Use of total intravenous anaesthesia in Colombia: A national survey among active anaesthetists in Colombia
Introduction: The use of total intravenous anaesthesia (TIVA) has been growing worldwide over the past 20 years due to the creation of new drugs and the development of new target-controlled infusion pumps, many of which have already been approved in the United States by the FDA (Food and Drugs Administration), in Europe and in Colombia. However, the use of TIVA has not been expanded yet as part of routine practice.
Objective: To determine the frequency of TIVA use in our country and to identify existing barriers for its implementation.
Materials and methods: Survey designed to determine the use of TIVA in general anaesthesia practice in Colombia. A representative random sample of the universe of anaesthetists registered in the database of the Colombian Society of Anaesthesiology and Resuscitation (S.C.A.R.E.) was calculated. Reminders were sent by e-mail and some of the selected respondents were contacted by phone.
Results: Overall, 141 (32.4%) responses were obtained. The frequency of TIVA use was reported as Always, 7 (5.0%), Almost Always, 52 (36.9%), Hardly Ever, 57 (40.4%) and Never, 25 (17.7%). The techology used for TIVA administration included macro drip devices (n = 30, 21.3%), volumetric pumps (n = 76, 53.9%), TCI pumps (n = 45, 31.9%), and computer programmes (n = 9,6.4%). The limitations identified for the use of TIVA included low availability of anaesthesia depth monitoring (n = 68, 48.2%) and infusion pumps (n = 52, 36.9%), lack of experience (n =41, 29.1%), little availability of workshops (n = 26, 18.4%), low availability of medications (n = 23, 16.3%), fear of intra-operative recall (n = 22, 15.6%), limited knowledge of pharmacology (n = 18, 12.8%), increased anaesthesia time (n = 13, 9.2%), and perceived difficulty for performing the technique (n = 13, 9.2%).
Conclusions: The use of TIVA has been limited by the low availability of technology, lack of experience or knowledge among anaesthetists, and a preference for the balanced anaesthesia technique. Many anaesthesiologists prefer balanced techniques for general anaesthesia. Some devices used for TIVA administration raise concerns about patient safety.
2. Visser K, Hassink EA, Bonsel GJ, Moen J, Kalkman CJ. Randomized controlled trial of total intravenous anesthesia with propofol versus inhalation anesthesia with isoflurane-nitrous oxide: postoperative nausea with vomiting and economic analysis. Anesthesiology. 2001;95:616-26.
3. Chandler JR, Myers D, Mehta D, Whyte E, Groberman MK, Montgomery CJ, et al. Emergence delirium in children: a randomized trial to compare total intravenous anesthesia with propofol and remifentanil to inhalational sevoflurane anesthesia. Paediatr Anaesth. 2013;23:309-15.
4. Bajwa SJS, Bajwa SK, Kaur J. Comparison of two drug combinations in total intravenous anesthesia: propofol-ketamine and propofol-fentanyl. Saudi J Anaesth. 2010;4:72-9.
5. Pérez López DC, Rodríguez Sánchez G, Tovar Cuevas JR, Vanegas Saavedra A. Comparison of emergence and discharge times between two total intravenous anesthesia techniques: remifentanil and fentanyl. Rev Colomb Anestesiol. 2013;41:250-6.
6. Eikaas H, Raeder J. Total intravenous anaesthesia techniques for ambulator surgery. Curr Opin Anaesthesiol. 2009;22:725-9.
7. Lauder GR. Total intravenous anesthesia will supercede inhalational anesthesia in pediatric anesthetic practice. Paediatr Anaesth. 2015;25:52-64.
8. Wright PJ, Dundee JW. Attitudes to intravenous infusion anaesthesia. Anaesthesia. 1982;37:1209-13.
9. Passot S, Servin F, Allary R, Pascal J, Prades JM, Auboyer C, et al. Target-controlled versus manually-controlled infusion of propofol for direct laryngoscopy and bronchoscopy. Anesth Analg. 2002;94:1212-6.
10. Eysenbach G. Improving the quality of Web surveys: the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). J Med Internet Res. 2004;6:e34.
11. Kelley K, Clark B, Brown V, Sitzia J. Good practice in the conduct and reporting of survey research. Int J Qual Health Care. 2003;15:261-6.
12. Sahinovic MM, Absalom AR, Struys MM. Administration and monitoring of intravenous anesthetics. Curr Opin Anaesthesiol. 2010;23:734-40.
13. Rosero EB. La caracterización de la profundidad de la anestesia durante las infusiones controladas a objetivo: no es un trabajo fácil. Rev Colomb Anestesiol. 2016;44:187-9.
14. Echeverry PC, Gómez F. Anestesia total intravenosa. In: Jaramillo J, Echeverry PC, Gómez JM, editors. Tratado de Anestesia Pediatrica. Primera edición Bogotá: Editorial Sociedad Colombiana de Anestesiología y Reanimación; 2015. p. 768-85.
15. Laso LF, López-Picado A, Olea de la Fuente E, Mendiguren A, Sanchez-Castro C, Pipaon L, et al. Inducción con propofol: infusión controlada por objetivo o manual. Un estudio observacional. Rev Colomb Anestesiol. 2016;44:272-7.
16. Ramirez DE, Calvache JA. Diseño y evaluación del desempeño del algoritmo iTIVA para la administración manual de anestésicos intravenosos según objetivo en sitio efecto. Rev Colomb Anestesiol. 2016;44:105-13.
17. Pardo M. Anesthesia: how to organize and train our teachers. Anesthesiology. 2010;112:773-4.
18. Nora FS, Aguzzoli M, Oliveira Filho GR. Current attitude of anesthesiologists and anesthesiology residents regarding total intravenous anesthesia. Rev Bras Anestesiol. 2006;56:362-9.
19. Mosquera-Dussán OL, Cárdenas A, Botero-Rosas DA, Yepes A, Oliveros H, Henao R, et al. Randomized cross-over clinical trial comparing two pharmacokinetic models of propofol using entropy indices. Rev Colomb Anestesiol. 2016;44:194-202.
The publisher (Sociedad Colombiana de Anestesiología y Reanimación S.C.A.R.E.) retains copyright for the published articles.
Creative Commons License
Articles published by Colombian Journal of Anesthesiology are licensed under the Creative Commons 4.0 license: Attribution-NonCommercial-NoDerivs: CC BY-NC-ND.
This journal uses Crossref's Cited-By and Reference Linking, so that we can display the citations registered in Crossref here.
This document does not have Crossref citations yet.