Uitenbosch Giulia, Sng Daniel, Carvalho Hugo N, Cata Juan P, De Boer Hans D, Erdoes Gabor, Heytens Luc, Lois Fernande Jane, Rousseau Anne-Françoise, Pelosi Paolo, Forget Patrice, Nesvadba David
School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen AB25 2ZD, UK.
Anesthesiology and Perioperative Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, 1090 Brussels, Belgium.
J Clin Med. 2022 Jun 17;11(12):3486. doi: 10.3390/jcm11123486.
The use of total intravenous anaesthesia (TIVA) has been well established as an anaesthetic technique over the last few decades. Significant variation in practice exists however, and volatile agents are still commonly used. This study aims to determine the motivations and barriers for using TIVA over the use of volatile agents by analysing the opinion of several international anaesthetists with specific expertise or interests. The Delphi method was used to gain the opinions of expert panellists with a range of anaesthetic subspecialty expertise. Twenty-nine panellists were invited to complete three survey rounds containing statements regarding the use of TIVA. Anonymised data were captured through the software REDCap and analysed for consensus and prioritisation across statements. Starting with 12 statements, strong consensus was defined as ≥75% agreement. Stability was assessed between rounds. Strong consensus was achieved for four statements regarding considerations for the use of TIVA. These statements addressed whether TIVA is useful in paediatric anaesthesia, the importance of TIVA in reducing the incidence of postoperative nausea and vomiting, its positive impact on the environment and effect on patient physiology, such as airway and haemodynamic control. Using the Delphi method, this international consensus showed that cost, lack of familiarity or training and the risk of delayed emergence are not considered obstacles to TIVA use. It appears, instead, that the primary motivations for its adoption are the impact of TIVA on patient experience, especially in paediatrics, and the benefit to the overall procedure outcome. The effect of TIVA on postoperative nausea and vomiting and patient physiology, as well as improving its availability in paediatrics were considered as priorities. We also identified areas where the debate remains open, generating new research questions on geographical variation and the potential impact of local availability of monitoring equipment.
在过去几十年里，全静脉麻醉（TIVA）作为一种麻醉技术已得到广泛应用。然而，实际应用中存在显著差异，挥发性麻醉剂仍被普遍使用。本研究旨在通过分析几位具有特定专业知识或兴趣的国际麻醉医师的意见，确定使用TIVA而非挥发性麻醉剂的动机和障碍。采用德尔菲法收集具有一系列麻醉亚专业知识的专家小组成员的意见。邀请29位小组成员完成三轮调查问卷，内容涉及TIVA的使用。通过REDCap软件收集匿名数据，并对各陈述进行共识分析和优先级排序。从12条陈述开始，将≥75%的一致意见定义为强烈共识。评估各轮之间的稳定性。关于TIVA使用考量的4条陈述达成了强烈共识。这些陈述涉及TIVA在小儿麻醉中是否有用、TIVA在降低术后恶心呕吐发生率方面的重要性、其对环境的积极影响以及对患者生理的影响，如气道和血流动力学控制。通过德尔菲法，这一国际共识表明，成本、缺乏熟悉度或培训以及苏醒延迟风险不被视为TIVA使用的障碍。相反，采用TIVA的主要动机似乎是其对患者体验的影响，尤其是在儿科，以及对整个手术结果的益处。TIVA对术后恶心呕吐和患者生理的影响，以及提高其在儿科的可及性被视为优先事项。我们还确定了仍存在争议的领域，从而产生了关于地域差异以及当地监测设备可及性潜在影响的新研究问题。
