To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
At some time during one’s practice in anaesthesiology, one cannot help but notice certain obsessive–compulsive tendencies in our colleagues. Such traits are quickly revealed when you put them under pressure by asking them to do an unplanned emergency case and disrupt the cocoon that is their elective list. In contrast to having known and prepared for all of the patient’s problems, they are now compelled to deal with a relatively unknown and often sub-optimal situation. More likely than not, they will have to induce anaesthesia with rapid sequence induction (RSI). Whereas some may be thrilled, others are less impressed with the disorder introduced into their world. What is it about emergency cases that should be such a bother? In particular, can TIVA enthusiasts thrive in this environment? At the time of writing, the use of TIVA in emergency is indeed somewhat uncharted territory as very few studies have examined this area.
In keeping with the spirit of producing a practical book, we took editorial privileges and removed some of the more detailed text from various chapters and yet felt it would be a waste if some of it weren’t shared with our readers. At the same time, there are aspects of TIVA that are not necessarily recommended for novices but may entice those who have had a bit of experience and want to extend their TIVA repertoire. Therefore we thought we would create a final chapter that would incorporate some such material, hopefully in a semi-logical fashion.
The arrival of versatile, easy-to-use, commercially available, target-controlled drug delivery systems have simplified TIVA making it as simple as using a vaporiser. Most have a choice of PK algorithms. The Marsh and Schnider models are the most commonly used for propofol and have various pros and cons. However, the important point about these models is that they can both make proportional changes in blood concentration allowing easy titration. New data is becoming available for more precise keo and PK that will improve accuracy – and therefore new models are likely to be developed. Remifentanil can also be administered with TCI using the Minto model but, as the pharmacokinetics are relatively simple, can also be delivered as an ordinary infusion (µg.kg−1.min−1). The use of these techniques is discussed elsewhere in the book so here we will concentrate on how to physically set up your TIVA system.
Like many of you, we’re sure, we were trained to use IV anaesthetic agents for induction of anaesthesia but volatiles for maintenance – a sensible and seemingly safe combination that has been used for decades. So why change? The initial attraction of TIVA was the extremely rapid, smooth and clear-headed recovery of patients when using propofol as the hypnotic component of an anaesthetic. This is particularly apparent when the drug is used for cases of short to intermittent duration, for example in day-case surgery with earlier discharge from the post-anaesthetic care unit. Clearly in modern practice, which is moving towards shorter in-patient stays, this represents a major advantage. In addition, improved levels of patient satisfaction occur with TIVA, presumably due to the favourable recovery profile. Certainly, desflurane and sevoflurane allow rapid recovery but it is not as smooth, there may be more emergence delirium and quality indicators are not as good.
Total intravenous anaesthesia (TIVA) is an innovative alternative to traditional inhalational anaesthesia. Often incorrectly perceived as overly complex, TIVA has numerous advantages over inhalational drugs, such as a lower risk of nausea, less pain and better cognitive recovery. Taking on TIVA is a practical, easy to read and engaging guide to TIVA. It demystifies this important technique and will empower the novice but also support more experienced practitioners. It is a clear step-by-step approach to treating everything from routine elective to paediatric, geriatric, obese and pregnant patients. Pharmacokinetic models, dosage calculations, and the use of TIVA in emergency medicine are also elucidated. Written by international experts in the field with many years of experience both conducting and teaching TIVA, this handbook is an essential resource for experienced and novice anaesthetists alike who want to improve their understanding and confidence with the technique.