Total Intravenous Anesthesia (TIVA) and Target Controlled Infusions (TCI) in Children

Abstract

Total intravenous anesthesia is increasingly used in children and in some situations is mandatory, for example in the child with malignant hyperthermia susceptibility. Propofol is most often used, either alone or concurrently with an opioid infusion. Pediatric dosing regimens have been calculated in small populations of healthy children and act as a guide for administration. Manual infusion schemes can be used quite effectively using conventional syringe drivers. Specifically programmed syringe drivers enable more careful titration to an estimated target concentration in blood or at the effect site using algorithms based upon pediatric pharmacokinetic data (target controlled infusion). In the future, more precise dosing and titration will be aided by near-real-time propofol analysis in blood or exhaled gases and further refinement of depth of anesthesia monitoring in children.