Which agents are typically used for total intravenous anesthesia (TIVA)?

• A. Propofol and Remifentanil
• B. Isoflurane and Nitrous oxide
• C. Sevoflurane
• D. Ketamine and Fentanyl

Answer: (A)

Total intravenous anesthesia is achieved with drugs given through the veins, avoiding inhaled anesthetic gases. The combination of propofol and remifentanil fits this approach perfectly. Propofol is a rapid-onset hypnotic that drives the patient into and maintains anesthesia, while remifentanil is an ultra-short-acting opioid that provides analgesia with a quick offset. This pair allows precise control of depth of anesthesia and very quick recovery once the infusion is stopped or reduced, which is a hallmark of TIVA.

Inhaled agents like isoflurane, nitrous oxide, and sevoflurane are gases used in inhalational anesthesia, not TIVA, so they don’t align with the “intravenous only” concept. Ketamine with fentanyl can be used IV in some scenarios, but it’s not the standard maintenance regimen for routine TIVA due to its distinct pharmacologic profile and longer emergence in typical practice.