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Total intravenous anaesthesia (TIVA) is the delivery of general anaesthesia entirely via the intravenous route. This can be achieved through a variety of drugs. The most common combination used is propofol and a short-acting opiate, such as remifentanil. Different target- controlled infusion (TCI) models are used, depending on the age of the child.TIVA use in paediatric anaesthesia offers certain benefits over volatile anaesthesia. Advantages for the patient include reduced postoperative nausea and vomiting (PONV), delirium, time in recovery and less airway reactivity.

Patients undergoing major vascular surgery are at high risk for myocardial infarction, renal failure, respiratory complications and death. Invasive procedures confer greater risk of complication, with patients undergoing open aortic surgery being at highest risk. Endovascular procedures are less invasive, yet not devoid of potentially serious complications. Reduction of myocardial oxygen demand is key, as is stabilizing cardiovascular parameters, maintaining normothermia, adequate volume resuscitation and effective analgesia.

Which of the below are true regarding the neurological monitoring techniques during carotid endarterectomy?

Maintaining an equilibrium between oxygen supply and demand is a principal function of the cardiovascular system. In times of altered metabolic demand, mechanisms exist to maintain the balance between supply and demand. Exercise, haemorrhage and pregnancy all lead to changes in oxygen demand and subsequently modification of cardiac output. During isotonic exercise, metabolic demands of muscle are greatly increased. Sympathetic stimulation and inhibition of the parasympathetic system lead to increases in heart rate and venous return, increasing cardiac output.