Contents

About the Author
Preface 1
Preface 2
Preface 3
Introduction
2007 Symbol of National Quality
1: Development of TIVA
2: TIVA Medications
3: Principles of TCI
4: How to Execute TIVA by Utilizing a Syringe Pump and TCI Machine
5: Future Prospects of Executing TIVA by Utilizing TCI
6: Answers to Anticipated Questions
7: Explanation of Examples
References

Preface 1

Since 2005, the Department of Anesthesiology in the Tri-service General Hospital (TSGH) has adopted the target-controlled infusion (TCI) method of anesthesia and has been the most advanced user of this technology in Taiwan. From a medical quality aspect, TCI reduces uncomfortable feelings in patients after their operation, such as nausea or vomiting, patients feel no sensation during the entire operation or intervention procedure, and feel comfortable after their emergence, as if they had just woken from a good night＇s sleep. From an environmental protection aspect, just two TCI machines reduce the amount of inhalation anesthetics used in our department by 20% per month, equivalent to the amount of greenhouse effect caused by 50 cars, or on the other hand equivalent to planting 400 more trees per year.

This book contains a description of this anesthetic method for almost all kinds of surgery. In particular, we have applied the TCI technique as the routine anesthetic technique for liver transplants. It can not only immediately evaluate the implanted liver function during surgery, but also reduce patient stay time in intensive care. Moreover, total intravenous anesthesia (TIVA) can also reduce brain edema and avoid the secondary harm caused by inhalation anesthetics, which cause an increase in intracranial pressure. In our hospital, all neurosurgical procedures are executed using our standard TCI surgical methods.

TIVA via TCI has the advantages of good anesthetic quality, environmental protection, and saving medical costs. We are the proud recipients of a Certificate of National Quality after a contest in 2007, and are willing to share our experiences with our medical colleagues. I heartily recommend this book!

The Vice-Superintendent of
Medical Affairs Bureau
General Ji-Hong Zhu, MD, PhD.

Preface 2

With the progress in monitoring systems, the safety of anesthesia has already been greatly improved. Here, we emphasize anesthetic quality. The quality of anesthesia is highly related to patient safety; the better the medical quality, the safer patients will be. That is why surgeons and anesthesiologists pay attention not only to the safety, but also to the quality of anesthesia.

Improvements in science have brought huge improvements in medical treatment. I never thought that one day we would gain so much praise from our patients. The TCI manual written by Professor Wong, Chief Cherng, and Dr. Wu introduces the theory and technique of TIVA. It details records of cases from all surgical specialties, which provide an efficient reference for clinical anesthesia in practice, and ensures the patients＇ safety and rights to quality.

In particular, the TCI manual describes, ＂During anesthesia induction, an individual plan for anesthesia is tailored for each patient.＂ in chapter 5. This is precisely an example of the renowned service that has distinguished TSGH as a medical center with high quality patient care. I sincerely recommend TIVA with TCI, and hope that every patient has the opportunity to obtain high-quality anesthesia such as achieved by this method.

The Superintendent of TSGH
General Da-Shung Yu, MD, PhD.

Preface 3

I am so glad to know that this book written by former Vice-Superintendent Wong is going to be published. It contains descriptions of cases from all surgical departments, which has made it very practical. It reduces the time that anesthesiologists need to learn a new technique.

After induction via inhalation anesthetics, it takes more than 10-15 minutes to reach an adequate depth of anesthesia for surgery; and it is not uncommon to observe a sudden rise in blood pressure and a tendency to bleeding. By using TIVA-TCI, operations become smoother and more quickly completed. No undesirable situations, such as severe bleeding during skin incisions, are likely to arise. During recovery, patients will not be agitated and bite the endotracheal tubes, but awake as if from sleep. Moreover, TIVA-TCI can also reduce the incidence of postoperative nausea and vomiting, and other feelings of discomfort.

Presently, many patients in our hospital receive this high-quality anesthesia, and experience a better recovery than when inhalation anesthetics are used. We have gained their high praise accordingly.

TIVA via TCI has advantages of high medical quality, environmental protection, and cost saving. I am so thankful that Vice-Superintendent Wong, Chief Cherng, and Dr. Wu have shared all their experiences without reservation. I will truly recommend the TIVA-TCI method and hope all my patients can receive this kind of anesthesia.

Professor and Chairman,
Department of surgery, TSGH
Jyh-Cherng Yu, MD