Taiwan Society of AnesthesiologistsShared Decision Making Series

Reviewed by Prof. Ting Hsiao-Hsien, Prof. Chen Chia-Wen, Prof. Chang Chuen-Chau.

August,2019 Version

TIVA Gas Anesthesia

TIVA Gas Anesthesia

40%

30%

20%

0%

50%

Klazina Visser, et al. Randomized Controlled Trial of Total Intravenous Anesthesia with Propofol versus Inhalation Anesthesia with Isoflurane–Nitrous Oxide: Postoperative Nausea and Vomiting and Economic Analysis. Anesthesiology 9 2001, Vol.95, 616-626

TOTAL INTRAVENOUS ANESTHESIA (TIVA)

VS. VOLATILE GAS ANESTHETICS

20%

15%

10%

5%

0%

25%

22%

5%

10%

VOMITING UPON PACU DISCHARGE

18%

40%

What You Should KnowAbout PostoperativeNausea & Vomiting

(PONV)

AM I AT HIGH RISK FOR POSTOPERATIVE NAUSEA &

VOMITING ?

○ Patient Factors ○ Female

○ Age < 50 years

○ Non-smoker

○ Motion sickness

○ History of Postoperative Nausea and Vomiting

○ Surgical Factors ○ Gynecological Operations

○ Cholecystectomies

○ Laparoscopic Operations

○ Extended Operations > 1 hour

○ Anesthesia Factors ○ General Anesthesia

○ Volatile Anesthetics

○ Postoperative opiod use

Please contact your anesthesia team for further information!

NAUSEA UPON PACU DISCHARGE

22% Reduction

17% Reduction

Taiwan Societyof Anesthesiologists

An estimated 50% of patients complain of post-operative nausea, and 30% experience vomit-ing. These not only cause a lot of anxiety and distress in patients, but also prolongs hospital-ization length and increases medical costs.

Postoperative Nausea and Vomiting (PONV) is Common after General Anesthesia

Anesthesia planning to lower PONV risks

Target Controlled Infusion of Total Intravenous Anesthesia (TIVA)

Under guidance of anesthesia depth monitor, computer controlled infusion pump administers propofol to reach target levels in the blood or brain.

American Society ofTMAnesthesiologists

Strategies with high evidence levelsRegional anesthesia when possibleAvoidance of volatile gas anestheticsUse of propofol for induction andmaintenance of anesthesiaAdequate hydrationProphylactic administration of antiemeticsMinimization of postoperative opioids

100%

80%

60%

40%

20%

0%0 1 2 3 4

TIVA vs. Inhalation Anesthesia

Patients at High Risk for PONVPONV risks can be as high as 80%

in patients with multiple risks factors

Risk factorsFemale gender

Nonsmoker

History of PONV

Postoperative opioids

1

1

1

1

0-4

Points

Risk score=

50%Post-OPNausea

30%Post-OPVomiting

PON

V risk

No. of risk factors

Specialist’s Recommendations

Volatile gas Anesthetics

Manual adjustment

Gas analysis

Low Incidence

Higher Risk

Higher Risk

More

Agent

Administration

Monitoring

Malignant Hyperthermia

Postoperative Nausea

Postoperative Vomiting

Residual Anesthetics

Propofol TIVA results in a reduction of PONV, and increases patient comfort.

Propofol used as part of TIVA is recommended to reduce baseline risk for PONV.

WIN

WIN

WIN

WIN

Intravenous propofol

Computer controlled infusion

Anesthesia Depth Monitor

Does Not Occur

Lower Risk

Lower Risk

Less

Total Intravenous Anesthesia (TIVA)

InhalationAnesthesia

These problems are preventable!