TIVA; anaesthetic techniques; peri-operative anaesthesia; total intravenous anaesthesia; volatile anaesthesia; General Medicine
Abstract :
[en] Introduction: The use of total intravenous anaesthesia (TIVA) has been well established as an anaesthetic technique over the last few decades. Significant variation in practice exists however, and volatile agents are still commonly used. This study aims to determine the motivations and barriers for using TIVA over the use of volatile agents by analysing the opinion of several international anaesthetists with specific expertise or interests. Methods and participants: The Delphi method was used to gain the opinions of expert panellists with a range of anaesthetic subspecialty expertise. Twenty-nine panellists were invited to complete three survey rounds containing statements regarding the use of TIVA. Anonymised data were captured through the software REDCap and analysed for consensus and prioritisation across statements. Starting with 12 statements, strong consensus was defined as ≥75% agreement. Stability was assessed between rounds. Results: Strong consensus was achieved for four statements regarding considerations for the use of TIVA. These statements addressed whether TIVA is useful in paediatric anaesthesia, the importance of TIVA in reducing the incidence of postoperative nausea and vomiting, its positive impact on the environment and effect on patient physiology, such as airway and haemodynamic control. Conclusions: Using the Delphi method, this international consensus showed that cost, lack of familiarity or training and the risk of delayed emergence are not considered obstacles to TIVA use. It appears, instead, that the primary motivations for its adoption are the impact of TIVA on patient experience, especially in paediatrics, and the benefit to the overall procedure outcome. The effect of TIVA on postoperative nausea and vomiting and patient physiology, as well as improving its availability in paediatrics were considered as priorities. We also identified areas where the debate remains open, generating new research questions on geographical variation and the potential impact of local availability of monitoring equipment.
Disciplines :
Anesthesia & intensive care
Author, co-author :
Uitenbosch, Giulia; School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen AB25 2ZD, UK
Sng, Daniel; School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen AB25 2ZD, UK
Carvalho, Hugo N ; Anesthesiology and Perioperative Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, 1090 Brussels, Belgium
Cata, Juan P; Department of Anesthesiology and Perioperative Medicine, Division of Anesthesiology, Critical Care, and Pain Medicine, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
De Boer, Hans D ; Department of Anesthesiology, Pain Medicine and Procedural Sedation and Analgesia, Martini General Hospital, 9728 NT Groningen, The Netherlands
Erdoes, Gabor ; University Department of Anaesthesiology and Pain Medicine, Inselspital, University Hospital Bern, University of Bern, 3010 Bern, Switzerland
Heytens, Luc; Departments of Anesthesiology and Neurology, University Hospital Antwerp, 2650 Edegem, Belgium ; Malignant Hyperthermia Research Unit, Born Bunge Institute, University of Antwerp, 2000 Antwerpen, Belgium
Lois, Fernande ; Centre Hospitalier Universitaire de Liège - CHU > > Service d'anesthésie - réanimation
ROUSSEAU, Anne-Françoise ; Centre Hospitalier Universitaire de Liège - CHU > > Service des soins intensifs
Pelosi, Paolo; Anaesthesia and Critical Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy ; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
Forget, Patrice ; Department of Anaesthesia, NHS Grampian, Aberdeen AB25 2ZD, UK ; Epidemiology Group, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen AB25 2ZD, UK
Nesvadba, David; Department of Anaesthesia, NHS Grampian, Aberdeen AB25 2ZD, UK
Language :
English
Title :
Expert Multinational Consensus Statement for Total Intravenous Anaesthesia (TIVA) Using the Delphi Method.
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