Total intravenous anesthesia (general anesthesia, propofol)

Total intravenous anesthesia (TIVA) is a form of general anesthesia in which the drugs for sleep, pain relief and, if needed, muscle relaxation are given intravenously. The method lets the anesthesiologist control the depth of anesthesia precisely at every stage of the procedure and does not require inhaled anesthetics.

TIVA is used only where there is an anesthesia team, full monitoring of vital functions, airway equipment and post-procedure observation. Anesthesia is given when indicated, after an examination and assessment of anesthetic risks, not at the patient's request or because of the name of the operation.

How the method works

During TIVA, the anesthesiologist gives drugs through an intravenous catheter, as a single dose and/or with an infusion pump. Separate components are responsible for:

• inducing and maintaining sleep;
• pain relief;
• preventing nausea and vomiting;
• protecting the airway and controlling breathing;
• keeping blood pressure, heart rate and temperature stable.

The anesthesiologist chooses how breathing is managed (monitored spontaneous breathing, a laryngeal mask or tracheal intubation with mechanical ventilation) individually, depending on the extent of the operation, the patient's condition and the features of the airway.

Stages for the patient

• Consultation with the anesthesiologist: the doctor assesses your health, chronic conditions, allergies, previous experience of anesthesia, current medication, body weight, the risk of a difficult airway and the risk of aspiration (stomach contents entering the airway).
• Preparation: you receive personal instructions on fasting, drinking and regular medication. Do not stop any medication on your own: the doctor adjusts the schedule.
• Start of anesthesia: in the operating room, an intravenous catheter is placed and monitoring is connected. You receive oxygen, and then drugs for sleep and pain relief are given through the vein. Falling asleep is usually quick and calm.
• During the operation: the anesthesiologist continuously adjusts the drugs based on the nature of the operation, the body's response and breathing and circulation readings.
• Waking up and observation: when the operation ends, the anesthetics are stopped, and you wake up in the operating room or recovery room under staff observation until consciousness, breathing and vital signs are restored.

Monitoring during anesthesia

During general anesthesia, blood oxygen saturation, ventilation, circulation and body temperature are monitored. Basic monitoring includes pulse oximetry, electrocardiography, non-invasive blood pressure measurement, heart rate and capnography (continuous monitoring of exhaled carbon dioxide). Capnography helps assess ventilation and confirm the correct position of the airway device.

When indicated, the following are added:

• monitoring of the oxygen concentration in the inhaled mixture;
• assessment of breathing rate and volume;
• body temperature monitoring;
• monitoring of anesthesia depth using EEG parameters;
• neuromuscular monitoring when muscle relaxants are used;
• invasive blood pressure monitoring for complex procedures or significant cardiovascular risks;
• monitoring of urine output, infusion volume and blood loss during long operations.

What safety is built on

TIVA is a controllable method of general anesthesia, but like any anesthesia it carries risks. That is why it is not performed “just for comfort” without assessing indications, and not outside conditions that ensure full anesthetic safety.

• A pre-operative examination and risk assessment by the anesthesiologist.
• Following individual recommendations on food, drink and medication.
• Checking equipment, venous access and drug delivery systems.
• The anesthesiologist is present throughout the entire anesthesia.
• Continuous monitoring of oxygen, ventilation, heart rhythm, blood pressure and temperature to general anesthesia monitoring standards.
• An organized system for checking and monitoring intravenous infusions.
• Equipment for ventilation, intubation, resuscitation and emergency care.
• Observation in the recovery room until consciousness, breathing and circulation are safely restored.