Course: Introduction to Using Total Intravenous Anaesthesia (TIVA)

Three Compartment Model A three-compartment model is commonly used to describe the pharmacokinetics (PK) of intravenous drugs After an IV bolus, the plasma concentration peaks and then exhibits an exponential …

‘If you always do what you always did, you will always get what you always got’ – A. Einstein It is time to break down these barriers, move out of …

Dexamethasone Perioperative indications for dexamethasone, a synthetic glucocorticoid, are expanding. It is has a well-established role in the prevention of postoperative nausea and vomiting. Synergistic analgesic, prolongation of regional anaesthesia …

Neuromodulators Gabapentinoids, a class of drugs that are derivatives of the inhibitory neurotransmitter gamma-aminobutyric acid, play an important role in multi-modal analgesia. The most commonly encountered drugs in this class …

NSAIDs NSAIDs play a central role in preventive analgesia regimens. They reduce both inflammation and analgesia requirements. NSAIDs inhibit COX enzymes. COX-1 is a constitutive enzyme (always present) whilst COX-2 …

Minimising adverse effects Caution is required to avoid adverse side effects pEEG can be used to help avoid excessively deep levels of anaesthesia Allows drug titration based on PD response, …

Paracetamol There is very little downside to prescribing oral paracetamol preoperatively. It is a cheap and effective opioid-sparing agent which is well tolerated. Uses: Analgesic and antipyretic. Preparations: PO tablet …

Preventive Analgesia Practice aimed at lowering short- and long-term post-surgery pain Reduces central pain sensitisation Interruption of pain signal transmission to the central nervous system Attenuates noxious stimulus Limits effects …

Magnesium Magnesium plays an important homeostatic role in both neurotransmission and neuromuscular activity. It is the fourth most common cation in the body and the second-highest intracellular cation. The reference …

IV Lidocaine Lidocaine is an amide local anaesthetic and a class 1b anti-arrhythmic. The addition of lidocaine to propofol maintained TIVA will reduce requirements by 10-20%. If given as a …

Ketamine Ketamine is a phencyclidine derivative that produces a state of dissociative anaesthesia. It has strong amnesic and analgesic properties and can have an important role in preventive analgesia and …

Alpha 2 Agonists Clonidine and dexmedetomidine are alpha-2 agonists. They inhibit the release of epinephrine and norepinephrine by binding to pre-junctional alpha-2 receptors . Dexmedetomidine is x8 more selective to …

Advances in Healthcare & Technology Global life expectancy has increased by 6.1 years to 73.2 in the last decade (2010 – 2020) The World Health Organisation define an elderly person …

Obesity Complex and multifactorial disease – Abnormal or excessive fat accumulation that may impair health – Genetic predisposition – Ethnic factors – Socioeconomic class (SEC) – Co-morbidities – Nutritional input …

Context-sensitive half-time (CSHT) The time for the plasma concentration (and effect-site concentration) to decrease by 50% after stopping an infusion maintaining a constant plasma concentration The “context” is the duration …