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Principles of Total Intravenous Anesthesia

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Essentials of Pharmacology for Anesthesia, Pain Medicine, and Critical Care

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Abstract

Anesthesiology, like any other specialty in medicine, is continuously evolving. Perhaps the most important changes are driven by applications of physics leading to improved monitoring, as well as by advances in pharmacology (e.g., improved understanding of drug targets). TIVA (total intravenous anesthesia) is an extension of the concept of balanced anesthesia using real-time pharmacokinetic modeling, delivering all anesthetic drugs via intravenous route targeted to achieve optimal operating conditions with maximal patient comfort and safety. However, there is a natural reluctance among physicians, in general, and anesthesiologists, in particular, to change their practice unless the advantages are striking or the established techniques are proven unsafe. This is probably the main reason why intravenous anesthesia is not being embraced as fondly as one might have expected. Coupled with this, the issues related to modalities of administration are not yet perfected and the pharmacological principles on which they are based are constantly evolving. The aim of the chapter is to explore briefly the intricacies of intravenous anesthesia, examine the potential advantages, briefly review the disadvantages, and wrap up with the areas where it is inevitable and areas where it is immensely useful.

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Author information

Authors and Affiliations

  1. Department of Anesthesiology and Critical Care Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, 680 Dulles, Philadelphia, PA, USA

    Basavana Gouda Goudra MD, FRCA, FCARCSI

  2. Department of Clinical Anesthesiology and Critical Care, Perelman School of Medicine, Philadelphia, PA, USA

    Basavana Gouda Goudra MD, FRCA, FCARCSI

  3. Department of Anesthesia, All India Institute of Medical Sciences, New Delhi, 110029, India

    Preet Mohinder Singh MD, DNB

Authors
  1. Basavana Gouda Goudra MD, FRCA, FCARCSI
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  2. Preet Mohinder Singh MD, DNB
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Corresponding author

Correspondence to Basavana Gouda Goudra MD, FRCA, FCARCSI .

Editor information

Editors and Affiliations

  1. Departments of Anesthesiology and Pharmacology, LSU Health Sciences Center, New Orleans, Louisiana, USA

    Alan David Kaye

  2. Department of Pharmacy Practice, Thomas J. Long School of Pharmacy and Health Sciences, Stockton, California, USA

    Adam M. Kaye

  3. Center for Perioperative Management and Medical Informatics, Brigham and Women’s Hospital, Boston, Massachusetts, USA

    Richard D. Urman

Chemical Structures

Chemical Structures

Chemical Structure 4.1
figure 2

Propofol

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Chemical Structure 4.2
figure 3

Remifentanil

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Chemical Structure 4.3
figure 4

Desflurane

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Chemical Structure 4.4
figure 5

Fentanyl

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Goudra, B.G., Singh, P.M. (2015). Principles of Total Intravenous Anesthesia. In: Kaye, A., Kaye, A., Urman, R. (eds) Essentials of Pharmacology for Anesthesia, Pain Medicine, and Critical Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8948-1_4

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  • DOI: https://doi.org/10.1007/978-1-4614-8948-1_4

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-8947-4

  • Online ISBN: 978-1-4614-8948-1

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