Skip main navigation

TIVA Dosing – Induction

TIVA Dosing - Induction

Standard induction

  • During standard induction, we give a bolus of a short-acting opioid and propofol, usually dosed according to body weight
  • After assessing loss of consciousness (LOC), we will administer muscle relaxants for intubation

TIVA induction

  • We recommend slowly titrating up the target propofol concentration to observe the Ce when LOC happens, this will give us an idea of how sensitive to the anaesthesia our patient is
  • The size of the initial target and the steps of increase can vary according to the perceived sensitivity to anaesthesia, with smaller steps for more sensitive patients
  • We usually start with a target of 0.5 – 1 mcg/ml and stepping up 0.5 – 1 mcg/ml each time
  • Depending on your plan for airway manipulation, propofol requirements may need to be titrated upwards to obtund the stimulation especially if your airway plan involves less opioid or without relaxants
  • Infusion rates with TCI propofol are much slower than standard bolus propofol induction, but the patient will lose consciousness at roughly the same predicted effect-site concentration
    • This is because the time to peak effect for propofol is much slower than for example, thiopentone
    • The quick loss of consciousness we see with standard induction is because the dose we give will cause a huge overshoot in the plasma concentration to drive up the effect-site concentration quickly
    • With TCI propofol infusion, a more gentle induction is possible with less of the side effects such as haemodynamic instability caused by the overshooting.

Caveats for a quicker induction:

  • Use effect-site targeting instead of plasma site targeting
  • Make sure all the dead space between the propofol infusion line and IV access is primed with propofol and consider a running drip
  • Begin propofol infusion as early as possible
  • Some TCI pumps will give you the bolus dose when an initial target infusion is being set, this can be adjusted to your desired bolus should a quick induction is deemed necessary

Caution

  • Change in the patient usually lags the calculation on the pump because it assumes instant distribution which is not the case in real life
This article is from the free online

Introduction to Using Total Intravenous Anaesthesia (TIVA)

Created by
FutureLearn - Learning For Life

Our purpose is to transform access to education.

We offer a diverse selection of courses from leading universities and cultural institutions from around the world. These are delivered one step at a time, and are accessible on mobile, tablet and desktop, so you can fit learning around your life.

We believe learning should be an enjoyable, social experience, so our courses offer the opportunity to discuss what you’re learning with others as you go, helping you make fresh discoveries and form new ideas.
You can unlock new opportunities with unlimited access to hundreds of online short courses for a year by subscribing to our Unlimited package. Build your knowledge with top universities and organisations.

Learn more about how FutureLearn is transforming access to education