intravenous anesthesia with propofol and air resulted in a reduction of PONV compared with iso-flurane–nitrous oxide anesthesia. Overall, patients in group I required less rescue antiemetic, compared to group II. Total intravenous anesthesia resulted in shorter stay in the postoperative anesthetic care unit compared to isoflurane–N2O group. How to cite this article Sandhya A, Mamatha R, Banerjee A, Sahajananda H. Postoperative Nausea and Vomiting in Day Care Patients: A Comparative Randomized Controlled Trial of Total Intravenous Anesthesia with Propofol, Air, and Oxygen vs Inhalation Anesthesia with Isoflurane and Nitrous Oxide. J Med Sci 2015;1(4):63-68.
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Evans, Roger G., Naoya Iguchi, Andrew D. Cochrane, et al. "Renal hemodynamics and oxygenation during experimental cardiopulmonary bypass in sheep under total intravenous anesthesia." American Journal of Physiology-Regulatory, Integrative and Comparative Physiology 318, no. 2 (2020): R206—R213. http://dx.doi.org/10.1152/ajpregu.00290.2019.
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Renal medullary hypoxia may contribute to the pathophysiology of acute kidney injury, including that associated with cardiac surgery requiring cardiopulmonary bypass (CPB). When performed under volatile (isoflurane) anesthesia in sheep, CPB causes renal medullary hypoxia. There is evidence that total intravenous anesthesia (TIVA) may preserve renal perfusion and renal oxygen delivery better than volatile anesthesia. Therefore, we assessed the effects of CPB on renal perfusion and oxygenation in sheep under propofol/fentanyl-based TIVA. Sheep ( n = 5) were chronically instrumented for measurement of whole renal blood flow and cortical and medullary perfusion and oxygenation. Five days later, these variables were monitored under TIVA using propofol and fentanyl and then on CPB at a pump flow of 80 mL·kg−1·min−1 and target mean arterial pressure of 70 mmHg. Under anesthesia, before CPB, renal blood flow was preserved under TIVA (mean difference ± SD from conscious state: −16 ± 14%). However, during CPB renal blood flow was reduced (−55 ± 13%) and renal medullary tissue became hypoxic (−20 ± 13 mmHg versus conscious sheep). We conclude that renal perfusion and medullary oxygenation are well preserved during TIVA before CPB. However, CPB under TIVA leads to renal medullary hypoxia, of a similar magnitude to that we observed previously under volatile (isoflurane) anesthesia. Thus use of propofol/fentanyl-based TIVA may not be a useful strategy to avoid renal medullary hypoxia during CPB.
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Ahn, Ahn, and Yi. "Total Intravenous Anesthesia Maintained the Degree of Pre-Existing Mitral Regurgitation Better than Isoflurane Anesthesia in Cardiac Surgery: A Randomized Controlled Trial." Journal of Clinical Medicine 8, no. 8 (2019): 1104. http://dx.doi.org/10.3390/jcm8081104.
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Accurate assessment of mitral regurgitation (MR) is critical during mitral valve repair surgery. However, anesthesia may influence the degree of mitral regurgitation by changing pre- and after-load or cardiac contractility. Therefore, we compared changes in mitral regurgitation by total intravenous anesthesia (TIVA) and inhalation anesthesia in patients with pre-existing mitral regurgitation. This was a double-blind randomized controlled study conducted at a tertiary care center in 2018. Fifty-four mitral regurgitation patents undergoing elective cardiac surgery were randomly assigned to receive TIVA or isoflurane. Primary endpoint was change of regurgitation volume by anesthesia. The reduction of regurgitation volume by anesthesia was greater in the isoflurane group than in the TIVA group (mean (95% confidence interval CI): −0.20 (−6.15, 5.75) vs. −9.66 (−15.77, −3.56), mL·beat−1, p = 0.0266) and this phenomenon was more prominent with severe mitral regurgitation (grade 3 or 4) (mean (95% CI): −0.33 (−9.10, 8.44) vs. −16.20 (−24.22, −8.18), mL·beat−1, p = 0.0079). Among patients with MR grade 3 or 4, 94% remained the same with TIVA during anesthesia compared to 56% with isoflurane. In conclusion, TIVA maintained the pre-anesthetic state of mitral regurgitation relatively well, while the severity of mitral regurgitation tended to decrease with isoflurane anesthesia.
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Li, Xiaoxi, Bin Zhang, Ling Yu, Jiaonan Yang, and Hongyu Tan. "Influence of Sevoflurane-Based Anesthesia versus Total Intravenous Anesthesia on Intraoperative Neuromonitoring during Thyroidectomy." Otolaryngology–Head and Neck Surgery 162, no. 6 (2020): 853–59. http://dx.doi.org/10.1177/0194599820912030.
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Objective To examine the influence of sevoflurane-based combined intravenous and inhaled anesthesia versus propofol-based total intravenous anesthesia (TIVA) on intraoperative neuromonitoring (IONM) during thyroidectomy. Study Design A randomized controlled trial. Setting The present study was conducted in a tertiary hospital. Subjects and Methods Forty patients were randomly assigned to a sevoflurane-based combined intravenous and inhalation group (group S) or a propofol-based total intravenous group (group P). Anesthesia was induced with midazolam, sufentanil, propofol, and cisatracurium in both groups and was maintained with sevoflurane and remifentanil in group S and with TIVA with propofol and remifentanil in group P. IONM was performed intermittently according to the IONM formula standard. Results The time until detection of the first positive electromyographic (EMG) signal was significantly longer in group S (median, 41.0 minutes [interquartile range, 37.5-49.3]) than in group P (37.0 minutes [33.3-41.5], P = .028). All patients in group P had a positive EMG signal at initial monitoring, whereas 8 patients (40.0%) in group S did not. The rate of positive EMG signal at initial monitoring was significantly higher in group P than in group S ( P = .006). The amplitude of the evoked potentials at V1, R1, R2, and V2 were similar between the groups. Conclusion Combined intravenous and inhaled anesthesia based on sevoflurane-remifentanil prolonged the time until detection of a positive EMG signal during IONM as compared with TIVA with propofol-remifentanil in patients undergoing thyroidectomy.
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Hadade, Adina, Daniela Ionescu, Teodora Mocan, Alexandru Necula, and Victor Cristea. "Total Intravenous Versus Inhalation Anesthesia in Patients Undergoing Laparoscopic Cholecystectomies. Effects on Two Proinflammatory Cytokines Serum Levels: Il-32 and TNF-Alfa." Journal of Critical Care Medicine 2, no. 1 (2016): 44–50. http://dx.doi.org/10.1515/jccm-2016-0008.
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Abstract Introduction: It has been reported that as compared with total intravenous anesthesia (TIVA), inhalation anesthesia is increasing the postoperative level of proinflammatory interleukins. The aim of the study is to investigate if there is an in-vivo relationship between proinflammatory cytokines, Interleukin- 32 (IL-32) and Tumour necrosis factor - α (TNF- α), in patients undergoing laparoscopic cholecystectomies with two different anesthetic techniques, TIVA or inhalation anesthesia. Material and Methods: Twenty two consecutive patients undergoing laparoscopic cholecystectomies were prospectively randomized into two groups: Group 1: TIVA with target-controlled infusion (TIVA-TCI) (n=11) and Group 2: isoflurane anesthesia (ISO) (n=11). IL-32 and TNF-α were determined before the induction of anesthesia (T1), before incision (T2) and at 2h (T3) and 24h (T4) postoperatively. Our primary outcome was to compare plasma levels of IL-32 and TNF- α concentrations (expressed as area-under-the-curve) over 24 hours between study groups. Our secondary outcome was to establish whether there is a correlation between plasma levels of IL-32 and of TNF-α at each time point between the two groups. Results: Area-under-the-curve (AUC) of IL-32 plasma concentration was 7.53 in Group 1 (TIVA) versus 3.80 in Group 2 (ISO), p= 1. For TNF-α, AUC of plasma concentration was 733.9 in Group 1 (TIVA) and 668.7 in Group 2 (ISO), p= 0.066. There were no significant differences in plasma concentrations of both IL-32 and TNF- α between the groups. Conclusions: IL-32 expression in response to minor surgery is very low. There were no significant difference between plasma levels ofTNF- α and IL-32 after TIVA versus inhalation anesthesia during the first 24 hours postoperatively. Further studies are needed on larger groups to investigate whether there can be a correlation between these interleukins after 2 different anesthetic techniques and the impact of this correlation on postoperative outcome.
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Kwon, Park, Lee, Oh, Lee, and Min. "Effects of Volatile versus Total Intravenous Anesthesia on Occurrence of Myocardial Injury after Non-Cardiac Surgery." Journal of Clinical Medicine 8, no. 11 (2019): 1999. http://dx.doi.org/10.3390/jcm8111999.
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The cardioprotective effects of volatile anesthetics versus total intravenous anesthesia (TIVA) are controversial, especially in patients undergoing non-cardiac surgery. Using current generation high-sensitivity cardiac troponin (hs-cTn), we aimed to evaluate the effect of anesthetics on the occurrence of myocardial injury after non-cardiac surgery (MINS). From February 2010 to December 2016, 3555 patients without preoperative hs-cTn elevation underwent non-cardiac surgery under general anesthesia. Patients were grouped according to anesthetic agent; 659 patients were classified into a propofol-remifentanil total intravenous anesthesia (TIVA) group, and 2896 patients were classified into a volatile group. To balance the use of remifentanil between groups, a balanced group (n = 1622) was generated with patients who received remifentanil infusion in the volatile group, and two separate comparisons were performed (TIVA vs. volatile and TIVA vs. balanced). The primary outcome was occurrence of MINS, defined as rise of hs-cTn I ≥ 0.04 ng/mL within postoperative 48 hours. The secondary outcomes were 30-day mortality, postoperative acute kidney injury (AKI), and adverse events during hospital stay (mortality, type I myocardial infarction (MI), and new-onset arrhythmia). In propensity-matched analyses, the occurrence of MINS was lower in the TIVA group compared to the volatile group (OR 0.642; 95% CI 0.450–0.914; p = 0.014). However, after balancing the use of remifentanil, there was no difference between groups in the risk of MINS (OR 0.832; 95% CI 0.554–1.251; p-value = 0.377). There were no significant associations between the two groups in type 1 MI, new-onset atrial fibrillation, in-hospital and 30-day mortality before and after balancing the use of remifentanil. However, the incidence of postoperative AKI was lower in the TIVA group (OR 0.362; 95% CI 0.194–0.675; p-value = 0.001). After balancing the use of remifentanil, volatile anesthesia and TIVA showed comparable effects on MINS in patients undergoing non-cardiac surgery without preoperative myocardial injury. Further studies are needed on the benefit of remifentanil infusion.
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Grathwohl, Kurt W., Ian H. Black, Phillip C. Spinella, et al. "Total Intravenous Anesthesia Including Ketamine versus Volatile Gas Anesthesia for Combat-related Operative Traumatic Brain Injury." Anesthesiology 109, no. 1 (2008): 44–53. http://dx.doi.org/10.1097/aln.0b013e31817c02e3.
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Background Traumatic brain injury is a leading cause of death and severe neurologic disability. The effect of anesthesia techniques on neurologic outcomes in traumatic brain injury and potential benefits of total intravenous anesthesia (TIVA) compared with volatile gas anesthesia (VGA), although proposed, has not been well evaluated. The purpose of this study was to compare TIVA versus VGA in patients with combat-related traumatic brain injury. Methods The authors retrospectively reviewed 252 patients who had traumatic brain injury and underwent operative neurosurgical intervention. Statistical analyses, including propensity score and matched analyses, were performed to assess differences between treatment groups (TIVA vs. VGA) and good neurologic outcome. Results Two hundred fourteen patients met inclusion criteria and were analyzed; 120 received VGA and 94 received TIVA. Good neurologic outcome (Glasgow Outcome Score 4-5) and decreased mortality were associated with TIVA compared with VGA (75% vs. 54%; P = 0.002 and 5% vs. 16%; P = 0.02, respectively). Multivariate logistic regression found admission Glasgow Coma Scale score of 8 or greater (odds ratio, 13.3; P &lt; 0.001) and TIVA use (odds ratio, 2.3; P = 0.05) to be associated with good neurologic outcomes. After controlling for confounding factors using propensity analysis and repeated one-to-one matching of patients receiving TIVA with those receiving VGA with regard to Injury Severity Score, Glasgow Coma Scale score, base deficit, Head Abbreviated Injury Score, and craniectomy or craniotomy, the authors could not find an association between treatment and neurologic outcome. Conclusion Total intravenous anesthesia often including ketamine was not associated with improved neurologic outcome compared with VGA. Multiple confounders limit conclusions that can be drawn from this retrospective study.
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Jo, Jun-Young, Yeon Ju Kim, Seong-Soo Choi, Jihoon Park, Han Park, and Kyung-Don Hahm. "A Prospective Randomized Comparison of Postoperative Pain and Complications after Thyroidectomy under Different Anesthetic Techniques: Volatile Anesthesia versus Total Intravenous Anesthesia." Pain Research and Management 2021 (February 2, 2021): 1–7. http://dx.doi.org/10.1155/2021/8876906.
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While the postoperative outcome is favorable, post-thyroidectomy pain is considerable. Reducing the postoperative acute pain, therefore, is considered important. This study investigated whether the pain intensity and need for rescue analgesics during the immediate postoperative period after thyroidectomy differ according to the methods of anesthesia. Seventy-two patients undergoing total thyroidectomy under general anesthesia were examined. Patients were randomly assigned to undergo either total intravenous anesthesia with remifentanil and propofol (TIVA, n = 35) or propofol induction and maintenance with desflurane and nitrous oxide (volatile anesthesia [VA], n = 37). The mean administered dose of remifentanil was 1977.7 ± 722.5 μg in the TIVA group, which was approximately 0.268 ± 0.118 μg/min/kg during surgery. Pain scores based on a numeric rating scale (NRS) and the need for rescue analgesics were compared between groups at the postoperative anesthetic care unit (PACU). The immediate postoperative NRS values of the TIVA and VA groups were 5.7 ± 1.7 and 4.7 ± 2.3, respectively ( P = 0.034). Postoperative morphine equianalgesic doses in the PACU were higher in the TIVA group than in the VA group (16.7 ± 3.8 mg vs. 14.1 ± 5.9 mg, P = 0.027). The incidence of immediate postanesthetic complications did not differ significantly between groups. In conclusion, more rescue analgesics were required in the TIVA group than in the VA group to adequately manage postoperative pain while staying in the PACU after thyroidectomy.
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Wong, Michelle. "Anesthesia for a Patient With Excessive Supragastric Belching." Anesthesia Progress 64, no. 4 (2017): 244–47. http://dx.doi.org/10.2344/anpr-64-04-01.
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Excessive supragastric belching is rarely described in the anesthesia literature. Anesthesia planning of a 26-year-old patient with excessive supragastric belching, history of superior mesenteric artery syndrome (SMAS), and dental anxiety requires preoperative assessment. This case report outlines the anesthetic considerations and the management to facilitate comprehensive dentistry. Key anesthetic considerations include anxiolysis, aspiration risk reduction, total intravenous anesthesia (TIVA), and postoperative nausea and vomiting (PONV) prophylaxis.
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Amin, Ayad A. "Clinical evaluation of TIVA by romifidine as a premedication, midazolam and ketamine in donkeys." Iraqi Journal of Veterinary Medicine 36, no. 0E (2012): 203–8. http://dx.doi.org/10.30539/iraqijvm.v36i0e.412.
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The objective of this study was to determine the clinical effects of total intravenous anesthesia (TIVA) by romifidine 0.1mg/kg as a premedication and anesthesia by intravenous injection of a mixture of midazolam 0.1 mg/kg and ketamine hydrochloride 2.2 mg/kg in the ten health She donkeys. The maintenance of anesthesia was performed by intravenous infusion of a mixture of the midazolam 0.065mg/kg/hrs and ketamine 6.6mg/kg /hrs prepared in 500ml normal saline. Data were collected just before intravenous administration of premedication (control data) and after the administration of anesthetics drugs at 5, 10, 15, 20, 25, 30, 45, 60 and 90 minutes. The clinical parameters measured included: Anesthetic Parameter (induction, anesthetic time and recovery), rectal body temperature, arterial oxyheamglobin saturation in blood (SPO2), analgesia, muscles relaxation, at the above times until the donkey responds to external stimuli. The results of the induction and maintenance of general anesthesia by this regime was found to be superior and stable. Recovery from anaesthesia was smooth and similar quality in all animals. The body temperature showed significant differences between control and 5min 37.35 ± 0.054 ;37.19 ± 0.08 ◦C with 15 min and above to the 60 min, while in SPO2 (%) the result showed significant difference (P<0.05) in time 90 min 97.4 ± 0.541 with 10min ; 15min 94.6 ± 1.229 ;93.7 ± 1.075 %and 20 min 93.9 ± 1.075%. There were no adverse effects noted following this anesthetic regime.
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Alhowary, Ala”a, Abdelwahab Aleshawi, Obada Alali, et al. "Effect of Depth of Total Intravenous General Anesthesia on Intraoperative Electrically Evoked Compound Action Potentials in Cochlear Implantation Surgery." Anesthesiology Research and Practice 2019 (December 1, 2019): 1–7. http://dx.doi.org/10.1155/2019/6838506.
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Purpose. This study aims to compare the effect of the depth of total intravenous anesthesia (TIVA) on intraoperative electrically evoked compound action potential (e-ECAP) thresholds in cochlear implant operations. Methods. Prospectively, a total of 39 patients aged between 1 and 48 years who were scheduled to undergo cochlear implantation surgeries were enrolled in this study. Every patient received both light and deep TIVA during the cochlear implant surgery. The e-ECAP thresholds were obtained during the light and deep TIVA. Results. After comparing the e-ECAP means for each electrode (lead) between the light and deep anesthesia, no significant differences were detected between the light and deep anesthesia. Conclusion. The depth of TIVA may have no significant influence on the e-ECAP thresholds as there was no statistical difference between the light and deep anesthesia.
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Morton, Neil S. "Total Intravenous Anesthesia (TIVA) and Target Controlled Infusions (TCI) in Children." Current Anesthesiology Reports 3, no. 1 (2012): 37–41. http://dx.doi.org/10.1007/s40140-012-0005-2.
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Lu, Chueng-He, Zhi-Fu Wu, Bo-Feng Lin, et al. "Faster extubation time with more stable hemodynamics during extubation and shorter total surgical suite time after propofol-based total intravenous anesthesia compared with desflurane anesthesia in lengthy lumbar spine surgery." Journal of Neurosurgery: Spine 24, no. 2 (2016): 268–74. http://dx.doi.org/10.3171/2015.4.spine141143.
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OBJECT Anesthesia techniques can contribute to the reduction of anesthesia-controlled time and may therefore improve operating room efficiency. However, little is known about the difference in anesthesia-controlled time between propofol-based total intravenous anesthesia (TIVA) and desflurane (DES) anesthesia techniques for prolonged lumbar spine surgery under general anesthesia. METHODS A retrospective analysis was conducted using hospital databases to compare the anesthesia-controlled time of lengthy (surgical time > 180 minutes) lumbar spine surgery in patients receiving either TIVA via target-controlled infusion (TCI) with propofol/fentanyl or DES/fentanyl-based anesthesia, between January 2009 and December 2011. A variety of time intervals (surgical time, anesthesia time, extubation time, time in the operating room, postanesthesia care unit [PACU] length of stay, and total surgical suite time) comprising perioperative hemodynamic variables were compared between the 2 anesthesia techniques. RESULTS Data from 581 patients were included in the analysis; 307 patients received TIVA and 274 received DES anesthesia. The extubation time was faster (12.4 ± 5.3 vs 7.0 ± 4.5 minutes, p < 0.001), and the time in operating room and total surgical suite time was shorter in the TIVA group than in the DES group (326.5 ± 57.2 vs 338.4 ± 69.4 minutes, p = 0.025; and 402.6 ± 60.2 vs 414.4 ± 71.7 minutes, p = 0.033, respectively). However, there was no statistically significant difference in PACU length of stay between the groups. Heart rate and mean arterial blood pressure were more stable during extubation in the TIVA group than in the DES group. CONCLUSIONS Utilization of TIVA reduced the mean time to extubation and total surgical suite time by 5.4 minutes and 11.8 minutes, respectively, and produced more stable hemodynamics during extubation compared with the use of DES anesthesia in lengthy lumbar spine surgery.
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Surbatovic, Maja, Zoran Vesic, Dragan Djordjevic, et al. "Hemodynamic stability in total intravenous propofol anesthesia with midazolam coinduction versus general balanced anaesthesia in laparoscopic cholecystectomy." Vojnosanitetski pregled 69, no. 11 (2012): 967–72. http://dx.doi.org/10.2298/vsp1211967s.
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Background/Aim. Laparoscopic cholecystectomy can be a greater challenge for anesthesiologist than for surgeon if the patient is ASA III with concomitant cardiovascular diseases. The aim of our study was to compare the effect of total intravenous anesthesia (TIVA - propofol with midazolam) and general balanced anesthesia (GBA - midazolam, thiopenton, nitrous oxide and O2) on hemodynamic stability in the ASA III patients who underwent laparoscopic cholecystectomy. Methods. In our study, 60 patients were randomized into two groups depending on whether they received TIVA or GBA. Heart rate, systolic, diastolic and mean arterial pressure were monitored continuously and recorded in five time intervals. Results. Statistical analysis showed that TIVA with propofol provides better hemodynamic stability (less than 10% deviation from basal values for each measured parameter) then GBA group (p < 0.01). Conclusion. Total intravenous anesthesia with propofol provides better hemodynamic stability for ASA III patients with concomitant cardiovascular diseases then GBA.
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Oliveros, Henry, Fernando Ríos, Daniel A. Botero-Rosas, et al. "Variability of anesthetic depth in total intravenous anesthesia vs balanced anesthesia using entropy indices: a randomized, crossover, controlled clinical trial." Colombian Journal of Anesthesiology 48, no. 3 (2020): 111–17. http://dx.doi.org/10.1097/cj9.0000000000000163.
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Introduction: Total intravenous anesthesia (TIVA) and balanced anesthesia (BA) are the most commonly used anesthetic techniques. The differences are the variability of the depth of anesthesia between these techniques that might predict which one is safer for patients and presents a lower risk of intraoperative awakening.
 Objective: To determine whether a difference exists in the variability of depth of anesthesia obtained by response entropy (RE). 
 Methods: A crossover clinical trial was conducted on 20 healthy patients receiving upper or lower limb ambulatory orthopedic surgery. Patients were randomly assigned to (a) target-controlled infusion of propofol using the Schnider model at a target concentration of 2.5mg/mL for 15minutes and a 10-minute washout, followed by sevoflurane administration at 0.8 minimal alveolar concentration (MAC) for the reminder of the surgery, or (b) the reverse sequence. Differences in the variability of the depth of anesthesia using RE were evaluated using paired t test.
 Results: The treatment effect showed no significant difference in the average values of RE, during TIVA=97.23 vs BA 97.04 (P=0.39). Carry Over (-4.98 vs 4.08) and Period (100.3 vs 94.68) effects were not significantly different.
 Conclusion: The present study suggests that both anesthetic techniques are equivalent in terms of the stability of the depth of anesthesia. It is important to keep testing the determinants of the efficacy of different populations because the individual behaviors of patients might ultimately tip the scale.
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Nakamura, Kazuhiro, Tomoyuki Yoshida, Takao Muto, et al. "Efficacy of Total Intravenous Anesthesia (TIVA) without Intubation for Laryngeal Framework Surgery." Nihon Kikan Shokudoka Gakkai Kaiho 56, no. 6 (2005): 476–83. http://dx.doi.org/10.2468/jbes.56.476.
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Wormald, Peter J., Graham van Renen, Jonathon Perks, Janine A. Jones, and Claire D. Langton-Hewer. "The Effect of the Total Intravenous Anesthesia Compared with Inhalational Anesthesia on the Surgical Field during Endoscopic Sinus Surgery." American Journal of Rhinology 19, no. 5 (2005): 514–20. http://dx.doi.org/10.1177/194589240501900516.
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Background Bleeding during endoscopic sinus surgery (ESS) may increase complications and negatively effect the surgery and its outcome. The aim of this study was to compare the surgical field in patients in whom total intravenous anesthesia (TIVA) is used as opposed to inhalation anesthesia. A prospective randomized controlled trial was performed. Methods Fifty-six patients undergoing ESS were randomly assigned to receive either inhaled sevoflurane with incremental doses offentanyl (n = 28) or TIVA via a propofol and remifentanil infusion (n = 28) for their general anesthesia. The surgical field was graded every 15 minutes using a validated scoring system. Results The two groups were matched for surgical procedure and computed tomography scores. Patients in the TIVA group were found to have a significantly lower surgical grade score than in the sevoflurane group (p < 0.001). Surgical grade score increased with time in both groups. Mean arterial pressure and pulse were found to influence the surgical field independently (p = 0.003 and p = 0.036 respectively). Mean surgical field grade scores were higher in the patients with allergic fungal sinusitis and nasal polyposis as opposed to chronic rhinosinusitis without polyps or fungus. Lund-Mackay computed tomography scores were found to correlate positively with surgical grade (Spearman rank correlation, p = 0.001). Conclusion In patients undergoing ESS, TIVA results in a better surgical field than inhalational anesthesia.
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de Resende, Marco Antonio Cardoso, Elizabeth Vaz da Silva, Osvaldo José Moreira Nascimento, Alberto Esteves Gemal, Giseli Quintanilha, and Eliana Maria Vasconcelos. "Total Intravenous Anesthesia (TIVA) in an Infant with Werdnig-Hoffmann Disease. Case Report." Brazilian Journal of Anesthesiology 60, no. 2 (2010): 170–75. http://dx.doi.org/10.1016/s0034-7094(10)70022-2.
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Esteves, Luis Otavio. "Total Intravenous Anesthesia (TIVA) in an Infant with Werdnig-Hoffmann Disease. Case Report." Brazilian Journal of Anesthesiology 60, no. 5 (2010): 563–64. http://dx.doi.org/10.1016/s0034-7094(10)70069-6.
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Ovechkin, A. M. "Propofol and postoperative pain. Time to change priorities?" Regional Anesthesia and Acute Pain Management 14, no. 3 (2021): 118–20. http://dx.doi.org/10.17816/1993-6508-2020-14-3-118-120.
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Currently, the use of inhalational anesthetics is the basic method of general anesthesia.Propofol-based total intravenous anesthesia (TIVA) is not widely used.However, over the past years, evidence-based medicine data have been obtained on a decrease in the intensity of postoperative pain and the need for analgesics in patients operated on under the conditions of propofol-based TIVA, compared with inhalation anesthesia.It is possible that this fact will form the basis for revising general anesthesia regimens.
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Zhou, Lu-Yang, Wei Gu, Yun Liu, and Zheng-Liang Ma. "Effects of Inhalation Anesthesia vs. Total Intravenous Anesthesia (TIVA) vs. Spinal-Epidural Anesthesia on Deep Vein Thrombosis After Total Knee Arthroplasty." Medical Science Monitor 24 (January 4, 2018): 67–75. http://dx.doi.org/10.12659/msm.904378.
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Mujagić, Zlata, Elsada Čičko, Vesna Vegar-Brozović, and Mirsada Prašo. "Serum levels of cortisol and prolactin in patients treated under total intravenous anesthesia with propofol-fentanyl and under balanced anesthesia with isoflurane-fentanyl." Open Medicine 3, no. 4 (2008): 459–63. http://dx.doi.org/10.2478/s11536-008-0051-9.
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AbstractThe study was designed to determine pre-, intra-and postoperative serum cortisol and prolactin (PRL) concentrations in patients subjected to low abdominal surgery under total intravenous anesthesia (TIVA) with propofol-fentanyl, and under general balanced anesthesia with isoflurane-fentanyl. The prospective study included 50 patients of both sexes, aged between 35 and 60 years, subjected to elective low abdominal surgery. Patients were randomly divided into two groups: an experimental group, consisting of 25 ASA I/II (American Society of Anesthesiologists I/II classification) patients treated under TIVA with propofol-fentanyl, and a control group consisting of 25 ASA I/II patients treated under balanced anesthesia with isoflurane-fentanyl. The length of the surgery and the degree of the surgical trauma did not differ significantly between the two anesthesia groups. Blood samples for cortisol and PRL measurements were drawn at exact time points: 30 minutes before the beginning of the surgery (T0), 30 minutes after the beginning of the surgery (T1), at the end of the surgery (T2), 2 hours after the surgery (T3), and 24 hours after the surgery (T4). Serum levels of cortisol and PRL were measured using commercially available kits. The results were evaluated with the nonparametric Mann-Whitney test. The serum concentration of cortisol measured at T1 time point in patients treated under TIVA was significantly lower (p=0.04) than that in patients treated under general balanced anesthesia. The average circulating levels of PRL measured at T1, T2 and T3 time points in patients treated under TIVA were significantly lower (p=0.003; p=0.002; p<0.05; respectively) than those in patients treated under balanced anesthesia. The results obtained suggest that the endocrine stress response developed in response to surgery is probably attenuated in patients treated under TIVA with propofol-fentanyl and, thus, that these patients are less stressed in comparison to patients treated under general balanced anesthesia with isoflurane-fentanyl.
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Kim, Uoo. "Anesthetic Management for Inclusion Body Myositis in Coronary Artery Bypass Graft Surgery." Case Reports in Anesthesiology 2020 (December 24, 2020): 1–3. http://dx.doi.org/10.1155/2020/6679156.
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Anesthetic management for patients with certain neuromuscular disorders may be challenging due to contraindications to triggering agents secondary to increased susceptibility for malignant hyperthermia (MH). Inclusion body myositis (IBM) is an inflammatory muscle disease that causes concern for the anesthesiologist due to potential respiratory muscle weakness and hyperkalemia with succinylcholine. Elevated serum creatinine kinase levels found in IBM also raise the possibility of increased susceptibility to MH. This case report describes a successful anesthetic course with special considerations in a patient with IBM undergoing general anesthesia for coronary artery bypass grafting (CABG) under cardiopulmonary bypass (CPB) using total intravenous anesthesia (TIVA).
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Kim, Seung Hyun, Hyang Mi Ju, Chong-Hyuck Choi, Hae Ri Park, and Seokyung Shin. "Inhalational versus intravenous maintenance of anesthesia for quality of recovery in patients undergoing corrective lower limb osteotomy: A randomized controlled trial." PLOS ONE 16, no. 2 (2021): e0247089. http://dx.doi.org/10.1371/journal.pone.0247089.
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Background Inhalational anesthesia and propofol-based total intravenous anesthesia (TIVA) are the two most popular methods of general anesthesia with distinct characteristics that may affect quality of recovery (QOR) differently. This study compared QOR after corrective lower limb osteotomy between desflurane-based inhalational anesthesia and propofol-based TIVA. Methods Sixty-eight patients, ASA class I or II who underwent corrective lower limb osteotomy were randomized to receive either desflurane anesthesia or propofol TIVA. The primary outcome was quality of recovery 40 (QoR-40) questionnaire scores on postoperative day (POD) 1 and 2. Postoperative nausea scores, antiemetic requirements, and amount of opioid consumption via intravenous patient-controlled analgesia (IV PCA) were assessed as secondary outcomes. Results Global QoR-40 scores on POD 1 (153.5 (140.3, 171.3) vs. 140.0 (120.0, 173.0), P = 0.056, 95% CI; -22.5, 0.2) and POD 2 (155.5 (146.8, 175.5) vs. 152.0 (134.0, 179.0), P = 0.209, 95% CI; -17.5, 3.9) were comparable between the two groups. Among the five dimensions of QoR-40, physical independence scores were significantly higher in the TIVA group compared to the Desflurane group on POD both 1 and 2. Nausea scores (0.0 (0.0, 0.0) vs. 1.0 (0.0, 3.5), P < 0.001) and number of patients requiring rescue antiemetics (0% vs. 15.2%, P = 0.017) were significantly lower in the TIVA group at the post anesthesia care unit (PACU). Although the number of bolus attempts between 0–24 h and the morphine equivalent dose of analgesics administered via IV PCA between 12–24 h were significantly less in the TIVA group compared to the Desflurane group, there was no significant difference between groups for the overall 48 h postoperative period. Conclusions Propofol-based TIVA did not improve global QoR-40 scores compared with desflurane-based inhalational anesthesia. However, considering the better QoR-40 scores in the domain of physical independence and less nausea in the early postoperative period, propofol TIVA should be considered as a useful option in patients undergoing corrective lower limb osteotomy.
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Wuesten, Rainer, Hugo Van Aken, Peter S. A. Glass, and Hartmut Buerkle. "Assessment of Depth of Anesthesia and Postoperative Respiratory Recovery after Remifentanil-versus Alfentanil-based Total Intravenous Anesthesia in Patients Undergoing Ear–Nose–Throat Surgery." Anesthesiology 94, no. 2 (2001): 211–17. http://dx.doi.org/10.1097/00000542-200102000-00008.
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Background The authors investigated whether total intravenous anesthesia (TIVA) with precalculated equipotent infusion schemes for remifentanil and alfentanil would ensure appropriate analgesia and that remifentanil would result in better recovery characteristics. Methods Forty consenting patients (classified as American Society of Anesthesiologists physical status I-III) scheduled for microlaryngoscopy were randomized to receive, in a double-blind manner, either remifentanil (loading dose 1 microg/kg; maintenance infusion, 0.25 microg x kg(-1) x min-1) or alfentanil (loading dose, 50 microg/kg; maintenance infusion, 1 microg x kg(-1) x min-1) as the analgesic component of TIVA. They were combined with propofol (loading dose, 2 mg/kg; maintenance infusion, 100 microg x kg(-1) min(-1)). To insure an equal state of anesthesia, the opioids were titrated to maintain heart rate and mean arterial pressure within 20% of baseline, and propofol was titrated to keep the bispectral index (BIS) less than 60. Neuromuscular blockade was achieved with succinylcholine. Drug dosages and the times from cessation of anesthesia to extubation, verbal response, recovery of ventilation, and neuropsychological testing, orientation, and discharge readiness were recorded. Results Demographics, duration of surgery, and anesthesia were similar between the two groups. Both groups received similar propofol doses. There were no difference in BIS values preoperatively (mean, 96), intraoperatively (mean, 55), and postoperatively (mean, 96). Recovery of BIS and times for verbal response did not differ. At 20, 30, and 40 min after terminating the opioid infusion, the peripheral oxygen saturation and respiratory rate were significantly higher in the remifentanil group compared with the alfentanil group. Conclusions When both the hypnotic and analgesic components of a TIVA-based anesthetic are administered in equipotent doses, remifentanil provides a more rapid respiratory recovery, even after brief surgical procedures, compared with alfentanil.
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Khelemsky, Yury. "Effect of Buprenorphine on Total Intravenous Anesthetic Requirements During Spine Surgery." Pain Physician 2;18, no. 2;3 (2015): E261—E264. http://dx.doi.org/10.36076/ppj/2015.18.e261.
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Buprenorphine is a partial mu receptor agonist and kappa/delta antagonist commonly used for the treatment of opioid dependence or as an analgesic. It has a long plasma halflife and a high binding affinity for opioid receptors. This affinity is so high, that the effects are not easily antagonized by competitive antagonists, such as naloxone. The high affinity also prevents binding of other opioids, at commonly used clinical doses, to receptor sites – preventing their analgesic and likely minimum alveolar concentration (MAC) reducing benefits. This case report contrasts the anesthetic requirements of a patient undergoing emergency cervical spine surgery while taking buprenorphine with anesthetic requirements of the same patient undergoing a similar procedure after weaning of buprenorphine. Use of intraoperative neurophysiological monitoring prevented use of paralytics and inhalational anesthetics during both cases, therefore total intravenous anesthesia (TIVA) was maintained with propofol and remifentanil infusions. During the initial surgery, intraoperative patient movement could not be controlled with very high doses of propofol and remifentanil. The patient stopped moving in response to surgical stimulation only after the addition of a ketamine. Buprenorphine-naloxone was discontinued postoperatively. Five days later the patient underwent a similar cervical spine surgery. She had drastically reduced anesthetic requirements during this case, suggesting buprenorphine’s profound effect on anesthetic dosing. This case report elegantly illustrates that discontinuation of buprenorphine is likely warranted for patients who present for major spine surgery, which necessitates the avoidance of volatile anesthetic and paralytic agents. The addition of ketamine may be necessary in patients maintained on buprenorphine in order to ensure a motionless surgical field. Key words: Buprenorphine, anesthesiology, intraoperative, total intravenous anesthesia, pharmacology
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Koşucu, Müge, İlker Coşkun, Ahmet Eroglu, et al. "The Effects of Spinal, Inhalation, and Total Intravenous Anesthetic Techniques on Ischemia-Reperfusion Injury in Arthroscopic Knee Surgery." BioMed Research International 2014 (2014): 1–7. http://dx.doi.org/10.1155/2014/846570.
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Purpose. To compare the effects of different anesthesia techniques on tourniquet-related ischemia-reperfusion by measuring the levels of malondialdehyde (MDA), ischemia-modified albumin (IMA) and neuromuscular side effects.Methods. Sixty ASAI-II patients undergoing arthroscopic knee surgery were randomised to three groups. In Group S, intrathecal anesthesia was administered using levobupivacaine. Anesthesia was induced and maintained with sevoflurane in Group I and TIVA with propofol in Group T. Blood samples were obtained before the induction of anesthesia (t1), 30 min after tourniquet inflation (t2), immediately before (t3), and 5 min (t4), 15 min (t5), 30 min (t6), 1 h (t7), 2 h (t8), and 6 h (t9) after tourniquet release.Results. MDA and IMA levels increased significantly compared with baseline values in Group S att2–t9andt2–t7. MDA levels in Group T and Group I were significantly lower than those in Group S att2–t8andt2–t9. IMA levels in Group T were significantly lower than those in Group S att2–t7. Postoperatively, a temporary 1/5 loss of strength in dorsiflexion of the ankle was observed in 3 patients in Group S and 1 in Group I.Conclusions. TIVA with propofol can make a positive contribution in tourniquet-related ischemia-reperfusion.
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Sakamizu, Airi, Erika Yaguchi, and Shinsuke Hamaguchi. "Anesthetic Management for an Adult With Glycogen Storage Disease Type 0." Anesthesia Progress 67, no. 4 (2020): 233–34. http://dx.doi.org/10.2344/anpr-67-02-06.
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A 20-year-old woman with glycogen storage disease type 0 (GSD-0) underwent velopharyngeal closure for velopharyngeal insufficiency following palatoplasty. To reduce the risk of complications attributed to GSD-0, general anesthesia was administered using a total intravenous anesthesia (TIVA) technique with propofol and remifentanil, along with supplemental glucose-containing intravenous fluids. Her blood glucose remained stable, intraoperative body temperature ranged from 36.5 to 37.2°C, and the velopharyngeal closure was completed without any adverse events.
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Cook, Richard I., and David D. Woods. "Implications of automation surprises in aviation for the future of total intravenous anesthesia (TIVA)." Journal of Clinical Anesthesia 8, no. 3 (1996): S29—S37. http://dx.doi.org/10.1016/s0952-8180(96)90009-4.
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Hong, Jeong-Yeon, Young Seok Jee, and Jae Young Lee. "A Comparisons of Remifentanil versus Alfentanil-based Total Intravenous Anesthesia (TIVA) for Oocyte Retrieval." Korean Journal of Anesthesiology 53, no. 3 (2007): S41. http://dx.doi.org/10.4097/kjae.2007.53.3.s41.
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Dang, Anh, Shital Vachhani, Tina Briere, Sujit Prabhu, and Susan McGovern. "RTHP-19. ANESTHETIC INDICATIONS, TECHNIQUES AND COMPLICATIONS FOR GAMMA KNIFE RADIOSURGERY." Neuro-Oncology 21, Supplement_6 (2019): vi213. http://dx.doi.org/10.1093/neuonc/noz175.890.
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Abstract PURPOSE We sought to describe our experience regarding anesthetic indications, techniques and complications with Gamma Knife radiosurgery (GKRS). METHODS We retrospectively evaluated the use of anesthesia for both adult and pediatric patients at a high-volume center. RESULTS Twenty-two adult cases and 10 pediatric cases were identified. For adult patients, the median age was 55.5 years. Pediatric patient ages ranged from 3 to 16 years. For adult patients, indications for sedation were claustrophobia (n=16), anxiety (n=4), chronic pain (n=1), and severe comorbidity (n=1). Twenty-five patients received general anesthesia with a secure airway (GA). Seven patients received total intravenous anesthesia with spontaneous ventilation (TIVA). One of these patients required placement of an airway after initial TIVA. The median sedation to treatment ratios for pediatric patients (3.76) and adult patients (4.06) did not significantly differ (P=0.49). However, the median sedation to treatment ratios for patients who received GA (4.08) was significantly higher than patients who received TIVA (1.88, P=0.0005). Anesthetic complications included cutaneous flushing, excessive secretions and airway obstruction that required unplanned placement of an airway, wheezing attributed to propofol sedation, and unspecified anesthetic issues that resulted in a MRI scan with a suboptimal time interval. All complications occurred in adult patients. CONCLUSIONS Gamma Knife radiosurgery with GA was associated with a longer sedation to treatment ratio compared to TIVA. However, despite the prolonged sedation time, use of GA was associated with few complications, none of which were severe and observed only in adult patients. Practitioners should consider the need for anesthesia in adult and pediatric patients who are intolerant to GKRS due to severe claustrophobia, anxiety, or pain when evaluating patients prior to GKRS. Due to the increased risk of respiratory complications in these patients, we recommend the use of general anesthesia with a secure airway despite the prolonged sedation time.
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Hasan, M. Shahnaz, Jin-Keat Tan, Chris Yin Wei Chan, Mun Keong Kwan, Fathil Syafiq Abdul Karim, and Khean-Jin Goh. "Comparison between effect of desflurane/remifentanil and propofol/remifentanil anesthesia on somatosensory evoked potential monitoring during scoliosis surgery—A randomized controlled trial." Journal of Orthopaedic Surgery 26, no. 3 (2018): 230949901878952. http://dx.doi.org/10.1177/2309499018789529.
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Background: Drugs used in anesthesia can affect somatosensory evoked potential (SSEP) monitoring, which is used routinely for intraoperative monitoring of spinal cord integrity during spinal surgery. Objective: The objective of this study was to determine whether combined total intravenous anesthesia (TIVA) technique with propofol/remifentanil is associated with less SSEP suppression when compared to combined volatile agent desflurane/remifentanil anesthesia during corrective scoliosis surgery at a comparable depth of anesthesia. Design: It is a randomized controlled trial. Setting: The study was conducted at the Single tertiary University Hospital during October 2014 to June 2015. Patients: Patients who required SSEP and had no neurological deficits, and were of American Society of Anesthesiologist I and II physical status, were included. Patients who had sensory or motor deficits preoperatively and significant cardiovascular and respiratory disease were excluded. A total of 72 patients were screened, and 67 patients were randomized and allocated to two groups: 34 in desflurane/remifentanil group and 33 in TIVA group. Four patients from desflurane/remifentanil group and three from TIVA group were withdrawn due to decrease in SSEP amplitude to <0.3 µV after induction of anesthesia. Thirty patients from each group were analyzed. Interventions: Sixty-seven patients were randomized to receive TIVA or desflurane/remifentanil anesthesia. Main outcome measures: The measurements taken were the amplitude and latency of SSEP monitoring at five different time points during surgery: before and after the induction of anesthesia, at skin incision, at pedicle screw insertion, and at rod insertion. Results: Both anesthesia techniques, TIVA and desflurane/remifentanil, resulted in decreased amplitude and increased latencies of both cervical and cortical peaks. The desflurane/remifentanil group had a significantly greater reduction in the amplitude ( p = 0.004) and an increase in latency ( p = 0.002) of P40 compared with the TIVA group. However, there were no differences in both amplitude ( p = 0.214) and latency ( p = 0.16) in cervical SSEP between the two groups. Conclusions: Compared with TIVA technique, desflurane/remifentanil anesthesia caused more suppression in cortical SSEP, but not in cervical SSEP, at a comparable depth of anesthesia.
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Lasala, Javier, Gabriel E. Mena, Maria D. Iniesta, et al. "Impact of anesthesia technique on post-operative opioid use in open gynecologic surgery in an enhanced recovery after surgery pathway." International Journal of Gynecologic Cancer 31, no. 4 (2021): 569–74. http://dx.doi.org/10.1136/ijgc-2020-002004.
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ObjectiveTo examine the effect of anesthesia technique in an enhanced recovery after surgery (ERAS) pathway on post-operative opioid use.MethodsPatients undergoing open gynecologic surgery under an ERAS pathway from November 2014 through December 2018 were included retrospectively. All patients received pre-operative analgesia consisting of oral acetaminophen, pregabalin, celecoxib, and tramadol extended release, unless contraindicated. Patients received local wound infiltration with bupivacaine; the post-operative analgesic regimen was standardized. Patients were categorized by anesthesia technique: (1) inhalational, (2) total intravenous anesthesia (TIVA), and (3) combined technique. The primary outcome was post-operative opioid consumption measured as morphine equivalent dose, recorded as the total opioid dose received post-operatively, including doses received through post-operative day 3.ResultsA total of 1184 patients underwent general anesthesia using either inhalational (386, 33%), TIVA (349, 29%), or combined (449, 38%) techniques. Patients who received combined anesthesia had longer surgery times (p=0.005) and surgical complexity was higher among patients who underwent TIVA (moderate/higher in 76 patients, 38%) compared with those who received inhaled anesthesia (intermediate/higher in 41 patients, 23%) or combined anesthesia (intermediate/higher in 72 patients, 30%). Patients who underwent TIVA anesthesia consumed less post-operative opioids than those managed with inhalational technique (0 (0–46.3) vs 10 (0–72.5), p=0.009) or combined anesthesia (0 (0–46.3) vs 10 (0–87.5), p=0.029). Similarly, patients who underwent the combined technique had similar opioid consumption post-operatively compared with those who received inhalational anesthesia (10 (0–87.5) vs 10 (0–72.5), p=0.34).ConclusionsTIVA technique is associated with a decrease in post-operative consumption of opioids after open gynecologic surgery in patients on an ERAS pathway.
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Toholj, Bojan D., Velibor D. Kujača, Milenko R. Stevančević, Jovan M. Spasojević, and Ozren B. Smolec. "The Use of Ketamine, Xylazine and Midazolam Combination for Total Intravenous Anesthesia (Tiva) in Surgical Removal of Abdominal Testis at Stallion." Macedonian Veterinary Review 37, no. 2 (2014): 185–88. http://dx.doi.org/10.14432/j.macvetrev.2014.09.024.
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AbstractEquine veterinarians frequently anesthetize horses. In majority of cases performing short-term anesthesia (duration, 20 minutes). But there is substantial need for long term anesthesia. The aim of this work is to present our experience with a long term and short term total intravenous anesthesia in horses. In this paper we are presenting results of anesthesia monitoring of a horse undergoing surgical remove of an abdominal testis (complete abdominal cryptorchid). Sedation of the horsewas conducted with xylazine, 1.0 mg/kg, iv, and midazolam 0.06 mg/kg, iv. The total anesthesia was induced using a combination of ketamine 2.2mg/kg/iv, and midazolam 0.1 mg/kg/iv. After induction the horse was restrained and anesthesia was maintained with continuous intravenous drip of a combination of drugs mixed in infusion bottle with midazolam (0.002 mg/kg/min), ketamine (0.03 mg/kg/min), and xylazine (0.016 mg/kg/min). Additional ketamine (0.03 mg/kg) and midazolam 0.03 mg/kg/iv was administered if the horse moved its head or limbs during the procedure. The duration of anesthesia was 90 minutes. During this time cardiopulmonary parameters and reflexes were monitored continuously.The recovery of anesthesia was 30 minutes and horse stood on the first attempt 40 minutes. Midazolam, ketamine, and xylazine in combination produced TIVA in this horse and can be used for short term, middle term, and longer lasting surgical procedures in the field.
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Biliškov, Ana Nevešćanin, Božena Ivančev, and Zenon Pogorelić. "Effects on Recovery of Pediatric Patients Undergoing Total Intravenous Anesthesia with Propofol versus Ketofol for Short—Lasting Laparoscopic Procedures." Children 8, no. 7 (2021): 610. http://dx.doi.org/10.3390/children8070610.
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Background: Combining ketamine and propofol (ketofol) was suggested as a new concept for sedation and general anesthesia in pediatric populations for various conditions. The aim of the present study was to determine the effect of total intravenous anesthesia (TIVA) with propofol and ketofol on recovery after laparoscopic surgery in pediatric patients. Methods: Two hundred children with median age of 5 years who underwent laparoscopic surgery were randomized into two groups. Propofol 1% was used for induction and maintenance of anesthesia in group I, while ketamine-propofol combination (ketofol) was used in group II. Ketamine-propofol combination (ketofol) was prepared in the same applicator for group II. Ketofol ratios of 1:4 and 1:7 were used for induction and maintenance of anesthesia, respectively. A reduced McFarlan infusion dose was used in group I (1.2, 1.0, and 0.8 mL/kg/h for 15, 15, and 30 min, respectively), while a McFarlan infusion dose was used in group II (1.5, 1.3, and 1.1 mL/kg/h for 15, 15, and 30 min, respectively). Extubating time, duration of anesthesia, and length of stay in post-anesthesia care unit (PACU) were recorded. Results: Extubating time was significantly lower in the ketofol group than in the propofol group (240 s vs. 530 s; p < 0.00001). Significantly shorter duration of anesthesia (47 min vs. 60 min; p < 0.00001) as well as length of stay in the PACU (35 min vs. 100 min; p < 0.00001) were recorded in ketofol compared to the propofol group. Total fentanyl (100 µg (interquartile range, IQR 80, 125) vs. 50 µg (IQR 40, 60); p < 0.00001) and propofol (260 mg (IQR 200, 350) vs. 160 mg (IQR 120, 210); p < 0.00001) consumption per body weight were significantly lower in the ketofol group. Conclusions: TIVA with ketamine-propofol combination (ketofol) using a reduced McFarlan dose regimen shortened extubating time, duration of anesthesia, as well as length of stay in the PACU in pediatric anesthesia after laparoscopic surgery.
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Yoon, Hyun-Kyu, Kwanghoon Jun, Sun-Kyung Park, et al. "Anesthetic Agents and Cardiovascular Outcomes of Noncardiac Surgery after Coronary Stent Insertion." Journal of Clinical Medicine 9, no. 2 (2020): 429. http://dx.doi.org/10.3390/jcm9020429.
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Patients undergoing noncardiac surgery after coronary stent implantation are at an increased risk of thrombotic complications. Volatile anesthetics are reported to have organ-protective effects against ischemic injury. Propofol has an anti-inflammatory action that can mitigate ischemia-reperfusion injury. However, the association between anesthetic agents and the risk of major adverse cardiovascular and cerebral event (MACCE) has never been studied before. In the present study, a total of 1630 cases were reviewed. Four different propensity score matchings were performed to minimize selection bias (propofol-based total intravenous anesthesia (TIVA) vs. volatile anesthetics; TIVA vs. sevoflurane; TIVA vs. desflurane; and sevoflurane vs. desflurane). The incidence of MACCE in these four propensity score-matched cohorts was compared. As a sensitivity analysis, a multivariable logistic regression analysis was performed to identify independent predictors for MACCE during the postoperative 30 days both in total and matched cohorts (TIVA vs. volatile agent). MACCE occurred in 6.0% of the patients. Before matching, there was a significant difference in the incidence of MACCE between TIVA and sevoflurane groups (TIVA 5.1% vs. sevoflurane 8.2%, p = 0.006). After matching, there was no significant difference in the incidence of MACCE between the groups of any pairs (TIVA 6.5% vs. sevoflurane 7.7%; p = 0.507). The multivariable logistic regression analysis revealed no significant association of the volatile agent with MACCE (odds ratio 1.48, 95% confidence interval 0.92–2.37, p = 0.104). In conclusion, the choice of anesthetic agent for noncardiac surgery did not significantly affect the development of MACCE in patients with previous coronary stent implantation. However, further randomized trials are needed to confirm our results.
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Shin, Seokyung, Seung Hyun Kim, Kwan Kyu Park, Seon Ju Kim, Jae Chan Bae, and Yong Seon Choi. "Effects of Anesthesia Techniques on Outcomes after Hip Fracture Surgery in Elderly Patients: A Prospective, Randomized, Controlled Trial." Journal of Clinical Medicine 9, no. 6 (2020): 1605. http://dx.doi.org/10.3390/jcm9061605.
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The superiority of distinct anesthesia methods for geriatric hip fracture surgery remains unclear. We evaluated high mobility group box-1 (HMGB1) and interleukin-6 (IL-6) with three different anesthesia methods in elderly patients undergoing hip fracture surgery. Routine blood test findings, postoperative morbidity, and mortality were assessed as secondary outcome. In total, 176 patients were randomized into desflurane (n = 60), propofol (n = 58), or spinal groups (n = 58) that received desflurane-based balanced anesthesia, propofol-based total intravenous anesthesia (TIVA), or spinal anesthesia, respectively. The spinal group required less intraoperative vasopressors (p < 0.001) and fluids (p = 0.006). No significant differences in HMGB1 (pgroup×time = 0.863) or IL-6 (pgroup×time = 0.575) levels were noted at baseline, postoperative day (POD) 1, or POD2. Hemoglobin, albumin, creatinine, total lymphocyte count, potassium, troponin T, and C-reactive protein were comparable among groups at all time-points. No significant differences in postoperative hospital stay, intensive care unit (ICU) stay, and ventilator use among groups were observed. Postoperative pulmonary, cardiac, and neurologic complications; and in-hospital, 30-day, and 90-day mortality were not significantly different among groups (p = 0.974). In conclusion, HMGB1 and IL-6, and all secondary outcomes, were not significantly different between desflurane anesthesia, propofol TIVA, and spinal anesthesia.
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Kashav, Ramesh Chand, Jasvinder Kaur Kohli, and Rohan Magoon. "TIVA versus Inhalational Agents for Pediatric Cardiac Intensive Care." Journal of Cardiac Critical Care TSS 5, no. 02 (2021): 134–41. http://dx.doi.org/10.1055/s-0041-1732834.
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AbstractThe field of pediatric intensive care has come a long way, especially with the recognition that adequate sedation and analgesia form an imperative cornerstone of patient management. With various drugs available for the same, the debate continues as to which is the better: total intravenous anesthesia (TIVA) or inhalational agents. While each have their own advantages and disadvantages, in the present era of balance toward the IV agents, we should not forget the edge our volatile agents (VAs) might have in special scenarios. And ultimately as anesthesiologists, let us not forget that be it knob and dial, or syringe and plunger, our aim is to put pain to sleep and awaken a new faith to breathe.