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Switching from inhaled to intravenous general anaesthesia
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Switching from inhaled to intravenous general anaesthesia
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Journal Article
Switching from inhaled to intravenous general anaesthesia
2024
Overview
A national audit of accidental awareness under general anaesthesia (where a patient is aware of events despite the intention to administer general anaesthesia) identified TIVA as a risk factor, particularly when unusual techniques were used or equipment checks were incomplete.3 A Cochrane review on cognitive outcomes in older people found that postoperative cognitive dysfunction (a persistent impairment of cognition following surgery) was less likely with propofol-based TIVA,4 and a meta-analysis of randomised controlled trials found that propofol based TIVA was associated with a lower incidence of emergence agitation in children.5 At present, we deem it reasonable to consider TIVA and inhalational anaesthesia equivalent from a safety perspective; three major ongoing randomised controlled trials (Vital, expected to conclude in 2026; Vapor-C, expected to conclude in 2026; and Thrive, expected to conclude in 2029) will add further information about the relative risks and benefits of both techniques.6 Evidence for the solution Multiple studies show that TIVA has a lower carbon footprint than inhalational anaesthesia.789 The studies are based on “life cycle analyses,” using 100 year global warming potential to quantify greenhouse gas emissions. Since 2021, the UK’s Royal College of Anaesthetists has specified that anaesthetists should be trained to use TIVA for non-complex cases in the first stage of training;13 further training can be sought for more complex situations. Ce=effect site concentration; Cet=effect site concentration target Anaesthetic teams should ensure that TIVA drugs and equipment are thoroughly checked before use, to minimise the risk of errors. Pharmacokinetic models are less well validated in pregnant women and children, yet these patients arguably have much to gain from TIVA (eg, because of the uterine relaxant qualities of volatile anaesthetics, and the increased risk of postoperative nausea and vomiting and agitation on emergence in paediatric practice).1618 Uncertainties include the pharmacokinetic implications of various pathologies and stages of pregnancy, and wide pharmacokinetic and pharmacodynamic variability across the paediatric population.
Publisher
British Medical Journal Publishing Group,BMJ Publishing Group LTD
Subject
/ Anesthesia, General - adverse effects
/ Anesthesia, Inhalation - adverse effects
/ Anesthesia, Intravenous - methods
/ Anesthetics, Inhalation - administration & dosage
/ Anesthetics, Inhalation - adverse effects
/ Anesthetics, Intravenous - administration & dosage
/ Anesthetics, Intravenous - adverse effects
/ Humans
/ Patients
/ Practice
/ Propofol
/ Surgery
/ Vomiting
