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Chapter 9 - Be Aware, Unaware and Confusion Everywhere

TIVA and Awareness

Published online by Cambridge University Press:  18 November 2019

By
Pablo Martinez-Vazquez ,
Claus Lindner ,
Umberto Melia ,
Jaideep J. Pandit  and
Erik Weber Jensen
Edited by
Michael G. Irwin ,
Gordon T. C. Wong  and
Shuk Wan Lam
Michael G. Irwin
Affiliation:
The University of Hong Kong
Gordon T. C. Wong
Affiliation:
The University of Hong Kong
Shuk Wan Lam
Affiliation:
The University of Hong Kong
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Summary

All anaesthetists need to be skilled in the administration of IV anaesthesia, yet evidence from the 5th National Audit Project (NAP5) of the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland documenting cases of accidental awareness during general anaesthesia (AAGA) suggests that this might not be the case. TIVA is used in only 7% of cases, with preponderance for certain surgical operations such as those on the airway where administration of an inhaled anaesthetic is not feasible. Conversely, TIVA has been almost completely avoided in other types of surgery such as Caesarean sections, at least in the UK and Ireland. TIVA is also used for transfer of patients and in remote areas that do not have the equipment required to deliver inhaled anaesthesia. For the purpose of this discussion, it should be clarified from the outset that there are several modes of TIVA delivery. The majority is target-controlled infusion (TCI), carried out with dedicated PK pumps and used in ~5% of all cases or ~81% of TIVA cases. The most basic is manual boluses of propofol using a hand-held syringe: the anaesthetist simply injects the amount they judge necessary to maintain anaesthesia (0.7% of all UK cases, or ~10% of all TIVA cases). The third is non-TCI infusions, which constitute ~0.6% of all cases, or ~9% of TIVA cases. However, there is some international geographic variation in this practice, because in the United States TCI remains unlicensed and therefore seldom used.

Type
Chapter
Information
Taking on TIVA
Debunking Myths and Dispelling Misunderstandings
 , pp. 63 - 72
Publisher: Cambridge University Press
Print publication year: 2019

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