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Factors affecting recovery profile

What can we do to help ensure a smooth recovery from anaesthesia? In this article, we outline multiple factors that need to be considered.

TIVA’s recovery profile

  • Associated with a pleasant and smooth nature of emergence from general anaesthesia
  • Multifactorial anaesthetic plan needs to be both patient and procedure specific
    • Procedure specific
      • Neurosurgery: prevention of coughing might be one of the most important considerations
      • Tonsillectomy: return of airway reflexes and timing of extubation
      • Day surgery: TIVA is associated with shorter time to home readiness
      • Longer surgery: consider a shorter-acting sedative
    • Patient-specific
      • Age and cognitive function
      • High risk of PND
      • Baseline anxiety and fears
  • Elements of a smooth recovery
    • Reasonable fast recovery
    • Patient comfort:
      • Adequate postoperative analgesia
      • Absence of PONV
      • Avoidance of agitation
    • Cardiovascular stability
    • Return of airway reflexes
  • To provide us with the highest chance of providing a smooth recovery from anaesthesia knowledge of the following is required
    • Pharmacokinetic characteristics and decrement times
    • Pharmacodynamic interactions between different drugs
    • Prevention of PONV
    • Adjuncts for postoperative analgesia
    • Optimal timing of emergence from anaesthesia
      • May be difficult to predict we should use all available information
      • Depth-of- anaesthesia (DoA) monitoring
        • Prevent excessive depth of anaesthesia
        • Improve the speed and quality of recovery from anaesthesia
        • Guidance states BIS range between 40-60 for general anaesthesia towards the end of the surgery this range can be narrowed to BIS between 50-60
  • Know your pump: Decrement function
  • Know your patient: The target effect site level that corresponds to loss of response to verbal stimlus when titrated slowly at induction corresponds well to return conciousness
  • Know your surgery: Noxious stimuli during the last part of surgery may result in the patient waking too soon if the dose of anaesthetic is turned off or reduced too soon
  • Know your surgeon: Consider reducing the target concentrations when wound closure begins.
    • Who will be closing the patient and how long will it take?
    • Stopping all drug infusions when the last sutures are being inserted
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Introduction to Using Total Intravenous Anaesthesia (TIVA)

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