Blog

Why Total Intravenous Anaesthesia (TIVA) An overview on aspects of patient outcome, oncology, and the environment. Nick Sutcliffe Friday 19 January 8:30-9:00 Introduction The safety of surgery under anaesthesia has improved markedly over the last century. New drugs and improved equipment have resulted in more accurate dosing and reduced side effects. As mortality has improved, focus has shifted to also include non-lethal postoperative complications such as nausea, vomiting, pain, and cognitive dysfunction. Similarly, it is no longer sufficient to consider only immediate survival after surgery, but also longer-term issues such as cancer recurrence, quality of life and cognitive decline following surgery under anaesthesia.  Propofol based TIVA has several potential advantages over volatile based anaesthesia (VBA), for both the patient and operating room staff, as well as environmental benefits. Evidence is accumulating to support the use of TIVA over VBA, in terms of improved patient outcomes, less toxicity in the local environment and less effect on the global environment relating to

Multimodal anesthesia and multimodal sedation: is two times one more than two? Francisco Lobo Friday 19 January 10:30-11:00 The state of General Anesthesia comprises unconsciousness, amnesia, analgesia/antinociception and immobility accompanied by physiological stability. Classically, this drug-induced reversible state has been achieved with the use of basic interactions between hypnotic drugs, opioids and muscular relaxants; the current balanced general anesthesia is  usually based on an hypnotic drug for induction, volatile agent of intravenous drug for maintenance and opioids administered by boluses or as an infusion while muscle relaxation and paralysis may be achieved with the interaction between these drugs or supplemented by muscle relaxants. A new paradigm has been suggested involving more drugs than this basic triple cocktail. This multimodal general anesthesia approach is based on the ideas that: additional drugs acting in multiple neuronal pathways by different mechanisms may contribute to optimize the nociception-antinociception balance; the synergic and additive interactions between  different drugs at lower doses will decrease the side

time Friday 19 January presenter 08:00-8:15 Registration 08:15-08:30 Chairmans welcome, introduction and practical issues Alain Borgeat 08:30-09:00 Why TIVA? An overview on aspects of patient outcome, oncology, and the environment. Nick Sutcliffe 09:00-09:30 The Eleveld model dissected Extended in the afternoon workshop Hugo Vereecke 09:30-10:00 With a hammer everything looks like a nail How to use the tivatrainer? Frank Engbers 10:00-10:30 Coffee break 10:30-11:00 Multimodal anaesthesia and multimodal sedation: is two times one more than two? Francisco Lobo 11:00-11:20 Patient maintained sedation Smart pharmacologic concepts beyond the OR Gavin Kenny 11:20-12:00 Collected questions from attending and on-line participants and possible answers Faculty 12:00-17:00 Snow and sweat, up and down All Skiers Present 15:00-16:30 Workshop on-line: my first TIVA/TCI do’s and don’ts when beginning with TIVA/TCI I.e.: infusion line handling,TCI setup and control,drug and model selection,titrate with and without TCI Frank Engbers + NSF(Non Skiing Faculty) 17:00-18:30 workshops:Basic Pk ;Deep dive into the Eleveld model; Train the trainer. Faculty time Saturday

The Eleveld model dissected Prof. Dr. Hugo Vereecke, University of Groningen, The Netherlands Friday 19 January 9:00-9:30 In 2018, Douglas Eleveld, from the University of Groningen,  published a new PKPD model for propofol based on the “open TCI initiative” database.1 This database, initiated by S. Shafer and C. Minto, combined a large amount of raw data derived from previously published studies on the PKPD of propofol, remifentanil and some other drugs. By combining these  globally acquired data, including several  demographic subgroups of people, Eleveld developed a so called “general purpose” model for propofol,  a single PKPD model that can adjust the propofol administration towards predictable results in all types of patients, including lean and obese adults, elderly and children. As even the largest database may contain limited information on rare demographic characteristics, the model also incorporates mathematical solutions to avoid extreme deviations of drug administration in such patients. The first prospective validation studies reveal promising results.2 However, when switching from one TCI

Patient-Maintained Sedation Smart pharmacologic concepts beyond the OR Gavin NC Kenny Friday 19 January 11:00-11:30 Conscious sedation allows patients to undergo procedures which they would otherwise be unable to tolerate. The sedation must not contribute any morbidity or mortality to the procedure and ideally should be safe when used by surgeons and physicians as well as anaesthetists. Satisfactory sedation has been reported with TCI propofol in patients undergoing upper gastrointestinal endoscopy and surgery under regional blockade. Patient-maintained sedation (PMS) allows the patient to control the target concentration of propofol using a button push. Studies suggest that this provides rapid, safe and effective relief of anxiety. The requirement was to develop a system which cannot allow the patient to overdose. Recent studies demonstrated the feasibility of using degradation in patient reaction time as a control function. The use of reaction time to control the target concentration of propofol may increase the margin of safety during sedation. With more procedures being undertaken using

Multimodal monitoring to guide TIVA:more windows more light? Luc Barvais MD, PhD1 and Sean Coeckelenbergh, MD2 Saturday 20 January 8:30-9:00 Erasme University Hospital, Brussels Paul Brousse Hospital, Paris Improving TIVA by personalizing monitoring TCI titration is very important in the daily clinical anaesthesia practice to decrease the risk of agitation and sometimes delirium in the postoperative period which could be associated with postoperative cognitive dysfunction.  The aim of new TCI techniques is to get perfect recovery with patients walking rapidly after moderate to major surgery without any mental alteration. In an international survey published in 2022, the rate of responses was essentially in Europe with 255 respondents in Western Europe, 96 respondents in Southern Europe and 76 respondents in Eastern Europe (1).  The majority of respondents considered anaesthetic depth monitoring EEG either always or on most occasions important while a majority never or occasionally found antinociception monitoring important with a statistically significant difference.  The respondents use EEG monitoring more often during

Measuring online exhaled propofol: – feasible, useful, the future of TIVA, or a toy from the industry? Johan Raeder1,2 Saturday  9:30- 10:00 Co-Authors: Martin Rygh Braathen1,2,  Ivan Rimstad2, Terje Dybvik2 Ståle Nygård3 1 Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway 2Dept. of Anaesthesiology, Division of Critical Care, Oslo University Hospital, Oslo, Norway 3 Dept. of Informatics, Faculty of Mathematics and Natural Sciences, University of Oslo. Oslo Centre for Biostatistics and Epidemiology, University of Oslo, Oslo, Norway Background/Introduction: Ion Mobility Spectrometry (IMS) allows for online quantification of exhaled propofol concentrations. The concentrations are extremely low (parts per billion!) and the technology has so far been very cumbersome and only used for research purposes. Recently a commercial bedside online IMS device, the Edmon®, were developed for predicting plasma concentrations of propofol in everyday OR practice. We got the opportunity to test this device in a series of gastrosurgical patients (normal weigt and obese) and children, by comparing exhaled propofol with plasma

With a Hammer everything looks like a Nail How to use Tivatrainer Frank Engbers Friday 19 January 9:00-9:30 Initially, pharmacokinetic models were developed in pharmacological research to elucidate and forecast the temporal profile of drug concentrations upon administration to the body. The utilization of these models in Target Controlled Infusion pumps involves reverse engineering them to eliminate the time component in dosing. Throughout the evolution of Target Controlled Infusion techniques, I believe that the significance of the virtual blood or effect site concentration has been somewhat overestimated, leading to chaotic and uncontrolled implementation in commercial infusion pumps. This is evident through various implementations of the same drug model, different models for the same drug, extrapolation of patient data to inexplicable extremes, the ongoing challenge of determining the correct blood brain equilibration delay and its impact on induction dosage, as well as references to publications that cannot be traced. Tivatrainer was developed several years ago to educate healthcare professionals on IV