I have started using total I.v. Anesthesia rather recently but I think I have fallen in love with it. It is convenient , simple and spares use of gases. As such , with a lack of scavenging system for waste gases in my settings, it is another possible way of preventing unnecessary exposure of theatre staff to these gases ( other being closed system which I posted in my earlier blog). And I believe such settings still prevail in many parts of the world. And that is why I wanted to share my experience.
As far as the practice of TIVA goes , I am sure you will find it written in many books and internet. So I will try to be brief and to the point so as to help you establish a system in case you are new to it. And those of you who have access to opioids may skip the part of using non-opiod analgesics .
1. PREMEDICATION
I use ketamine with midazolam for this. However you can use any medicine which you use regularly.
1. INDUCTION OF ANESTHESIA
I use propofol for induction ( 2 mg/kg body weight)
2. MAINTENANCE OF ANESTHESIA
Propofol infusion at 6mg/kg/hr delivered through an syringe infusion pump. In case you have remifentanil then add 1mg to 50ml of propofol. This will take care of analgesia and there is no need for other analgesics. In the event of non availability of opioids I use inj tramadol (1mg/kg) + inj diclofenac (1mg/kg ) + inj paracetamol (15 mg/kg max 1g ) as infusions in the standard I.v fluids for analgesia.
3. MUSCLE RELAXANTS
If you add remifentanil to propofol then you won't need to use muscle relaxants as the anesthesia depth will be sufficient to allow surgery as well as tolerate LMA OR an ET tube by a spontaneously breathing patient. In case you don't have opioids , using any of the NMDR will suffice ( but aaah!! it puts the burden of ventilation on me)
4. REVERSAL
Switch of the Propofol infusion . Not that I need to tell you if you are reading this but just for the sake of it ...In case you have used NMDR GIVE REVERAL (neostigmine with Atropine/Glycopyrolate).
I guess that would do it.
Comments would be nice.
As far as the practice of TIVA goes , I am sure you will find it written in many books and internet. So I will try to be brief and to the point so as to help you establish a system in case you are new to it. And those of you who have access to opioids may skip the part of using non-opiod analgesics .
1. PREMEDICATION
I use ketamine with midazolam for this. However you can use any medicine which you use regularly.
1. INDUCTION OF ANESTHESIA
I use propofol for induction ( 2 mg/kg body weight)
2. MAINTENANCE OF ANESTHESIA
Propofol infusion at 6mg/kg/hr delivered through an syringe infusion pump. In case you have remifentanil then add 1mg to 50ml of propofol. This will take care of analgesia and there is no need for other analgesics. In the event of non availability of opioids I use inj tramadol (1mg/kg) + inj diclofenac (1mg/kg ) + inj paracetamol (15 mg/kg max 1g ) as infusions in the standard I.v fluids for analgesia.
3. MUSCLE RELAXANTS
If you add remifentanil to propofol then you won't need to use muscle relaxants as the anesthesia depth will be sufficient to allow surgery as well as tolerate LMA OR an ET tube by a spontaneously breathing patient. In case you don't have opioids , using any of the NMDR will suffice ( but aaah!! it puts the burden of ventilation on me)
4. REVERSAL
Switch of the Propofol infusion . Not that I need to tell you if you are reading this but just for the sake of it ...In case you have used NMDR GIVE REVERAL (neostigmine with Atropine/Glycopyrolate).
I guess that would do it.
Comments would be nice.
