Total Intravenous Anaesthesia (TIVA) for Ambulatory Surgery: An Update

Abstract

Total intravenous anesthesia (TIVA) has several potential benefits in the context of ambulatory surgery. This review explores the use of propofol-based TIVA from a wide number of perspectives: we review relevant literature in relation to patient and institutional outcomes attributable to TIVA; we provide an overview of the pharmacology of propofol and how TIVA delivery systems have evolved; we explore the advent of closed loop anesthesia systems; and we briefly review some of the pharmacological adjuncts used in TIVA. Propofol-based TIVA is associated with less post-operative nausea and vomiting, better pain outcomes, higher quality of recovery scores and better measures of perioperative efficiency when compared to vapor-based anesthesia. The combination of propofol and low-dose remifentanil appears to confer some benefit to the use of propofol alone. Infusion algorithms based on drug pharmacokinetics can be used in combination with biometrics such as processed EEG, skin conductance and heart rate variability to deliver closed-loop anesthesia. Successful ambulatory surgery programmes require anaesthesia that permits rapid return of consciousness with minimal morbidity. Propofol-based TIVA appears to meet this challenge. The advent of new technology may further enhance this anesthesia modality.