Total Intravenous Anesthesia (TIVA)/Sevoflurane Initiated Intravenous Anesthesia (SIIVA) in Pediatric Patients

A Prospective Observational Study Evaluating Extubation Criteria in Children Less 10 Years of Age and Younger Undergoing Intravenous Anesthesia

Because Propofol is the primary "anesthetic agent," and inhalational agents remain in trace quantities at the end of the procedure Sevoflurane initiated intravenous anesthesia (SIIVA) or not present at all Total intravenous anesthesia (TIVA) it is likely that different criteria may be predictive of extubation success in these patients compared to inhalational anesthesia.

This is because these anesthetic regimens have different pharmacologic mechanisms of actions, and therefore interact with central nervous system in different ways leading to potentially the need for different extubation criteria in patients receiving TIVA or SIIVA. Additionally, intravenous agents likely have less of an effect on airway reflexes and ventilation at light levels of anesthesia. This study is proposing an observational study to examine the predictive value of various extubation criteria in the setting of SIIVA and TIVA.

Inclusion Criteria:

• Pediatric patients <10 years of age
• Undergoing elective or emergency surgery with planned airway instrumentation with an endotracheal tube (ETT)
• Patients having general anesthesia with a planned SIIVA or TIVA technique
• Patients with an end tidal agent concentration of Sevoflurane<0.1% at the time of emergence and extubation
• following sevoflurane induction to place IV

Exclusion Criteria:

• History of home oxygen use or ventilator dependence
• Patients with cyanotic congenital heart disease
• Patients undergoing anesthesia for imaging procedures alone
• Patients intended to be managed with supraglottic airway
• Patients having an anesthesia time < 30 minutes
• Monitored Anesthesia Care (not general anesthesia)
• Patients with contraindication to receiving Propofol (i.e. mitochondrial myopathy)