Total intravenous anaesthesia in children

SummaryThe use of total intravenous anaesthesia (TIVA) in children has become a popular technique for the induction and maintenance of anaesthesia following the introduction of newer short-acting drugs and more elaborate delivery systems. Advances in microprocessor technology and increased complexity of pharmacokinetic modelling have further refined TIVA to target controlled infusions (TCI). TCI delivery systems offer a continuously variable rate of intravenous drug administration, conferring advantages including greater haemodynamic stability, a stable depth of anaesthesia, and a rapid recovery with a low incidence of post-operative nausea and vomiting. This review will describe the development of TIVA and TCI for paediatric anaesthesia, the pharmacology of the common agents used, and possible future directions for the use of TIVA.