Circulation 94,429 • Volume 27, No. 1 • Summer-Spring 2012   Issue PDF

Should Inhalational Anesthesia Capability Be Required as Backup for TIVA?

Stefan Strömberg

A Dear Q&A,

From a patient safety perspective, do you consider it necessary to be able to switch to vaporizer-based inhalational anesthesia during TIVA, e.g., in case of an infusion line disconnect or would it be sufficient with anesthesia equipment for performing TIVA only in, e.g., an ambulatory anesthesia setting?

Stefan Strömberg
Sigtuna, Sweden

Dear Reader,

  1. If the primary concern is a patient who loses his/her IV and for whatever reason another one cannot be started in time before the patient awakens, the choice is an anesthesia machine with a vaporizer (e.g., sevoflurane), especially if the patient has received neuromuscular blocking agents.
  2. If the IV is lost (pulled out or infiltrated) and another can be started easily and quickly, there is no need for a vaporizer.
  3. If the pump fails it should be easy to administer agent with a syringe while another working pump is setup and turned on.
  4. If the pump tubing fails, again a syringe could be connected to the IV cannula and used to bolus the agent until the tubing can be replaced and the pump restarted.

This is the safety issue (not the vaporizer): In all cases there should be a correctly sized self- inflating breathing bag with appropriate sizes of masks and an oxygen tank to which it can be connected, immediately available in the room with the patient.

Under ideal circumstances an anesthesia machine with ASA monitoring should be available everywhere an anesthetist or anesthesiologist will deliver anesthesia care to the patient.

If this is an area where non-anesthesia personnel will be sedating patients, the self-inflating bag and oxygen tank must be present. An anesthesia machine and vaporizer will be of little value.

The APSF Committee on Technology

Numerous questions to the Committee on Technology are individually and quickly answered each quarter by knowledgeable committee members. Many of those responses would be of value to the general readership, but are not suitable for the Dear SIRS column. Therefore, we have created this simple column to address the needs of our readership.

The information provided is for safety-related educational purposes only, and does not constitute medical or legal advice. Individual or group responses are only commentary, provided for purposes of education or discussion, and are neither statements of advice nor the opinions of the APSF. It is not the intention of the APSF to provide specific medical or legal advice or to endorse any specific views or recommendations in response to the inquiries posted. In no event shall the APSF be responsible or liable, directly or indirectly, for any damage or loss caused or alleged to be caused by or in connection with the reliance on any such information.