Total intravenous anaesthesia: Practices and training in an anaesthesiology department

Abstract

Background: Total intravenous anaesthesia (TIVA) provides an alternative to the classic volatile based anaesthetic, with a number of clinical benefits. Volatile anaesthesia has dominated general anaesthesia practices, despite improvements in intravenous agents and drug delivery systems for TIVA. This study aimed to describe the practices and training of anaesthetists in TIVA, in the Department of Anaesthesiology at the University of the Witwatersrand. Methods: A prospective, contextual, descriptive study was undertaken, using a self-administered questionnaire. Results: One hundred and fifty three questionnaires were completed, representing 73.6% of the department. TIVA usage was infrequent, with 67.3% of participants using it <10 times in the past year. Conversely, 88.9% reported that they would like to use TIVA more often. Of the participants, 56.9% experienced a situation where TIVA would have been ideal, but they lacked confidence in its use. Target controlled infusion was preferred by 78.4% of participants for TIVA administration. TIVA was viewed as advantageous over volatile anaesthesia in malignant hyperthermia (98.7%), to reduce postoperative nausea and vomiting (86.9%) and decrease environmental pollution (89.5%). The unavailability of depth of anaesthesia monitors was the greatest obstacle to TIVA use, reported by 85%. Only 24% perceived their training in TIVA as adequate. Conclusion: TIVA usage was infrequent and participants lack confidence in its administration. TIVA is an important skill in the armamentarium of an anaesthetist and improving training should be prioritised