Total intravenous anaesthesia (TIVA): when and how? (for nurses)

A benefit of TIVA over inhalational anaesthesia is:

Endotracheal intubation is unnecessary

Oxygen supplementation is unnecessary

Apnoea and hypoventilation never occur

Anaesthetic gas scavenging is not required

A benefit of TIVA over inhalational anaesthesia is:

Cost

Simpler dose calculations

Dose dependent cardiorespiratory depression does not occur

Negative environmental impact of anaesthesia may be reduced

Which is NOT an example of when delivery of inhalational anaesthesia is impractical:

Bronchoscopy of a cat

Gastroduodenoscopy of a brachycephalic dog

Placement of a tracheal stent

Field anaesthesia during a remote sterilisation trip

Balanced general anaesthesia involves the provision of:

Unconsciousness only

Unconsciousness and analgesia

Unconsciousness, analgesia, and muscle relaxation, usually by use of >1 drug type

Unconsciousness, analgesia, and muscle relaxation by use of only one drug

A benefit of using propofol as a TIVA agent is:

Analgesia

Provides dose-dependent unconsciousness and muscle relaxation with smooth induction and recovery in dogs and cats

Common formulation does not support bacterial growth

Does not cause any cardio-respiratory depression

This agent should never be included via the IV route for TIVA in cats:

Propofol

Medetomidine

Lignocaine

Ketamine

Regarding delivery of TIVA drugs to dogs and cats:

Repeated injections are preferable to a constant rate infusion

Loading doses are rarely required prior to starting TIVA infusions

A loading dose of propofol may not be required if it is used for anaesthetic induction and an infusion started immediately afterwards

Adding drugs directly to the fluid bag is preferable to use of a separate syringe driver

A 20kg border collie requires propofol (concentration 10mg/mL) at 0.2 mg/kg/minute. What rate should the infusion be set at?

24 mL/hr

240 mL/hr

0.4 mL/hr

4 mL/hr

Appropriate anaesthetic monitoring during TIVA in dogs and cats:

Is measuring heart rate and respiratory rate every 15 minutes

Is continuous monitoring or heart rate and respiratory rate, anaesthetic depth assessment every 5 minutes, and temperature check every 15 minutes. Capnography, pulse oximetry, and blood pressure every 5 minutes if possible.

Plasma drug concentration levels

Does not involve assessment of anaesthetic depth, as this is not possible during TIVA

In the recovery period following a TIVA anaesthetic you should

Expect dogs and cats to wake up much faster than they would following inhalational anaesthesia

Stop monitoring as soon as the anaesthetic drug infusion is stopped

Ensure to stop all analgesic infusions as soon as the surgical/medical procedure has finished

Continue basic monitoring until fully awake and provide oxygen supplementation and ventilation as required.

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Total intravenous anaesthesia (TIVA): when and how? (for nurses)