Total intravenous anesthesia
A total intravenous anesthesia or total intravenous anesthesia ( TIVA ) is a form of general anesthesia ( "anesthesia") that the use of inhaled anesthetics dispensed with, and the loss of consciousness and the freedom from pain exclusively by intravenous supply of sleeping pills ( hypnotics ) and painkillers ( analgesics causes) .
Usually, TIVA (total intravenous anesthesia) refers to the supply of short-acting hypnotics (mostly propofol ) and analgesics (mostly opioids , e.g. remifentanil ) with the help of programmable syringe pumps . Thereby consciousness and pain sensation are switched off. Due to the very short duration of action of the drugs mentioned, the anesthesia is very easy to control and the recovery phase is comparatively very short, even after a long period of anesthesia, due to the low accumulation effects. However, after a long infusion, the wake-up time may be somewhat longer. This depends on the context-sensitive half-life of the active ingredients. A special form of TIVA is the Target Controlled Infusion , in which a computer automatically determines the supply based on a desired and programmable level of active ingredient in the blood plasma .
The distinction between TIVA and continuous sedation - for example in intensive care medicine - is fluid. During sedation, the patient is less deeply anesthetized (see Richmond Agitation Sedation Scale ); longer-acting substances such as sufentanil and midazolam are often used.
Indications
- Patients at Risk of Malignant Hyperthermia
- Lack of application options for anesthetic gases, for example in the rescue service , intensive care transport or during interventional procedures
- Patients with increased intracranial pressure
Relative indications that do not necessarily require TIVA are
- Patients with known post-operative nausea and vomiting
- One-lung ventilation in thoracic surgery : An unfavorable influence on the hypoxic pulmonary vasoconstriction in the non-ventilated lungs when using volatile anesthetics (anesthetic gases) has been scientifically proven.
- Anesthesia with special requirements regarding the controllability of the depth of anesthesia and / or the need for a short recovery phase after the procedure (e.g. outpatient anesthesia ).
literature
- Rossaint, Werner, Zwissler (ed.): The anesthesiology. General and special anesthesiology, pain therapy and intensive care medicine. 2nd edition, Springer, Berlin 2008, ISBN 978-3-540-76301-7 , pp. 604 f.
