Edward I McIlroy1, Kate Leslie1,2,3. 1. Department of Anaesthesia and Pain Management, Royal Melbourne Hospital. 2. Centre for Integrated Critical Care, Melbourne Medical School, and Department of Pharmacology and Therapeutics, University of Melbourne. 3. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
Abstract
PURPOSE OF REVIEW: The purpose of this article is to review the use of total intravenous anaesthesia (TIVA) in ambulatory care. RECENT FINDINGS: The number of ambulatory surgery cases is likely to increase in coming years. Recent meta-analyses suggest that TIVA offers decreased postoperative nausea and vomiting (PONV) and decreased pain scores in the postanaesthesia care unit (PACU) in day case/ambulatory surgery patients when compared with volatile anaesthesia. Particular improvements have also been shown in endoscopic nasal surgery in terms of decreased blood loss. TIVA consistently scores higher than volatile techniques in patient satisfaction surveys. Surveys of anesthetists suggest that TIVA is not in widespread use. This may be because of the perceived lack of training or confidence in the technique, therefore, recent internationally agreed guidelines aimed at formalizing its practice are welcome. There is also some recent evidence to suggest that intraoperative dexmedetomidine is superior to remifentanil with respect to postoperative pain and speed of recovery, and that intraoperative lignocaine infusion may reduce chronic pain incidence in breast surgery. SUMMARY: Review of recent evidence of TIVA's use in ambulatory surgery and summary of new international guidelines on its use.
PURPOSE OF REVIEW: The purpose of this article is to review the use of total intravenous anaesthesia (TIVA) in ambulatory care. RECENT FINDINGS: The number of ambulatory surgery cases is likely to increase in coming years. Recent meta-analyses suggest that TIVA offers decreased postoperative nausea and vomiting (PONV) and decreased pain scores in the postanaesthesia care unit (PACU) in day case/ambulatory surgery patients when compared with volatile anaesthesia. Particular improvements have also been shown in endoscopic nasal surgery in terms of decreased blood loss. TIVA consistently scores higher than volatile techniques in patient satisfaction surveys. Surveys of anesthetists suggest that TIVA is not in widespread use. This may be because of the perceived lack of training or confidence in the technique, therefore, recent internationally agreed guidelines aimed at formalizing its practice are welcome. There is also some recent evidence to suggest that intraoperative dexmedetomidine is superior to remifentanil with respect to postoperative pain and speed of recovery, and that intraoperative lignocaine infusion may reduce chronic pain incidence in breast surgery. SUMMARY: Review of recent evidence of TIVA's use in ambulatory surgery and summary of new international guidelines on its use.