A Comparison of Inhaled Anesthesia and Total Intravenous Anesthesia with Target-Controlled Infusion for Neuroanesthesia

  • Pablo O. Sepúlveda V.
  • Francisco A. Lobo


This chapter compares anesthetic outcomes following the administration of volatile or intravenous agents in daily neuroanesthesiology practice. We also provide state-of-art understanding of the role of intravenous anesthetics as neuroprotectants. Intravenous drugs have demonstrated to be more specific for each component in anesthesia. Target-controlled infusion (TCI) has shown more flexibility and gives more precision in the administration form of the drugs. Finally, we summarize concept of target-controlled infusion (TCI) and the most used intravenous drugs to improve the act of titration and individualizing the requirement of each patient. Combination of adequate drugs and titration are the advantage of the TIVA-TCI technique to contribute to prevent postoperative cognitive dysfunction and delirium and optimize brain homeostasis.


Total intravenous anesthesia Bispectral index Processed EEG Remifentanil Dexmedetomidine 

Suggested Reading

  1. Bilotta F, Stazi E, Zlotnik A, Gruenbaum SE, Rosa G. Neuroprotective effects of intravenous anesthetics: a new critical perspective. Curr Pharm Des. 2014;20(34):5469–75.CrossRefGoogle Scholar
  2. Chui J, Mariappan R, Mehta J, Manninen P, Venkatraghavan L. Comparison of propofol and volatile agents for maintenance of anaesthesia during elective craniotomy procedures: systematic review and meta-analysis. Can J Anaesth. 2014;61(4):347–56. Epub 2014 Jan 31CrossRefGoogle Scholar
  3. Fritz B, Kalarickal PL, Maybrier HR, Muench MR, Dearth D, Chen Y, Escallier K, Avidan MS. Intraoperative electroencephalogram suppression predicts postoperative delirium. Anesth Analg. 2016;1:234–42.CrossRefGoogle Scholar
  4. Hannivoort LN, Eleveld DJ, Proost JH, Reyntjens KMEM, Absalom AR, Vereecke HEM, Struys MMRF. Development of an optimized pharmacokinetic model of dexmedetomidine using target-controlled infusion in healthy volunteers. Anesthesiology. 2015;123:357–67.CrossRefGoogle Scholar
  5. Hu C, Horstman D, Shafer S. Variability of target-controlled infusion is less than the variability after bolus inyection. Anesthesiology. 2005;102:639–45.CrossRefGoogle Scholar
  6. Iannuzzi M, Iannuzzi E, Rossi F, et al. Relationship between bispectral index, electroencephalographic state entropy and effect-site EC for propofol at different clinical endpoints. Br J Anaesth. 2005;94:613–6.CrossRefGoogle Scholar
  7. Jevtovic-Todorovic V, Absalom AR, Blomgren K, Brambrink A, Crosby G, Culley DJ, Fiskum G, Giffard RG, Herold KF, Loepke AW, Ma D, Orser BA, Planel E, Slikker W Jr, Soriano SG, Stratmann G, Vutskits L, Xie Z, Hemmings HC Jr. Anaesthetic neurotoxicity and neuroplasticity: an expert group report and statement based on the BJA Salzburg Seminar. Br J Anaesth. 2013;111(2):143–51.CrossRefGoogle Scholar
  8. Karwacki Z, Niewiadomski S, Rzaska M, Witkowska M. The effect of bispectral index monitoring on anaesthetic requirements in target-controlled infusion for lumbar microdiscectomy. Anaesthesiol Intensive Ther. 2014;46(102):284–8.CrossRefGoogle Scholar
  9. Lin B-F, Huang Y-S, Kuo C-P, Ju D-T, Lu C-H, Cherng C-H, Wu C-T. Comparison of A-line autoregressive index and observer assessment of alertness/sedation scale for monitored anesthesia care with target-controlled infusion of propofol in patients undergoing percutaneous vertebroplasty. J Neurosurg Anesthesiol. 2011;23:6–11.CrossRefGoogle Scholar
  10. Qiao Y, Feng H, Zhao T, Yan H, Zhang H, Zhao X. Postoperative cognitive dysfunction after inhalational anaesthesia in elderly patients undergoing major surgery: the influence of anesthetic technique, cerebral injury and systemic inflammation. BMC Anesthesiol. 2015;15:154.CrossRefGoogle Scholar
  11. Servin FS. TCI compared with manually controlled infusión of propofol: a multicentre study. Anaesthesia. 1998;53(Suppl, 1):82–6.CrossRefGoogle Scholar
  12. Whitlock EL, Villafranca AJ, Lin N, Palanca BJ, Jacobsohn E, Finkel KJ, Zhang L, Burnside BA, Kaiser HA, Evers AS, Avidan MS. Relationship between Bispectral Index values and volatile anesthetic concentrations during the maintenance phase of anesthesia in the B-Unaware trial. Anesthesiology. 2011;115:1209–18.Google Scholar
  13. Absalom AR, Glen JB (Iain), Zwart GJC, Schnider TW, Struys MMRF. Target-controlled infusion. Anesth Analg. 122(1):70–8.Google Scholar
  14. Sepúlveda PO, Tapia LF, Monsalves S. Neural inertia and differences between loss of and recovery from consciousness during total intravenous anaesthesia: a narrative review. Anaesthesia. 2019;74(6):801–9.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Pablo O. Sepúlveda V.
    • 1
  • Francisco A. Lobo
    • 2
  1. 1.Clínica Alemana Santiago de Chile, Anesthesiology and Pain, VitacuraSantiagoChile
  2. 2.Department of AnesthesiologyICU and Peri-operative Medicine, Hamad General Hospital, Hamad Medical CorporationDohaQatar

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