CC BY-NC-ND 4.0 · J Neuroanaesth Crit Care 2018; 05(03): 141-149
DOI: 10.1055/s-0038-1673544
Review Article
Indian Society of Neuroanaesthesiology and Critical Care

Total Intravenous Anesthesia in Neurosurgery

Narmadhalakshmi Kannabiran
1   Department of Neuroanaesthesiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
Prasanna Udupi Bidkar
2   Division of Neuroanaesthesia, Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
› Author Affiliations
Further Information

Publication History

Received: 01 July 2018

Accepted after revision: 21 August 2018

Publication Date:
24 October 2018 (online)


In recent years, neurosurgical anesthesia has been rapidly evolving in the fields of pharmacotherapy and techniques to administer safe anesthesia. Intravenous (IV) anesthetic agents reduce both cerebral blood flow and intracranial pressure besides maintaining flow–metabolism coupling in contrast to inhalational agents. In neuroanesthesia, the technique and choice of drugs directly influence the outcome of the patients. The purpose of this review is to provide the updated information of total intravenous anesthesia (TIVA) in neuroanesthesia. Administration of TIVA using target-controlled infusion technique is emerging as a standard method to administer safe anesthesia in neurosurgical patients. The propofol–remifentanil combination has become very popular due to their favorable pharmacokinetic and pharmacodynamic properties for neurosurgery cases. Plasma-effect site concentration monitoring from target TCI devices together with electroencephalogram or bispectral index monitors allows easy titration of anesthetic agents to ensure adequate depth of anesthesia depending upon the nociceptive stimulus. TIVA is associated with smooth induction and rapid emergence with less postoperative nausea and vomiting.