Systematic review identifies barriers to TIVA use

A systematic review published in BMC Health Services Research has identified specific barriers and facilitators influencing anaesthesiologists’ adoption of total intravenous anaesthesia, commonly known as TIVA. The study, which utilized the Theoretical Domains Framework to categorize determinants, found that while many organizations recommend TIVA to reduce environmental impact, consistent usage among practitioners remains limited. The review synthesized data from fourteen studies involving 3,579 anaesthesia providers to understand the complex behavioral and environmental factors at play. The findings highlight that the decision to use TIVA is not solely a clinical choice but is deeply embedded in institutional resources, individual decision-making processes, and perceived consequences for patient safety.

Anaesthetic gases contribute up to 63% of perioperative greenhouse gas emissions, making the shift to intravenous agents a critical strategy for reducing the carbon footprint of surgical care. Many anaesthesia organizations have issued recommendations to adopt TIVA where possible to mitigate these emissions and potentially improve patient outcomes. Despite these strong institutional and environmental incentives, the review found that anaesthesiologists do not consistently use TIVA in appropriate clinical scenarios.

To conduct this review, the researchers registered their protocol on Prospero in May 2024 and searched four major databases: Embase, Medline, Web of Science, and Scopus. The search covered journal articles published between January 2000 and May 2024, focusing on terms related to anaesthesiologists, TIVA, and behaviors and attitudes. The inclusion criteria required studies to be original research that identified barriers or facilitators to TIVA use. After screening abstracts, extracting data, and evaluating quality, the team identified fourteen studies for the final analysis.

The analysis revealed 24 distinct themes covering 10 of the 14 domains within the Theoretical Domains Framework. The most commonly cited barrier was related to the environmental context and resources, mentioned in 13 of the included studies. A frequent specific issue was the lack of availability of TIVA equipment, which directly hinders the ability of anaesthesiologists to implement the technique. Another major domain was memory, attention, and decision processes, cited in 12 studies.

Beliefs about consequences also emerged as a significant barrier, appearing in 11 studies. On the facilitator side, the review identified intentions as a key domain, cited in four studies. This included the desire to learn more about TIVA or to use it more frequently, indicating that a willingness to change exists among some practitioners.

The quality of the evidence base was a notable limitation of the review. Most of the included studies were surveys, which are subject to concerns about representativeness and non-response bias.

Based on the identified barriers, the authors proposed several potential interventions to support the transition to TIVA. These include ensuring there is adequate time and support to implement changes to both individual routines and hospital culture. Increasing resources, such as ensuring access to TIVA equipment, is also essential to remove practical obstacles.

The review concludes that while the barriers to TIVA use are widespread across multiple theoretical domains, the evidence for these barriers is primarily derived from surveys with known limitations. Future researchers should take these identified barriers and related interventions into account, while remaining cognisant of the local context in which anaesthesia is practiced.

Subject of Research: Systematic review of barriers and facilitators to TIVA use among anaesthesiologists

Article Title: Barriers and facilitators to the use of total intravenous anaesthesia amongst anaesthesiologists: a systematic review using the Theoretical Domains Framework

Article References: Batcup, C., Chambon, M., Pinar, V., de Wit, S., Sperna Weiland, N. H., Dalege, J., Bouvy, N. D., & van Harreveld, F. (2026). Barriers and facilitators to the use of total intravenous anaesthesia amongst anaesthesiologists: a systematic review using the Theoretical Domains Framework. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15898-w

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15898-w

Keywords: total intravenous anaesthesia, anaesthesiologists, systematic review, greenhouse gas emissions, Theoretical Domains Framework, clinical practice, health services research, perioperative care, Barriers, facilitators, total, intravenous