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
Gidac
Sigtuna, Sweden


A
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.


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