Update on TIVA.

Mehernoor Watcha, over 10 years ago, wrote an article for Current Opinion entitled ‘Intravenous anaesthesia for paediatric patients’ (1). The main focus of the article was on the agents suitable for intravenous (i.v.) anesthesia and in 10 years only one new drug has been added to the list, remifentanil. Propofol, the main feature of Watcha’s paper, still is not indicated for use in children <3 years old. It is difficult from the literature alone to assess the frequency of use of total intravenous anesthesia (TIVA) in pediatric anesthetic practice, but as a pure technique, it does not appear to be mainstream. In its simplest form and without elaborate delivery systems, all that is required is a syringe, a needle, respiratory management and monitoring, and this is widespread practice in simple short cases. With the introduction of more elaborate delivery systems such as the Diprafusor and Paedfusor and a deeper understanding of the pharmacological principles of the drugs used, the popularity of TIVA has advanced. Although i.v. anesthesia can be delivered by bolus, single or multiple, a continuous variable rate i.v. drug delivery system has advantages, among which include: • greater hemodynamic stability; • more stable depth of anesthesia; • more predictable and rapid recovery; • potential lower total dose of drug used; • less pollution and toxicity than incurred by volatile agents.