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Chapter 6 - Let’s Get Started

The Know-Hows and No-Hows of Setting Up TIVA

Published online by Cambridge University Press:  18 November 2019

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 arrival of versatile, easy-to-use, commercially available, target-controlled drug delivery systems have simplified TIVA making it as simple as using a vaporiser. Most have a choice of PK algorithms. The Marsh and Schnider models are the most commonly used for propofol and have various pros and cons. However, the important point about these models is that they can both make proportional changes in blood concentration allowing easy titration. New data is becoming available for more precise keo and PK that will improve accuracy – and therefore new models are likely to be developed. Remifentanil can also be administered with TCI using the Minto model but, as the pharmacokinetics are relatively simple, can also be delivered as an ordinary infusion (µg.kg−1.min−1). The use of these techniques is discussed elsewhere in the book so here we will concentrate on how to physically set up your TIVA system.

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