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Target Controlled Infusion Anaesthesia

In certain situations the use of balanced anaesthesia is not indicated (e.g. malignant hyperthermia). If we cannot use balanced anaesthesia nor regional anaesthesia (due to the characteristics of the surgery) – a TIVA (Total Intravenous Anaesthesia) should come to our minds. And TCI (Target Controlled Infusion) is a way how TIVA can be performed. The advantages of TCI in comparison to manually performed TIVA are for example – easier titration of the anaesthetic agent, it leads to fewer interventions by anaesthesiologist and helps us anticipate the wake up time. The purpose of this algorithm is to introduce the TCI syringe pump, to demonstrate how it works, what the indications are, what parameters are needed and how the complications can be solved with the use of TCI.

Author: Ivo Křikava, MD, PhD, Bönisch Vít, Křemečková Petra, Illustrations-Bakošová Mária

Institution: Faculty of Medicine at Masaryk University in Brno

Medical discipline: Emergency Medicine

Keywords: TCI | propofol | peroperative monitoring | intraoperative awarness

Educational evel: Undergraduate level | Graduate

In certain situations the use of balanced anaesthesia is not indicated (e.g. malignant hyperthermia). If we cannot use balanced anaesthesia nor regional anaesthesia (due to the characteristics of the surgery) – a TIVA (Total Intravenous Anaesthesia) should come to our minds. And TCI (Target Controlled Infusion) is a way how TIVA can be performed. The advantages of TCI in comparison to manually performed TIVA are for example – easier titration of the anaesthetic agent, it leads to fewer interventions by anaesthesiologist and helps us anticipate the wake up time. The purpose of this algorithm is to introduce the TCI syringe pump, to demonstrate how it works, what the indications are, what parameters are needed and how the complications can be solved with the use of TCI.


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Review

This very practical and well-arranged algorithm shows the alternative pathway of general anaesthesia with avoidance of inhalation anesthetics. It clearly shows the general anaesthesia management using Total Intravenous Anaesthesia (TIVA) or Target Controlled Infusion (TCI) in interactive and practical way. It describes and clarifies the individual modes of setting as well as its practical design, including the depth monitoring of such anaesthesia and, from choosing the right pharmacokinetic model to explaining what target concetration is and how patient's parameters . This algorithm is a great and instructive aid to explain the management of general anaesthesia such as TIVA / TCI, which is certainly the future of general anaesthesia management.

publikováno: 3.7.2018 | last modified on: 1.9.2018