Making the move from gas to TIVA/TCI
Timely, precise and effective anaesthesia
Clinical challenges
Despite its widespread use, inhaled volatile anaesthesia or gas is considered a major risk factor for developing postoperative nausea and vomiting (PONV)1. When transferring patients anaesthetised with inhalation agents from the anaesthetic room to the operating room (OR), there is a risk of accidental awareness during general anaesthesia (AAGA) while administration is interrupted2. AAGA may result in mild to severe negative consequences for patients undergoing surgery3. Patients reported higher levels of postoperative pain following administration of inhaled anaesthesia then those who received total intravenous anaesthesia (TIVA)4,5.
Healthcare worker safety
Accidental exposure to waste anaesthetic gases when administering inhaled anaesthesia to patients may have a negative impact on your health6.
Environmental challenges
Gases from inhaled anaesthesia accumulate in the atmosphere, absorb radiation, re-emit it to Earth and contribute to global warming6.
Medication errors
The stressful and fast-paced environment of ORs may increase the rate of anaesthetic medication errors7. Manual infusion of TIVA may lead to dosing errors if the pharmacokinetics are not calculated correctly8. Insufficient dosing of anaesthetic medication is thought to be a principal cause of AAGA3.
OR turnover times
Excessive OR turnover times may result in decreased patient satisfaction, overtime staffing costs, and wasted opportunity costs for potential revenue9. OR turnover time partly depends on post-anaesthesia care unit (PACU) availability. If staff or beds aren’t ready when the surgical procedure is terminated, the patient is obliged to wait in the operating room9. When compared with TIVA, inhaled anaesthesia may result in slower recovery times5.
Supply issues
Medication delivery supply issues, such as stockouts, backorders or expired products may contribute to medication administration errors10.
20–30%
Of surgical patients experience PONV following general anaesthesia1
0.75%
Is the average estimated rate of anaesthetic medication errors7
35%
Of surgical nurses’ work time is spent on documentation compared with 20% for direct patient care11
Discovering the advantages of TIVA/TCI
Maintenance of anaesthesia using total intravenous anaesthesia (TIVA) with target-controlled infusion (TCI) is well-established in clinical practice and has several potential advantages over inhaled volatile anaesthesia4. The development of novel TCI models allows you to achieve anaesthetic precision in patients with a range of ages and weights12,13.
Clinical benefits
When compared with gas, TIVA/TCI may:
- Reduce PONV6
- Improve neuromonitoring during surgery14
- Lower postoperative pain4,5
Medication safety
Each TCI model adapts the dose using the patient's biometric and/or pharmacokinetic data12. An algorithm adjusts the infusion to meet target drug concentrations12. With TIVA/TCI, there is less risk of underdosing the patient15.
Workflow efficiency
Replacing inhaled anaesthesia with TIVA may result in faster recovery times4, leading to earlier discharge and increased patient satisfaction5.
Inventory management
Improvements in supply chain management can significantly lower unnecessary costs and waste in the OR9.
New models for TCI—meet the developers!
In this webinar, the scientists who created the Eleveld models explained how they developed these models and why they are a game-changer for TCI.
Prof. Dr. Michel M. R. F. Struys
Dr. Laura N. Hannivoort
Dr. Douglas J. Eleveld
University Medical Center Groningen, The Netherlands
TCI anaesthesia: new and more universal models
TCI is an established technique for anaesthesia. The new Eleveld models for propofol and remifentanil, and the new model for dexmedetomidine are significant additions to the technique.
Natalie Samuda, Senior Clinical Resource Consultant, BD
Dr. James Waterson, Medical Affairs Manager, Middle East & Africa, BD
Bringing you connected medication management for anaesthesia
Designed by anaesthetists for anaesthetists
BD offers anaesthetists and nurse anaesthetists like you a comprehensive range of solutions that can help:
- Enhance clinical outcomes4,5,6,14
- Promote patient safety
- Increase medication safety12,15
- Improve workflow efficiency4,5
- Optimise inventory management9
BD Alaris™ neXus PK Syringe Pump
Latest TCI drug models
- Propofol (Eleveld)16
- Remifentanil (Eleveld)17
- Dexmedetomidine (Hannivoort-Colin)18
- Remifentanil (Kim-Obara-Egan) (for obese patients)19
Patient safety features
- Easily differentiate between anaesthetic drugs when a pump is programmed
- Patented technology: automatic weight-height default parameter adjustment based on the patient's age
Simplified drug setup
- With a user-friendly interface and large display showing all critical infusion data at a glance
- Unique visual identification of propofol
BD Alaris™ neXus Solution
Help to simplify the infusion experience through award-winning IT1 and connectivity solutions.
Wi-Fi enabled IV medication safety systems for all care areas in hospitals:
- Designed to help prevent medications errors2-4
- Whilst simplifying the process to release time for care and improve workflow efficiency5
With the overall BD Alaris™ neXus Infusion Solutions and BD Alaris™ Communication Engine (ACE), you can benefit from:
- Automated transfer of datasets to pumps over the hospital network during infusion
- Continuous collection of pump log events and continuous quality improvement (CQI) data
- Remote and central visualisation of infusions and asset management (asset tracking)
- Infusion data documentation into patient data management system flow sheets
BD Alaris™ Guardrails™ Safety Software
Our BD Alaris™ neXus Pumps use unique BD Alaris™ Guardrails™ Safety Software, which provides safety limits for each drug by care area, promoting safe delivery of IV medication.
It can help reduce IV medication errors, improve the overall quality of patient care, track and measure system performance and help increase compliance with national safety standards. It can help you deliver the right medicine with the right dose at the right concentration for safe medication management and administration.
With BD Alaris™ neXus Solutions we are addressing your key concerns when it comes to IV administration.
BD TIVA Administration Sets
Specifically designed for use with TCI pumps8, these sets help ensure the patient receives:
- A more predictable onset of drugs4
- Greater accuracy and ease of maintenance
- A more predictable offset of drugs8
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