Total Intravenous Anesthesia

• TIVA is a common choice for non-OR anesthetics, and usually consists of propofol along with fentanyl, remifentanil, or ketamine.
• These drugs are given via infusion or bolus.
• Advantages of TIVA vs inhalational anesthesia
  • Do not need gas scavenging
  • Reduced PONV
• Discussed in a different section, the ERAS program, or enhanced recovery after surgery, aims to improve surgical outcomes and allow patients to return to normal activities as quickly as possible. TIVA is a main component to this focus because of the decreased chance of PONV vs general anesthesia.
• Regarding evoked potentials, inhalational anesthetics have the greatest inhibitory effect that cause an amplitude decrease and wave latency increase. TIVA is helped in patients with neurological impairments.
  • Propofol and opioids have limited effect on somatosensory evoked potentials (SSEPs).
  • Etomidate and ketamine, however, can enhance SSEP waveforms.