Total intravenous anaesthesia techniques for ambulatory surgery

The purpose of the present review is to provide an updated discussion on the use of total intravenous anaesthesia (TIVA) for ambulatory surgery, based on results from recent studies put into the context of issues already known.

The current use of TIVA for ambulatory surgery seems to be abundant. It is encouraged by the simplicity of the method, increased experience and declining costs with the propofol and remifentanil combination. The TIVA methods are well tolerated and perceived to give good quality patient care; with rapid, clear-headed emergence and low incidence of postoperative nausea and vomiting. Cost-efficacy and other benefits of recovery from TIVA versus alternative techniques of anaesthesia seem to depend more on the patient and the individual perioperative setting than on the TIVA concept per se. Further development of TIVA will include the refinement of target control systems, the introduction of new drugs and adjuvants and advanced equipment for automatic drug delivery, as well as improved effect monitoring.

TIVA is well tolerated and simple. It is associated with less postoperative nausea and vomiting than inhalational anaesthesia and has no residual paralyses as are possible with locoregional techniques. Propofol with remifentanil seems to be the dominating TIVA technique, delivered either by conventional pumps or by target control systems.