Advantages and Safety of Total Intravenous Anesthesia (TIVA) for outpatient procedures.

For anyone planning elective plastic surgery, one of the biggest decisions involves the type of anesthesia that will be used. Depending upon which cosmetic procedure is being planned, the plastic surgeon will make a recommendation about anesthesia, based upon the length of the surgical procedure, patient's overall health, which body part is involved, and his or her preference and experience. General anesthesia is often recommended for outpatient cosmetic surgery.

What is TIVA?

 

TIVA is a type of general anesthesia, which uses IV (intravenous) anesthetic drugs only. This means that TIVA (Total Intravenous Anesthesia) involves placing a needle into a vein, typically in the back of the patient's hand. Throughout the surgery, the needle continually injects just the right dosage of medication(s) required to keep the patient asleep and pain-free.

When TIVA is used, the dosage of anesthetic medication is computer-controlled (with target-controlled infusion or TCI), adjusted and monitored throughout the surgery to maintain the utmost level of patient safety. The computer doesn’t act alone however. TIVA patients can rest assured that their trusted medical team, including an anesthesiologist or nurse anesthetist, is also monitoring their vital signs and welfare during the surgical procedure.

What Other Types of Anesthesia Exist?

 

TIVA is a more precise alternative to other general anesthesia methods. Other methods deliver anesthetic medications via inhalation or using a combination approach of inhaled drugs and IV anesthetics. In these cases, an anesthesiologist or nurse anesthetist monitors the patient and makes adjustments during surgery.  

When general anesthesia is not needed, lesser methods like IV sedation can be used, when the patient is not completely unconscious. (However, patients are unaware and pain-free during surgery. Under IV sedation, patients cannot generally remember what happened during surgery, or immediately before and after, once the medication wears off.) 

Local anesthesia, used for minor procedures, numbs the operative region only via a single injection, which may be repeated if necessary during treatment, while the patient remains awake and aware throughout. 

TIVA Advantages in Outpatient Plastic Surgery

 

Although general anesthesia of any type is considered safe when administered by a certified and experienced medical professional, TIVA can offer distinct advantages for the patient, including: 

• Precise control of medications and dosage for a safe and painless procedure.
• Less chance of post-op nausea. Nausea after inhaled or combination general anesthesia is very common and often stems from the patient receiving too much medication during surgery. Nausea is rare after TIVA because precision computer control of the medication throughout the entire surgery ensures the patient receives just the right dosage every second of surgery. Proper, optimised anesthetic dosages are given with TIVA's computerized delivery system.
• Avoids sore throat, hoarseness and vocal cord irritation from inhaled general anesthesia.
• Quicker wakeup after surgery, which can mean less grogginess for a shorter time and less expense. 
• Possibly less expense. TIVA often means less time in the recovery room, as mentioned. In some cases, patients experiencing severe side effects from inhaled or combo, non-TIVA, general anesthesia end up in hospital overnight. This is expansive, uncomfortable and may add risk--exposing patients needlessly to hospital infections.

Patients considering elective plastic surgeries, such as a facelift with blepharoplasty (eyelid surgery), breast augmentation, lifting or reduction, rhinoplasty (nasal surgery or nose job), etc., should ask their surgeon about TIVA. Taking an active role in planning surgery, including selecting an experienced surgeon and making informed anesthesia choices, helps ensure your comfort, wellbeing and a successful surgical outcome. 

Important: All general anesthesia carries risk and TIVA may not be appropriate in every case for every patient. Be sure to consult a well-qualified and experienced plastic surgeon.