[A review of recent advances in total intravenous anesthesia]

Recent articles on total intravenous anesthesia (TIVA) were reviewed. The definition of TIVA is a combination of hypnotic agent, analgesic drugs and muscle relaxants, excluding simultaneous administration of any inhaled drugs. Anesthesia with single and massive doses of narcotic drugs such as fentanyl for cardiac anesthesia is not described in this paper. About thirty articles on TIVA which appeared in the journals of our specialty for three years from 1988 through 1990 were reviewed. In these papers, midazolam, ketamine, propofol were employed as the hypnotic agents, and fentanyl, alfentanyl, or sufentanyl were administered for analgesia during surgery. Based on pharmacokinetic studies, continuous intravenous administration of these agents are strongly recommended and infusion pumps with or without computer may be used for this purpose. The reviewer has developed a new TIVA using droperidol, fentanyl and ketamine 2 micrograms.kg-1.hr-1 and has applied it for over 800 cases excluding cardiac surgery and craniotomy. This combination of the drugs is considered the best, because propofol, alfentanyl and sufentanyl are not available in Japan so far. TIVA has many advantages over inhaled anesthesia and it can be easily employed not only in the modern sophisticated situations but also in so-called field conditions. We anesthesiologists should be much more familiar with this method of anesthesia.