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TIVA

QuestionAnswer
Benefits of TIVA? Stress free awake extubation, free of laryngospasm; reduced risk of PONV; can be used for malignant hyperthermia: more environmentally friendly
When is the remi and propofol started? If effect site targeting is used for both, start simultaneously. If using plasma targeting for remi and effect site for propofol, start Remi first (otherwise patient will have too much propofol and not enough Remi)
Pros and cons of low propofol, high Remi? Rapid recovery but associated with apnoea
Minimum effect site propofol concentration Less than 50yo - 3mcg/ml. More than 50yo - 2mcg/ml
When can muscle relaxant be given After loss of response to jaw thrust
Suggested effect site concentration of propofol and Remi in spont breathing Less than 50yo. Prop 4-6. Remi 1-3 More than 50yo. Prop 2-4. Remi 1-2
Suggested effect site concentration of propofol and remi in IPPV Less than 50. Prop 3-4. Remi 5-8 More than 50. Prop 2-3. Remi 3-6
Why is Remi plasma targeting often chosen over effect targeting Minto model gives a bolus dose 3-4x higher than plasma targeting leading to increased risk of chest wall rigidity and bradycardia
What precautions should be used to avoid technical problems in TIVA
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