The availability of short-acting sedative-hypnotics (i.e., propofol) and opioids (i.e., remifentanil) and smart delivery systems (e.g., target-controlled infusion [TCI] systems) have increased the popularity of total intravenous anesthesia (TIVA). TIVA techniques are increasingly being used in an ambulatory setting, particularly the office-based anesthesia (OBA) practice in which the office “operating room” may have limited space and minimal equipment, as administration of TIVA does not require an anesthesia machine and scavenging equipment. In addition, TIVA is associated with lower incidence of postoperative nausea and vomiting (PONV) and avoids the risk of malignant hyperthermia (MH). Although TIVA techniques are generally considered to be more expensive, the differences in costs between inhaled anesthetic and TIVA techniques are difficult to measure because of the many factors that may influence costs. Despite its advantages, TIVA has some limitations. TIVA lacks the muscle relaxant effects of inhaled anesthesia. Also, in contrast to inhaled anesthesia...

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