General anesthesia is a crucial aspect of modern medical procedures, ensuring patients undergo surgery comfortably and safely without feeling pain or discomfort. There are two primary modes of delivering general anesthesia: Total Intravenous Anesthesia (TIVA) and Inhalational Anesthesia. Each method has its own characteristics and benefits and is suited to different patient needs and surgical requirements.
Inhalational anesthesia involves administering anesthetic agents through inhalation, typically via a mask or a breathing tube inserted into the patient’s airway. The most common inhalational agents used are sevoflurane, isoflurane, and desflurane. These agents are gases or volatile liquids that patients breathe in. Once inhaled, the agents travel to the brain via the bloodstream and induce a state of unconsciousness. Throughout the surgery, the anesthesiologist maintains control over the depth of unconsciousness by continuously monitoring patients’ vital signs and making adjustments to anesthetic concentration.
Inhalational anesthesia is the more common mode of general anesthesia and is the standard of care in many situations. However, inhalational anesthesia may not be suitable for certain patients, such as those with certain respiratory conditions, a preference for avoiding inhalation of gases, or a history of reactions to inhalational anesthetics. It also requires specialized equipment to administer and monitor the concentration of anesthetic gases effectively. Depending on patient factors, available resources, and the anesthesiologist’s clinical judgement, OR teams can weigh the pros and cons of the two modes of general anesthesia.
Total Intravenous Anesthesia (TIVA), as the name suggests, involves administering anesthesia solely through intravenous (IV) medications. Unlike inhalational anesthesia, which relies on gases, TIVA utilizes a combination of intravenous drugs such as propofol, opioids (like fentanyl), and sometimes muscle relaxants (such as rocuronium) to achieve anesthesia. The anesthesiologist carefully adjusts the infusion rate of these medications to maintain the desired level of unconsciousness throughout the surgical procedure. TIVA offers precise control over anesthesia depth and can be advantageous in patients with respiratory issues or those for whom inhalational anesthetics are riskier.
Another significant benefit of TIVA is its potential to reduce the risk of postoperative nausea and vomiting compared to inhalational anesthesia. This makes it a preferred choice for patients who are prone to these side effects. However, TIVA requires continuous monitoring of the patient’s vital signs and drug levels to ensure proper anesthesia depth. The drugs used in TIVA can also take longer to clear from the body after surgery, potentially prolonging recovery times.
The choice between general anesthesia modes – TIVA and inhalational anesthesia — depends on various factors, including the patient’s medical history, the type of surgery, and preferences discussed between the patient and their anesthesiologist. Overall, both methods are safe and effective when administered by trained professionals in a controlled medical environment. While inhalational anesthesia offers rapid onset and recovery, TIVA provides precise control
and may reduce certain postoperative complications. Patients should feel confident discussing their options and preferences with their healthcare team to ensure a safe and comfortable surgical experience tailored to their individual needs.