Total Intravenous Anesthesia

70 Pages·2013·7.95 MB·English

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A Rational Approach to
Anesthetic
Management
Michael Rieker, DNP, CRNA
DDiirecttor, NNurse AAnestthhesiia PProgram
Wake Forest Baptist Medical Center
Objectives
Review drugs and methods in TIVA
DDiiscuss hhow propoffoll hhas aiiddedd addmiiniisttrattiion off
TIVA
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administration of TIVA safe and effective
List new drugs and drug combinations that are used
to improve TIVA
Outline medical conditions, disease processes and
ttyyppeess ooff ssuurrggeerryy tthhaatt lleenndd tthheemmsseellvveess ttoo TTIIVVAA ffoorr GGAA
Discuss contraindications to TIVA for GA
Drug administration
(cid:1)Intravenous agents
administered by manual
bolus on a dose/kgg basis is
probably as old-fashioned
aass aaddmmiinniissttrraattiioonn ooff vvoollaattiillee
agents by the
SScchhiimmmmeellbbuusscchh mmaasskk.(cid:2)
Armin Holas MD, University of Graz, Austria.
Why Intravenous anesthetics?
Safety
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Rapid titration
Avoid vasodilatation,, exppansion of
gas cavities
Reduced PONV
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Smooth emergence, less hangover
Avoid MH risk
Cost benefit?
Why Intravenous Anesthetics?
Impproved mucociliaryy transpport
Ledowski. Anesth Analg. 2006;102(5):1427-30.
Reduced PONV
Rohm. Acta Anaesth Scand. 2006 50(1):14-8.
Less effect on heppatic enzyymes
Rohm. Europ J Anaesth. 2005 ;22(3):209-14.
Advantages of TIVA
Improved V/Q matching
Praetel. Anesth Analg. 2004; 99(4):1107-13
Reduced stress response.
LLeddowskkii AAnestthh AAnallg. 22000055;110011((66)):11770000-55.
Improved surgical field (bleeding)
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Volatiles assoc. with increased inflammation
aanndd ddeeccrreeaasseedd iimmmmuunnee ffuunnccttiioonn
Kurosawa Curr Opin Anaesthesiol. 2012;25(3):376.
Optimal technique for neuroanesthesia
Improved extent and duration of cerebral metabolic
ssuupppprreessssiioonn.
Yoon, Kim, & Kim. J Neurosurg Anesthesiol 2012 24(2):146.
Improved CPP, less interference with SSEP, MEP,
AEP; Minimal post-op side-effects; potential
neuroprotective effects via antioxidant properties.
Hans, P, Current Opp Anaes. 2006;19((5)):498-503.
Better preservation of cerebral autoregulation vs.
volatile
Ishikawa, Masui. 2003;52(4):370-7
McCulloch Anesthesiology. 2007;106(1):56-64

Not a panacea
+ Titratable, but no diff in shivering,
PPOONNVV, HHTTNN.
Wong AY. Eur JAnaes 2006;23(7):586-90
NNoo ddiiffff iinn ppaaiinn;; mmoorree sshhiivveerriinngg wwiitthh TTIIVVAA.
Naito, Aya. Comparative study of anesthesia with
remifentanil VS fentanyl in terms of postoperative pain
andd shhiiveriing. MMasuii 22000099;5588 ((11)), p. 7777.
Cost.
(But less PONV)
RRohhm KKDD. AActta AAnaestthhesiiollogiica SScanddiinaviica. 22000066;5500((11)):1144-
8
Not a panacea
Pre-conditioning/tissue protection from
vollattiilles iis a niice siidde-effffectt.
Landoni, G. "Reducing perioperative myocardial infarction with anesthetic
drugs and techniques". Current drug targets 2009;10 (9), p. 858.
FFr(cid:228)(cid:228)ssddorff, JJan. IImpactt off preconddiittiioniing prottocoll on anestthhettiic-iindducedd
cardioprotection in patients having coronary artery bypass surgery. The
Journal of thoracic and cardiovascular surgery 2009;137 (6), p. 1436.
No differences between TIVA and
inhalational anesthesia groups with regard to
duration of anesthesia, time to discharge
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adverse events.
Vlessides, M. Anesthesiology News (07/01/12) Vol. 38, No. 7