Total intravenous anaesthesia (TIVA) use is becoming increasingly popular for a number of reasons, including quality of patient recovery, the possibility of an impact on cancer recurrence and environmental sustainability 1. However, the 5th UK National Audit Project NAP5 reported an association between TIVA and increased risk of accidental awareness during general anaesthesia (AAGA) 2. This risk occurs because pharmacological monitoring of drug delivery to the patient is not possible with TIVA, as it is for volatile anaesthetics. This means anaesthetists may be unaware of technical problems with drug delivery including accidental disconnection or displacement of the intravenous (i.v.) line. Three current guidelines recommend that the i.v. access site should be visible ‘where practical’ when TIVA is used; the Association of Anaesthetists minimum monitoring guidelines 3; the NAP5 report 2; and the Association of Anaesthetists/Society of Intravenous Anaesthesia TIVA guidelines 4. These publications also recommend processed EEG ‘depth of anaesthesia’ monitoring when TIVA is used with a neuromuscular blocking (NMB) drug and the TIVA guidelines recommend a lower threshold for its use when the i.v. access site is not continuously visible.
Reference:Davies, A., Corbett, L., Kelly, F.E. and Cook, T.M. (2020) An audit of intravenous access visibility and bispectral (BIS) use during total intravenous anaesthesia. Are we compliant with guidelines? Anaesthesia. 75(3), p.411-412. doi: 10.1111/anae.14954.