Recent Updates in Total Intravenous Anesthesia (TIVA)

Abstract

Total intravenous anesthesia (TIVA) can be defined as a technique of general anesthesia using a combination of agents given solely by the intravenous route and in the absence of all inhalational agents including nitrous oxide. The intravenous route has been used to administer drugs for hundreds of years and the provision of anesthesia solely by the intravenous route using chloral hydrate was documented as early as the 1870’s. Thiopentone was introduced into clinical practice in 1934 and made intravenous induction of anesthesia popular. Propofol was introduced into clinical practice in 1986 and now seems to be taking over that role. It has also become widely used as a component of TIVA. Many different intravenous compounds can be used in a number of combinations to provide TIVA. Most commonly, an opioid is combined with another drug more likely to provide hypnosis and amnesia. For example, the combination of alfentanil and propofol produces excellent TIVA. Profound synergism also exists when more than two agents, such as propofol-alfentanil-midazolam, are combined. Keywords: Intravenous anesthesia; alfentanil, propofol