Paediatric total intravenous anaesthesia

Abstract

### Key points Total i.v. anaesthesia (TIVA) has been used in adult practice since 1982 with target-controlled infusion (TCI) regimes available since 1989. Conversely, the use of TIVA in paediatric practice is far less routine with a survey finding only 10% of paediatric anaesthetists using it weekly or more.1 It has previously been the subject of a special edition of the journal Pediatric Anaesthesia 2 and the use for paediatric anaesthesia care is an increasing component at international meetings: educational sessions at the European Society for Paediatric Anaesthesia (2013), ASA (2014), and the Society for Intravenous Anaesthesia meeting in November 2015. Despite a number of obstacles (including interindividual pharmacokinetic and pharmacodynamic variability and safety concerns regarding propofol infusion syndrome—PrIS), there are notable benefits to TIVA and particular areas where it is indicated for anaesthetic or surgical reasons, where it may surpass volatile anaesthesia.3 It is a mandatory technique when inhalation agents are contraindicated. ### Advantages and disadvantages For physiological and clinical3 reasons (Table 2), TIVA has increasingly established a significant role in surgery in or around the airway (e.g. ENT) by obtunding airway reflexes (Table 2). The changes in airway reactivity facilitate extubation and result in a minimal incidence of laryngospasm and stridor …