TOTAL INTRAVENOUS ANAESTHESIA (TIVA): PHARMACOLOGY AND CLINICAL APPLICATIONS

Abstract

Total Intravenous Anaesthesia (TIVA) has been a major technique in anaesthesia and has been adopted since the use of hypnotic and analgesic intravenous drugs for stable anaesthesia without using inhalational drugs. Rapid onset, predictable recovery profile, antiemetic effect, low environmental contamination and haemodynamic control have led to the wide acceptance of TIVA using propofol, especially in surgical and critical care. This paper briefly summarizes the pharmacological characteristics, mechanism of action, clinical application, advantages and disadvantages of propofol based TIVA in clinical practice. The study also analyses the clinical outcome of these two methods of anaesthesia – TIVA and inhalational anaesthesia – by means of a structured approach. The second analytical method completes the research, based on studies published in the literature and clinical research that have been published. Anesthesia datasets, anesthesia records and comparative studies that have been published in medical databases and in peer-reviewed literature. The operative recovery, postoperative nausea and vomiting, haemodynamic stability, patient satisfaction, duration of recovery, need for analgesics and adverse event rates are analysed. The following indicators were used as a reference to evaluate the numerical values: Perioperative outcomes of selected clinical studies have been conducted on adult surgical patients during TIVA and volatile anaesthesia. The results show that propofol-based TIVA has better recovery properties, reduces the occurrence of PONV, eliminates the emergence delirium and generates more patient comfort than does inhalational recovery. TIVA also highlights several applications that are beneficial to neurosurgery, bariatric surgery, ambulatory surgery, paediatric anaesthesia and surgery where the use of neurophysiological monitoring is required. However, there are important clinical limitations such as infusion problems, need for sophisticated monitoring devices, risk for awareness during anaesthesia, and the need for experienced anaesthetists. Pharmacokinetic variation and accumulation of drugs with long duration of infusion also have an impact on intra operative management strategies. The study demonstrates that, if properly monitored and pharmacologically planned, it is an effective and clinically useful technique of anaesthesia in modern Perioperative care of TIVA. The introduction of multimodal anaesthetic protocols, monitoring systems, and target controlled infusion (TCI) systems has helped to make the use of propofol more widespread and this trend continues. The use of TIVA will continue to be made more robust and clinically relevant by the advances of pharmacological modelling and precision anaesthesia in a wide range of surgical specialties, and will be made more safe and effective.