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Chapter 6 - Let’s Get Started

The Know-Hows and No-Hows of Setting Up TIVA

Published online by Cambridge University Press:  18 November 2019

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

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.

Type
Chapter
Information
Taking on TIVA
Debunking Myths and Dispelling Misunderstandings
, pp. 40 - 45
Publisher: Cambridge University Press
Print publication year: 2019

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References

Nimmo, A.F., Absalom, A.R., Bagshaw, O., et al. Guidelines for the safe practice of total intravenous anaesthesia (TIVA): Joint Guidelines from the Association of Anaesthetists and the Society for Intravenous Anaesthesia. Anaesthesia 2018.Google Scholar
Nimmo, A.F., Cook, T.M.. Accidental awareness during general anaesthesia in the United Kingdom and Ireland. In: Pandit, J.J. and Cook, T.M., eds. NAP: Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland. 2014: 151–8.Google Scholar
Irwin, M.G., Wong, G.T.C.. Taking on TIVA. Why we need guidelines on total intravenous anaesthesia. Anaesthesia 2018.Google Scholar
Engbers, F.H.M., Dahan, A.. Anomalies in target-controlled infusion: an analysis after 20 years of clinical use. Anaesthesia 2018; 73: 619–30.Google Scholar
Glen, J.B., Engbers, F.H.. The influence of target concentration, equilibration rate constant (ke0) and pharmacokinetic model on the initial propofol dose delivered in effect-site target-controlled infusion. Anaesthesia 2016; 71: 306–14.CrossRefGoogle ScholarPubMed
Cortinez, L.I.. What is the ke0 and what does it tell me about propofol? Anaesthesia 2014; 69: 399402.Google Scholar
Scott, H.B., Choi, S.W., Wong, G.T., Irwin, M.G.. The effect of remifentanil on propofol requirements to achieve loss of response to command vs. loss of response to pain. Anaesthesia 2017; 72: 479–87.Google Scholar

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