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TIVA

Junior -Small Animal Anesthesia Lecture 4

QuestionAnswer
Adv to injectable anesthesia: easier, decreases stress, quicker way to control airway, less environmental pollution
Disadv to injectable anesthesia: prolonged recovery, hypoventilation and hypoxemia, delay in attempting to lighten the depth of anesthesia
4 components of general anesthesia strived to achieve with TIVA: amnesia, autonomic areflexia, analgesia, muscle relaxation
CRI vs. intermittent boluses: fewer sudden hemodynamic changes, lower total amt of drug given, more rapid recovery, constant plane of anesthesia
What is the biggest cost associated with CRI a precision infusion device
How do we determine infusion rate clearance of the drug and plasma drug concentration
Most common CRI agent = propofol
Why is propofol a popular CRI choice? higher elimination clearance, shorter elimination half life, good recovery
Why is thiopental not suitable for TIVA prolonged recovery w/ longer infusions
By itself, why is ketamine not a good choice for TIVA some metabolites are active and accumulate resulting resulting in prolonged drug action, also seizures may occur
Is etomidate a good CRI no - it suppresses cortisol, can cause hemolysis, and may cause bradycardia and obtundation, plus $$$$
Are benzos good in TIVA yes, especially fi given with an opion --- they produce minimal CV depression, but don't use alone
Common opioids used in TIVA: fentanyl, remifentanil, alfentanil, sufentanil
Why is fentanyl a good choice for TIVA? 50x stronger than morphine, good for analgesia, effective in 4-7 minutes, half-life longer than remifentanil, cheaper than remifental, does not need reconstitution
Disadvantages of fentanyl CRI can cause severe bradycardia - tx w/ atropine
What is unique about remifentanil Nonhepatic metabolism, immediate effect b/c levels in the blood and brain equilibrate rapidly
Indications for TIVA when endotracheal tube may interfere w/ sx, for pts with high ICP, post-op seizures, for mechanically ventilation in ICU, for diagnostic procedures (MRI, radiation), or when general anesthesia is unavailable
What can propofol be diluted with in an IV set: 5% dextrose in water, final concentration should not be less than 2mg/mL
What premeds are preferred with TIVA opioid (pain control) and a sedative (ace, benzo, or A2) --- reversible agents preferred (opioids + benzos)
Reversal of diazepam flumazenil
Reversal of opioids naloxone
Guideline for bolus of propofol 10-20% of induction dose actually given to the patient
Propofol induction with CRI 4mg/kg --- give 1/2 dose over 40s, then if necessary give the rest. Maintain on 10% of half dose (0.2mg/kg/min) and bolus as necessary - infusion rate may need to be adjusted by 0.1mg/kg/min increments
In painful procedures what should be added to a propofol CRI? opioid infusion (fentanyl or remifentanil) -- give slowly, + have mechanical ventilation ready
Most common complication with propofol CRI Respiratory depression, also arterial hypotension
What can be added to the TIVA to provide muscle relaxation? neuromuscular blocking agent (atracurium, pancuronium, vecuronium)
What needs to be done if a neuromuscular blocking agent is added and why? Ventilatory support b/c it paralyzes the diaphragm
Created by: Sara2420