Anesthesia Management in Surgical Procedures

Introduction to Anesthesia Techniques

The American College of Cardiology recommends that the choice between total intravenous anesthesia (TIVA) and volatile anesthetics should be based on the specific needs of the patient, as there is no significant difference in cardiac protection between the two techniques for non-cardiac surgery (Clase IIa, Nivel de Evidencia A) 1

The American Heart Association suggests that TIVA and volatile anesthetics are equally effective for patients undergoing non-cardiac surgery, with no significant difference in myocardial infarction rates, and the choice should be determined by factors other than cardiac protection 1
The use of volatile anesthetics versus TIVA is reasonable for patients undergoing non-cardiac surgery, and the choice is determined by factors other than the prevention of myocardial ischemia and infarction (Clase IIa, Nivel de Evidencia A) 1
A meta-analysis of over 6,000 patients undergoing non-cardiac surgery showed no difference in myocardial infarction rates between patients who received volatile anesthetics and those who received TIVA 1

TIVA with propofol significantly reduces postoperative nausea and vomiting (PONV) compared to volatile anesthetics, which is particularly important in major abdominal surgery 3, 4
The American Society of Anesthesiologists recommends considering TIVA for patients at high risk of PONV, such as those undergoing gastrointestinal surgery or with a history of PONV 3, 4

Volatile anesthetics are cardioprotective in the context of ischemia and reperfusion, leading to their widespread use in coronary artery bypass grafting in the United States 2
The American Heart Association suggests that volatile anesthetics may be preferred for cardiac surgery due to their cardioprotective effects 2

The American College of Cardiology recommends that TIVA and volatile anesthetics are equally effective for patients with significant cardiovascular disease undergoing non-cardiac surgery, with no difference in myocardial ischemia or infarction 1
The American Thoracic Society suggests that TIVA may be preferred for patients with severe chronic obstructive pulmonary disease (COPD) to minimize airway irritation caused by volatile anesthetics 5

The International Anesthesia Research Society notes that volatile anesthetics are greenhouse gases with >95% of the administered agent exhaled without metabolism and released into the atmosphere 7, 8
TIVA has mainly indirect greenhouse gas emissions related to the supply infrastructure and manufacturing of plastic components (syringes, pumps) 7, 8