Propofol based total intravenous anaesthesia (TIVA) can substantially improve a patient’s recovery profile and comfort but despite having these advantages, it accounts for less than 5% of general anaesthetics. Why may this be?
TIVA delivered by weight-based algorithms was cumbersome and perhaps a “hit or miss” technique. The target controlled infusion (TCI) technique, which significantly simplified TIVA, was initially restricted to proprietary drug preparations and infusion pumps that significantly increased costs and thus reduced access. These negative circumstances prevented the initial development of critical masses of local experts to provide widespread training opportunities.
Since these “dark ages” of TIVA, delivery systems have matured with the market opened for competition; depth of anaesthesia monitoring being widely available and drugs costs becoming very competitive. The conditions are ripe for a “renaissance” and anaesthesiologists should be equipped to bring benefits of TIVA to our ever-growing surgical population.