Intravenous anaesthesia for thoracic procedures

Purpose of refresher course This refresher course reviews the rationale for using intravenous anaesthesia for thoracic operations and the drugs and equipment required. Recent findings Recent studies examining whether intravenous anaesthesia offers a physiological advantage over inhalational anaesthesia for thoracic surgery remain inconclusive. Nevertheless, intravenous anaesthesia is inarguably preferable for certain thoracic procedures incompatible with effective delivery of inhalational anaesthetics. Additionally, TIVA offers advantages in procedures conducted in non-ideal environments, such as offsite or austere scenarios. Summary TIVA is indicated for procedures in which inhalational anaesthetics may not be safely or effectively delivered, including endobronchial procedures using flexible or rigid bronchoscopy and proximal airway-disrupting surgeries. TIVA may also be beneficial in lung volume reduction surgery, lung transplantation, and thymectomy. In addition, TIVA is safer and more practical for thoracic procedures performed outside of the operating room, such as offsite locations, in the military field, or impoverished areas of the world. Propofol, dexmedetomidine, ketamine, and remifentanil may be used in combination with anaesthetic depth monitoring to execute an effective TIVA regimen. Target controlled infusion may improve the delivery of TIVA and is a focus for future research.