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anesthesiativa (TIVA ** )

TIVA — total intravenous anesthesia

TIVA — Remifentanil / propofol infusions
  • Add appropriate amount of saline to a vial of remifentanil to make a 500 mcg per cc mixture
  • Put 500 mcg of the remifentanil mixture in 48 cc of propofol
  • This yields 10 mcg of remifentanil per cc in the syringe
  • Induce with a regular amount of propofol and fentanyl, and be sure to give midazolam also
  • Give 3-4 cc of the remifentanil-propofol mixture after induction
  • Start the infusion at 150 mcg/kg/min, and maintain that flow for 5 minutes
  • Slow the infusion to about 100 mcg/kg/min after 5 minutes
  • Titrate to vital signs
  • Bill runs 2-3% desflurane “just to be sure” on back cases
  • Recommended remifentanil rate is 0.15 to 0.2 mcg/kg/min
  • On the infusion pump, adjust the weight to change the anesthetic depth as opposed to using the m/k/m dial
  • Clark adds 50% N2O on his TIVA cases

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