E Pugh H Husaini on behalf of INCARNNET Freeman Hospital NewcastleuponTyne UK Total intravenous anaesthesia TIVA is an important method of delivery of anaesthesia however its teaching is widely variable Regional surveys in two other deaneries have illustrated trainees desir ID: 812669
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A survey of trainee experience with total intravenous anaesthesia (TIVA) in the northern deanery.
E. Pugh, H. Husaini on behalf of INCARNNETFreeman Hospital, Newcastle-upon-Tyne, UK
Total intravenous anaesthesia (TIVA) is an important method of delivery of anaesthesia, however its teaching is widely variable. Regional surveys in two other deaneries have illustrated trainees’ desire for further training in this area [1,2]We undertook a survey of anaesthetic trainees in the Northern region to establish their experience of TIVA and their desire for a formal regional teaching course. MethodsAn online survey (Survey Monkey) was sent to all trainee anaesthetists in the Northern region. There were 8 questions; all were compulsory. Data collection was conducted over a two-week period at the beginning of August 2014. Ethical approval was not required.Results69 (32%) trainees completed the survey; 28% were core trainees, 20% ST3-4, 51% ST5-7 and 1% other. All respondents had experience with TIVA. 26% reported rarely using (0-10 cases), 51% infrequently used the technique (10-40 cases) and 23% were more experienced (40+ cases). 90% had received informal training with only 6% undertaking education at a course or conference. Chart 1 - A patient with malignant hyperthermia presents for an emergency laparotomy requiring urgent surgery whilst you are the anaesthetist on-call overnight. Would you feel confident using TIVA in this scenario?
Risk
of awareness is a key concern for those using TIVA. Failure of delivery of anaesthetic agent is an important cause of unintended awareness as described in the recent National Audit Project (NAP) 5 report [3]. Over 80% of trainees in the region would use a depth-of-anaesthesia (DOA) monitor. The only DOA monitor used was BIS ™.The two most common perceived advantages for using TIVA were less postoperative nausea and vomiting and safety in malignant hyperthermia. In a theoretical case of a patient with malignant hyperthermia presenting out-of-hours for an emergency laparotomy (see Chart 1), the majority of trainees (59%) stated they would feel confident managing a TIVA-based anaesthetic however 6% felt very uncomfortable with this situation. Finally, 86% felt a regional teaching session would be beneficial.DiscussionTIVA is a widely used technique in the region with all respondents being exposed at some point during their training. Only a small proportion receive formal teaching in the scientific and practical basis of TIVA with trainees overwhelmingly feeling that a regional teaching session would be useful. As a quality improvement programme, we will be introducing a half-day programme to our regional teaching programme in 2015 to address this and will take the findings of this survey into consideration when planning the content. References1. S.C.Griffiths et al. Training in TIVA: A survey of anaesthetic trainees in Merseyside and the Northwest.2. P. Madhivathanan, R. Kasivisvanathan, A. Cohen. Training in total intravenous anaesthesia: a regional survey Anaesthesia, 2010, 65; 540–542 3. Pandit, J. J., et al. "The 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors." Anaesthesia 69.10 (2014): 1089-1101.