Targeting Blocking Autonomic Response (BAR) with TIVA

This video is made as an educational complement for the THRIVE trial and shows how to use the software StanpumpR.io to plan for TIVA with the goal of blocking autonomic response (BAR).

[@intestinomedicino]

Does you routinely administer a Fentanyl bolus at induction while at the same time initiating a Remifentanil infusion on your patients? or its just an example to compare the effects that a different opioid has on BAR?

[@craigmcfarland8757]

Not my video, so I know you didn’t ask me, but since the poster didn’t respond, I’ll give you my take on it. If you just start a remifentanil infusion without a bolus dose of an opioid at the same time, it will take 15 minutes or so to achieve a steady state. If you mean to intubate the patient right after starting the infusion you won’t have the remi fully on board. I usually give a bolus of fentanyl a short time before induction, so the autonomic response to intubation is blocked. By the time the fentanyl levels have dropped, the remi infusion has created the desired effect.