There have been immense advances in the safety and variety of
intravenous anesthetic delivery systems including drug cost reduction, development of more effective
opioids, and improvement in depth of
anesthesia monitoring in the last 20 years.
Propofol-based total
intravenous anesthesia (TIVA) with target-controlled infusion (TCI) is relatively easy to practice. While this technique promotes a higher overall
anesthesia quality and patient survival, especially for
cancer patients, there are deficiencies in training and education of the technique. Therefore, the Society for
Intravenous Anesthesia and the Association of Anesthetists (United Kingdom) have laid out guidelines in an attempt to highlight multiple important TIVA-related safety issues to help clinicians feel more confident. In the present article, we discuss five recommendations and four special clinical situations. Preparation, equipment familiarity, and safe delivery techniques are extremely important for the proper employment of this method. Herein, we emphasize the importance of proper education, and the clinical practice experience of the TIVA technique. Additionally, we suggest a modified connection method to set up a safely administered line. We highlight the advantages of using processed electroencephalogram monitoring (such as bispectral index or Entropy) to prevent awareness during TIVA administration in difficult clinical situations. These situations may include triple low patients (e.g.,
low blood pressure, low maintained effect-site concentration of
propofol, and low
body weight ≤ 18), obese patients, and patients with difficult infusion site monitoring or use of
neuromuscular blocking agents. Due to a limited consensus among Taiwanese medical professionals, this document is intended to act as a safe practice reference for the use of TIVA with TCI. Additionally, two pithy formula codes, 4321 for
propofol with
fentanyl/
alfentanil and 42222111 for
propofol with
remifentanil, are provided for the general population and one pithy formula code, 4321 for
propofol with
fentanyl, is provided for pediatric patients.