Total intravenous anaesthesia: a survey of practices and training at an anaesthesiology department

Abstract

Background: Total intravenous anaesthesia (TIVA) provides an alternative to the classic volatile agent-based anaesthetic, with several clinical benefits. Volatile agent-based 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 at the Department of Anaesthesiology at the University of the Witwatersrand.
Methods: A prospective, cross-sectional study was undertaken using a self-administered questionnaire.
Results: In total, 153 questionnaires were completed, representing 73.6% of anaesthetists in the department. TIVA was infrequently used; 67.3% of participants reported using it < 10 times during the past year. Conversely, 88.9% of participants reported that they would like to use TIVA more often. Significantly more juniors than seniors performed ≥ 10 TIVAs during the past year (p < 0.0001). Of the participants, 56.9% experienced a situation where TIVA would have been ideal, but they lacked the confidence to use it. Anaesthetists who had performed ≥ 10 TIVAs were not significantly more confident in its use (p = 0.059). Seniors were significantly less deterred by a lack of understanding of the pharmacology of TIVA as an obstacle to TIVA use, compared to juniors (p < 0.0001). Target-controlled infusion (TCI) was preferred by 78.4% of participants for the administration of TIVA. TIVA was viewed as advantageous over volatile agent-based anaesthesia in malignant hyperthermia (98.7%), to reduce postoperative nausea and vomiting (86.9%) and to decrease environmental pollution (89.5%). The lack of availability of depth of anaesthesia monitors was the greatest obstacle to TIVA use, reported by 85% of participants. Only 24% of participants perceived their training in TIVA as adequate.
Conclusion: TIVA usage was infrequent and participants lacked confidence in its administration. TIVA is an important skill in the armamentarium of an anaesthetist and, therefore, improved training should be prioritised.