Total Intravenous Anesthesia (TIVA) and Target Controlled Infusions (TCI) in Children

Abstract

Total intravenous anesthesia is increasingly used in children and in some situations is mandatory, for example in the child with malignant hyperthermia susceptibility. Propofol is most often used, either alone or concurrently with an opioid infusion. Pediatric dosing regimens have been calculated in small populations of healthy children and act as a guide for administration. Manual infusion schemes can be used quite effectively using conventional syringe drivers. Specifically programmed syringe drivers enable more careful titration to an estimated target concentration in blood or at the effect site using algorithms based upon pediatric pharmacokinetic data (target controlled infusion). In the future, more precise dosing and titration will be aided by near-real-time propofol analysis in blood or exhaled gases and further refinement of depth of anesthesia monitoring in children.

Alfaxalone TIVA bij de chirurgische excisie van een tracheaal adenocarcinoma bij een kat

“…In de humane geneeskunde wordt steeds meer interesse getoond in TIVA bij pediatrische patiënten (Morton, 2013) en vooral in de neurochirurgie wordt in de meerderheid van de gevallen voor TIVA gekozen (Zuleta-Alarcòn et al, 2015). Bij ernstig zieke honden blijkt TIVA minder cardiovasculaire depressie te veroorzaken dan onderhoud met inhalatie-anes-thetica, tenminste wanneer aangepaste protocollen gebruikt worden (Keegan en Green, 1993;Deryck et al, 2010).…”

Total Intravenous Anaesthesia with Propofol-a comparison of Target-controlled infusion (TCI) with manual controlled infusion (MCI). A randomized study

“…(3) As a consequence of these favourable indices, Propofol remains widely used for gynecological, neurosurgical, and day-case anaesthesia. TIVA is particularly mandatory when anaesthetizing patients with malignant hyperthermia (4).…”

“…or an infusion at a fixed rate of 6mg/kg/hr. (4,5,6) Maintenance of anaesthesia with TIVA is considered more complex than maintenance with inhalational agents, and so innovative delivery systems were investigated which consequently resulted in the development of computerized target-controlled infusions (TCI) for propofol. (7) The system allows drugs to be administered to achieve a target blood or site-effect concentration, with dosages automatically adjusted by an inbuilt computerized software mechanism.…”