TIVA TCI (total intravenous anesthesia with target-controlled infusion) is total intravenous anesthesia delivered using the target-controlled infusion method.

General anesthesia with propofol using TCI models is safer for the patient and more comfortable for the anesthesiologist. [1]

 The TCI technique uses a software-controlled infusion pump that administers a drug (e.g., an anesthetic) to the patient based on patient parameters (age, sex, weight, height, etc.). The goal is to achieve a stable target plasma concentration of the drug. [2]

 The mathematical algorithms of TCI models for infusion pumps are designed so that the anesthesiologist sets the desired propofol plasma concentration, and the pump then adjusts the infusion rate according to the TCI algorithm.

 With no other method of administering propofol (for example, a fixed infusion rate on a pump) is a stable plasma propofol concentration achieved [4]. As a result:

●       the patient may wake up during anesthesia, especially when neuromuscular blockers are used without brain monitoring (BIS). This leads to the need for repeated bolus dosing, which may cause a decrease in blood pressure [5]

●       with a fixed infusion rate, there is a risk of underdosing or overdosing the drug [6]

●       for critically ill patients or elderly patients, using lower target drug concentrations with titration to clinical effect is safer and may reduce the number of hemodynamic reactions [1]

 

The use of infusion pumps with TCI models for propofol, remifentanil, midazolam, etc. is a modern global practice. The most authoritative anesthesia associations (AAGBI, ESA) recommend this in their guidelines.

 

  1. A. F. Nimmo et al Guidelines for the safe practice of total intravenous anaesthesia (TIVA) Anaesthesia 2018
  2. J Crit Care Med (Targu Mures). 2022 Jan; 8(1): 3–5.22
  3. Absalom AR, Mani V, De Smet T, Struys MM. Pharmacokinetic models for propofol–defining and illuminating the devil in the detail. British Journal of Anaesthesia 2009; 103: 26–37
  4. 5th National Audit Project of The Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland
  5. Absalom AR, Mani V, De Smet T, Struys MM. Pharmacokinetic models for propofol–defining and illuminating the devil in the detail. British Journal of Anaesthesia 2009; 103: 26–37