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TIVA
Junior -Small Animal Anesthesia Lecture 4
| Question | Answer |
|---|---|
| Adv to injectable anesthesia: | easier, decreases stress, quicker way to control airway, less environmental pollution |
| Disadv to injectable anesthesia: | prolonged recovery, hypoventilation and hypoxemia, delay in attempting to lighten the depth of anesthesia |
| 4 components of general anesthesia strived to achieve with TIVA: | amnesia, autonomic areflexia, analgesia, muscle relaxation |
| CRI vs. intermittent boluses: | fewer sudden hemodynamic changes, lower total amt of drug given, more rapid recovery, constant plane of anesthesia |
| What is the biggest cost associated with CRI | a precision infusion device |
| How do we determine infusion rate | clearance of the drug and plasma drug concentration |
| Most common CRI agent = | propofol |
| Why is propofol a popular CRI choice? | higher elimination clearance, shorter elimination half life, good recovery |
| Why is thiopental not suitable for TIVA | prolonged recovery w/ longer infusions |
| By itself, why is ketamine not a good choice for TIVA | some metabolites are active and accumulate resulting resulting in prolonged drug action, also seizures may occur |
| Is etomidate a good CRI | no - it suppresses cortisol, can cause hemolysis, and may cause bradycardia and obtundation, plus $$$$ |
| Are benzos good in TIVA | yes, especially fi given with an opion --- they produce minimal CV depression, but don't use alone |
| Common opioids used in TIVA: | fentanyl, remifentanil, alfentanil, sufentanil |
| Why is fentanyl a good choice for TIVA? | 50x stronger than morphine, good for analgesia, effective in 4-7 minutes, half-life longer than remifentanil, cheaper than remifental, does not need reconstitution |
| Disadvantages of fentanyl CRI | can cause severe bradycardia - tx w/ atropine |
| What is unique about remifentanil | Nonhepatic metabolism, immediate effect b/c levels in the blood and brain equilibrate rapidly |
| Indications for TIVA | when endotracheal tube may interfere w/ sx, for pts with high ICP, post-op seizures, for mechanically ventilation in ICU, for diagnostic procedures (MRI, radiation), or when general anesthesia is unavailable |
| What can propofol be diluted with in an IV set: | 5% dextrose in water, final concentration should not be less than 2mg/mL |
| What premeds are preferred with TIVA | opioid (pain control) and a sedative (ace, benzo, or A2) --- reversible agents preferred (opioids + benzos) |
| Reversal of diazepam | flumazenil |
| Reversal of opioids | naloxone |
| Guideline for bolus of propofol | 10-20% of induction dose actually given to the patient |
| Propofol induction with CRI | 4mg/kg --- give 1/2 dose over 40s, then if necessary give the rest. Maintain on 10% of half dose (0.2mg/kg/min) and bolus as necessary - infusion rate may need to be adjusted by 0.1mg/kg/min increments |
| In painful procedures what should be added to a propofol CRI? | opioid infusion (fentanyl or remifentanil) -- give slowly, + have mechanical ventilation ready |
| Most common complication with propofol CRI | Respiratory depression, also arterial hypotension |
| What can be added to the TIVA to provide muscle relaxation? | neuromuscular blocking agent (atracurium, pancuronium, vecuronium) |
| What needs to be done if a neuromuscular blocking agent is added and why? | Ventilatory support b/c it paralyzes the diaphragm |
Created by:
Sara2420
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