Abstract

TAFUR, Luis Alberto  and  LEMA, Eduardo. Total Intravenous Anesthesia: from Pharmaceutics to Pharmacokinetics. Rev. colomb. anestesiol. [online]. 2010, vol.38, n.2, pp.215-231. ISSN 0120-3347.

Introduction. The availability of medications such as remifentanyl and propofol has made anesthesiologists feel the need to understand the basics of total intravenous anesthesia (TIVA). In fact. beyond knowing how to develop a pharmacokinetic model, it is essential to differentiate among the pharmaceutical, pharmacokinetic and pharmacodynamic approach for administering a particular drug. Objective. To review the basic concepts the modern anesthesiologist needs for the pharmacokinetic administration of the drugs used for intravenous anesthesia. Methodology. A search of the indexed literature was done to identify educational and illustrative articles about total intravenous anesthesia concepts and pharmacokinetics. The most relevant articles were selected for this review and it was supplemented with anesthesia textbooks in the guearea of pharmacokinetics and total intravenous anesthesia. Results. 51 articles and 5 chapters from textbooks on anesthesia were selected. Regardless of the instruments used or how accurate they may be, what is really important is knowing that we have the tools available and based on the estimated plasma levels, we can adjust the anesthesia to the different stages of the surgical procedure; in the case of remifentanyl, it can be adjusted to the specific conditions such as the age of the patient. The point is that the anesthesiologist has to evolve keeping pace with the increasingly more predictable drugs now available and with the possibility of achieving a safer, more predictable and costeffective anesthesia with greater control both by the experienced professional and the trainee.

Keywords : Intravenous anesthesia; remifentanyl; propofol; infusion pump; nomograms.

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