‘But I’m Used to MAC!’

doi:10.1017/9781316659069.010

Chapter 8 - ‘But I’m Used to MAC!’

How Do I Get the Dose Right with TIVA?

Published online by Cambridge University Press: 18 November 2019

Nicholas Peter Sutcliffe and

Michael G. Irwin

Edited by

Michael G. Irwin ,

Gordon T. C. Wong and

Shuk Wan Lam

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Michael G. Irwin: Affiliation:
The University of Hong Kong
Gordon T. C. Wong: Affiliation:
The University of Hong Kong
Shuk Wan Lam: Affiliation:
The University of Hong Kong

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Summary

The recent NAP 5 report in the UK showed that many of the cases of awareness associated with TIVA were due to poor technique and inadequate dosing.[1] In short, we don’t teach TIVA as well as we do inhalational anaesthesia. Yes, we have those occasional lectures and workshops built into our curriculum for trainees, covering pharmacokinetics/pharmacodynamics (PK/PD) and TIVA. However, trainees learn from watching their seniors from day to day in the operating room (OR). The vast majority of this training is gas based; it’s easy to use, everything is set up, the vaporiser is full and you’re ready to go as soon as you reach the OR. Why bother going to all the work of setting up for TIVA: surely that’s just for specialised cases? Thus our trainees are rarely exposed to TIVA and, in turn, become the gaseous trainers of the future. No wonder that when called upon to use TIVA in those circumstances where there is no alternative, even experienced anaesthetists can have difficulty. It’s often our trainees who are called upon to provide sedation for patients transferring between locations, or provide anaesthesia and sedation in remote sites without the infrastructure to support inhalational anaesthesia. These same trainees have often not learned TIVA in a practical way and are then struggling to remember, was it mg.kg−1.h−1, or µg.kg−1.min−1? How can we transfer the knowledge and skills that we have learned, over many years of passing the gas, to the art of TIVA?

Type: Chapter
Information: Taking on TIVA
Debunking Myths and Dispelling Misunderstandings
, pp. 52 - 62

DOI: https://doi.org/10.1017/9781316659069.010 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2019

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