Total Intravenous Anesthesia (TIVA)

Total intravenous anesthesia, or TIVA, maintains general anesthesia entirely through an intravenous line rather than with inhaled anesthetic gases. A hypnotic and an analgesic are combined — commonly a propofol infusion with a short-acting opioid such as remifentanil — and infusion rates are adjusted continuously to the patient's response. Delivery may be manually controlled or use target-controlled infusion technology, in which a pump calculates infusion rates from a pharmacokinetic model.

TIVA is one option among several for maintaining general anesthesia, and it is selected according to the patient and the procedure. Propofol-based TIVA is associated with a lower incidence of postoperative nausea and vomiting than inhalational anesthesia, so it may be considered when reducing that risk is a priority — for example, in patients with previous postoperative nausea or motion sickness. Because it avoids volatile agents altogether, TIVA is also an option for patients with known or suspected susceptibility to malignant hyperthermia, whose anesthetic plan must also avoid succinylcholine.

Recovery is monitored in the same way as after any general anesthetic, and its character varies with the medications used, the procedure and the individual patient; TIVA should not be understood as guaranteeing a faster or clearer awakening. The choice of technique follows an individualized assessment and discussion between the patient and Dr. Seitz.