1) Total intravenous anesthesia (TIVA) is an alternative to traditional general anesthesia that utilizes intravenous agents instead of inhalational gases. 2) A study compared outcomes of TIVA versus traditional general anesthesia for 150 patients undergoing shoulder arthroscopy in the beach chair position. 3) The study found that TIVA resulted in significantly faster recovery times, with no occurrences of postoperative nausea and vomiting compared to one occurrence in the general anesthesia group.

1. “Recent Advancements In Total Intravenous
Anaesthesia (TIVA) And Anaesthetic Pharmacology”
Presented By : Komal Chandrapaxi
M.Pharm (Pharmacology)
A
PRESENTATION ON

2. INTRODUCTION
PAGE 02
• Total intravenous anaesthesia (TIVA) is an advancement in the field of anaesthesia.
• An alternative approach to anaesthesia delivery by utilizing intravenous agents.
• An ideal drug for TIVA should have a rapid onset of action, rapid recovery, be potent and lipid soluble,
and be stable in solution.
• Patients undergoing TIVA have shown improved hemodynamic stability, reduced incidence of
postoperative complications, faster recovery, and enhanced Satisfaction compared to traditional
anaesthesia techniques.
• This technique has gained popularity due to its numerous advantages-
-Rapid onset and offset of anaesthesia.
- Precise control of anaesthetic depth.
- Improved hemodynamic stability, and potential for enhanced recovery.

3. PRINCIPLES
AND
MECHANISM OF TIVA
1 Intravenous Agents
2 Target-Controlled Infusion (TCI)
3 Pharmacokinetic Models
PAGE 03

4. INTRAVENOUS AGENTS :
Minimize the need
for volatile
inhalational agents.
Promotes opioid-
sparing anaesthesia.
Adjuvant medications,
Use to enhance
patient comfort.
PAGE 04
The commonly used intravenous agents
in TIVA include propofol, opioids,
and adjuvant medications.
Propofol : Act on
GABA, rapid
onset-offset of
action.

5. TARGET-CONTROLLED INFUSION (TCI) :
TCI allows for precise control and delivery
of intravenous agents based on individual
pharmacokinetic models.
This system
utilize computer
algorithms,
It also
individualize drug
administration &
optimize depth.
Parameters such
as- age, sex and
weight

6. CLOSED LOOP SYSTEMS ;
These systems use real-time monitoring of
patient variables, such as bispectral index (BIS)
or entropy.
The feedback loop
enables precise
control of
anaesthesia depth
Also known as
‘feedback control
system’
minimizing the
risk of under or
overdosing

7. NOVEL INTRAVENOUS
AGENTS IN (TIVA)
Remimazolam Dexmedetomidine Sugammadex
Intravenous
acetaminophen
PAGE 07
These agents offer unique
properties and applications,
enhancing the safety,
efficacy, and patient
experience during TIVA -

8. BENEFITS OF TIVA
TIVA offers several advantages over inhalational anaesthesia techniques -
PAGE 08
• Avoidance of inhaled agents reducing the risk of occupational exposure
• Precise control of anaesthetic depth helps to ensure patient stability during surgery.
• TIVA has been associated with a lower incidence of postoperative nausea and
vomiting(PONV) it a preferred option for patients prone to these complications

9. PAGE 09
ADVANCEMENTS IN TIVA TECHNIQUES AND EQUIPMENTS :
These advancements have improved TIVA's precision, safety, and efficacy,
improving patient outcomes and perioperative care.
Intraoperative Monitoring
Smart Infusion Pumps
Ultrasound-Guided Techniques
Integration of Electronic Medical Records (EMR)

10. EMERGING TRENDS IN ANAESTHETIC PHARMACOLOGY :
Anaesthetic pharmacology is a rapidly
evolving field continuously exploring new
approaches and agents to optimize
anaesthesia management.
Some of the key emerging trends in
anaesthetic pharmacology -
Opioid-Sparing Techniques
Pharmacogenomics-Based Dosing
Novel Analgesic Agents

11. “Total intravenous anesthesia compared to traditional
general anesthesia in shoulder arthroscopy with
interscalene block in the beach chair position”
AUTHORS : Lindsay Barrera, MDa,* , Behnam Sharareh, MDa , Poornima Tamma, BSb , Anup Shah, MD

12. AIM OF THIS STUDY
The purpose of this study is to determine if TIVA is superior to traditional GA
methods in terms of improving operating room(OR) effificiency, shortening
recovery time, and reducing adverse events while theoretically preserving cerebral
autoregulation in patients undergoing shoulder arthroscopy in the beach chair
position.

13. METHOD
150 total patients - 75patients went shoulder arthroscopy with TIVA
& 75patients went with traditional GA in beach chair position.
TIVA group received-ropivacaine, GA group patient received –
ropivacaine.
An unpaired t-test was performed to determine statistical
significance between the TIVA group and the GA group with
respect to the above variables
phase 1 and 2 post-anesthesia care, PONV, and readmission rates
were collected from the electronic medical.

14. RESULT
• Compared to GA, the patients who received TIVA had faster recovery times.
• The patients in the TIVA group had a significantly faster time in phase 1 recovery and
had a faster total recovery time.
• No patients developed PONV in the TIVA group, compared to 1 occurrence in the GA
group.

15. Phase 1 is defined as care focused on the patient’s recovery from
anesthesia and return to baseline vital signs, while the goal of phase 2 is
to prepare the patient to be transferred home or to an extended care
facility.

16. CONCLUSION
In conclusion, TIVA has significantly shorter recovery time and shorter time from
case finish to out-of-room compared to traditional GA. TIVA did not save time
from in-room to case start; however, this measure is highly variable. Larger scale
studies are needed to evaluate the risk of adverse events. Overall, this study
demonstrates that TIVA may be a safe and eficient alternative to GA in shoulder
arthroscopy in the beach chair position.