Background and Aims

Total Intravenous Anaesthesia (TIVA) is a less commonly used than inhalational vapour based anaesthesia (VBA). TIVA is preferred to VBA in those at high risk of postoperative nausea and vomiting, and those susceptible to malignant hyperthermia. TIVA is not a core competency for Irish anaesthesia trainees. The National Audit Project 5 (NAP 5)1 reported 28 cases of probable/possible accidental awareness under general anaesthesia (AAGA) involving intravenous anaesthesia, 75% of which were considered preventable. NAP 5 recommendations included:

•	All anaesthetists should be trained in the maintenance of anaesthesia with intravenous infusions. 
•	Anaesthetic organisations should establish a set of standards and recommendations for best practice in TIVA. 

We aimed to quantify teaching opportunities for anaesthesia trainees and to ascertain confidence in providing TIVA in both trainees and consultants.

Methods

Online survey circulated to all trainees (262) and consultants (395) in Ireland.

Results

Response rates – 
Trainees 45% (95% C.I. for responses +/- 6.7%)  
Consultants 16.5% (95% C.I. for responses +/- 11.1%) 

5.1% of trainees use TIVA weekly, compared with 32% of consultants
65% of trainees rarely have consultants led teaching in TIVA
69% of trainees felt they have inadequate consultant teaching (TIVA)
80% of consultants felt trainees did not receive enough teaching (TIVA)
Confidence in using TIVA – 25% of all trainees, 42% of senior trainees, 65% consultants
86% of all felt TIVA should be a core competency for training

Conclusions

As per NAP 5, TIVA is a risk factor for AAGA. Irish trainees do not receive adequate consultant led teaching in TIVA and anaesthetists of all levels are not confident in providing TIVA. We recommend that the College of Anaesthetists of Ireland defines competency in TIVA for trainees and increases training opportunities.

Training and confidence in providing total intravenous anaesthesia: a national audit of anaesthetists in Ireland