Intravenous Anesthesia for Thoracic Procedures

Total intravenous anesthesia (TIVA) is indicated for procedures in which inhalational anesthetics 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. TIVA is safer and more practical for thoracic procedures performed outside of the operating room, such as off-site locations, military field, or impoverished areas of the world. Target-controlled infusion (TCI) is a relatively new delivery system for TIVA that is based on pharmacokinetic models to optimize intravenous anesthetic delivery. TCI has many advantages over conventional calculator pumps but is not currently available in the United States. Because well-established MAC-type systems for intravenous anesthetics are not available, anesthetic depth monitors are useful in monitoring patients undergoing TIVA. Propofol, dexmedetomidine, ketamine, lidocaine, and remifentanil may be used in combination with anesthetic depth monitoring to execute an effective TIVA regimen. This chapter reviews the balanced TIVA technique currently used at the University of Texas MD Anderson Cancer Center.