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Total Intravenous Anaesthesia for War Surgery
  1. Major S Lewis, RAMC, Specialist Registrar in Anaesthesia & Critical Care1 and
  2. S Jagdish, Associate Specialist in Anaesthesia2
  1. 1St George’s Healthcare NHS Trust, London
  2. 233 Field Hospital, Gosport & Chief of Staff, Dept of Military Anaesthesia, Pain & Critical Care
  1. C/O Army Medical Directorate Support Unit, The Former Army Staff College, Slim Road, Camberley, Surrey GU15 4NP drselewis{at}


Total Intravenous Anaesthesia (TIVA) and Target-Controlled Infusion (TCI) of anaesthesia are techniques that have benefited from recent advances in microprocessor technology and drug design. Though dependant on technology, they offer significant clinical benefits and logistic advantages. Manipulation of complex data derived from population pharmacokinetics has enabled greater understanding of drug handling models, thus enabling individual patient titration of anaesthesia. This has also informed manual techniques of intravenous anaesthesia. These approaches constitute a useful and logical alternative in the field, both in austere circumstances as well as the more established deployed setting. The pharmacodynamics and pharmacokinetics of potent intravenous anaesthesia agents in the complex combat trauma patient require continued examination.

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