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When you arrive for surgery at Centre for Surgery, you will be cared for by a consultant anaesthetist who will administer your anaesthetic using a technique called TIVA — Total Intravenous Anaesthesia. You may never have heard this term before your consultation, but it is one of the most important things that distinguishes the anaesthetic care we provide from what you might experience at an NHS hospital or at many other cosmetic surgery providers. This guide explains what TIVA is, how it works, and why Centre for Surgery uses it as standard for all procedures requiring general anaesthesia.
Understanding your anaesthetic is a meaningful part of preparing for surgery. The type of anaesthetic used affects how you feel when you wake up, how quickly you recover, and your risk of common side effects such as nausea and vomiting. It is worth knowing what you are being given and why.
What Is TIVA?
TIVA stands for Total Intravenous Anaesthesia. As the name describes, it is a method of delivering general anaesthesia entirely through intravenous (IV) drugs — that is, drugs delivered directly into the bloodstream through a cannula, typically placed in the back of the hand or forearm. No inhaled anaesthetic gases are used at any point during the procedure.
This is in contrast to the traditional method of general anaesthesia, which uses inhaled agents — volatile anaesthetic gases such as sevoflurane, desflurane, or isoflurane — breathed in through a mask or breathing tube to maintain the anaesthetic state during surgery. In the traditional approach, an IV drug (usually propofol) is used to induce anaesthesia, and then the inhaled gas takes over to maintain it. With TIVA, IV drugs handle both induction and maintenance throughout the entire procedure.
The primary drugs used in TIVA are propofol — which produces the anaesthetic state — and a short-acting opioid such as remifentanil, which provides analgesia (pain relief) during surgery. These are administered through precisely calibrated infusion pumps using a system called Target Controlled Infusion (TCI), which calculates and continuously adjusts the drug dose based on the patient’s weight, age, and physical characteristics to maintain a precise, predictable level of anaesthesia throughout the procedure.
How Does TIVA Work?
The TIVA process begins before you enter the operating theatre. Your anaesthetist will place a cannula in your hand or forearm and connect you to monitoring equipment that tracks your heart rate, blood pressure, oxygen saturation, and depth of anaesthesia throughout the procedure.
When surgery is ready to begin, your anaesthetist starts the propofol infusion. Within seconds, you will feel a mild sensation — often described as a cool feeling or a slight dizziness — and then you will be asleep. The transition into unconsciousness with propofol is very smooth and rapid, without the unpleasant smell or sensation of inhaling anaesthetic gas.
Throughout the procedure, the infusion pumps continuously deliver propofol and remifentanil at precisely calculated rates. Your anaesthetist monitors your depth of anaesthesia and your physiological responses in real time, adjusting the infusion rates as needed to keep you at exactly the right level of unconsciousness — not too deep, not too light.
When surgery is complete, the infusion is switched off. Propofol and remifentanil are short-acting drugs that are rapidly metabolised and cleared from the body, so the anaesthetic state wears off quickly and predictably. Most patients wake up smoothly within minutes of the infusion stopping, without the grogginess, confusion, or nausea that can accompany recovery from inhaled gas anaesthesia.
Why Does Centre for Surgery Use TIVA?
At Centre for Surgery, TIVA is our standard anaesthetic technique for all procedures requiring general anaesthesia. This is not a marketing choice — it is a clinical one, based on the evidence for patient outcomes and the specific characteristics of the cosmetic surgery patient population.
Significantly Reduced Nausea and Vomiting
Post-operative nausea and vomiting (PONV) is one of the most common and distressing side effects of general anaesthesia. It delays recovery, causes genuine discomfort, and can prolong the time patients need to spend in the recovery suite before being discharged. Inhaled volatile anaesthetics are a primary contributor to PONV — they are emetogenic (nausea-inducing) by nature.
Propofol, the primary drug in TIVA, has anti-emetic properties — it actively reduces the risk of nausea rather than increasing it. The published evidence consistently shows that TIVA produces significantly lower rates of PONV compared to inhaled gas anaesthesia, and this benefit is particularly pronounced in patients who are at higher baseline risk of PONV — which includes women undergoing longer cosmetic surgery procedures, exactly the patient population we most commonly treat.
Faster, Cleaner Recovery
Propofol and remifentanil are rapidly cleared from the body, so recovery from TIVA is typically faster and smoother than recovery from inhaled gas anaesthesia. Patients wake up with clearer heads, less confusion, and less residual sedation. This translates into a shorter time in the recovery suite, earlier readiness for discharge, and a more comfortable post-operative experience overall.
No Operating Theatre Pollution
Volatile anaesthetic gases are environmental pollutants. They are potent greenhouse gases — desflurane, for example, has a global warming potential thousands of times greater than carbon dioxide. When inhaled gases are used in the operating theatre, a proportion escapes into the environment through scavenging systems. TIVA eliminates theatre gas pollution entirely, which is both an environmental benefit and an occupational health benefit for theatre staff who would otherwise have chronic low-level exposure to volatile agents over their working lives.
Smoother Induction and Emergence
The experience of going to sleep with propofol and waking up after TIVA is generally described by patients as smoother and more pleasant than the experience with inhaled gas. There is no smell of anaesthetic gas, no unpleasant taste, and no sensation of fighting the anaesthetic on the way in or out. Emergence — the process of waking up — tends to be quicker and without the prolonged confusion that can occur after inhaled agents.
Reduced Risk of Anaesthetic Awareness
Anaesthetic awareness — the experience of regaining consciousness during surgery — is rare but is a recognised risk with all forms of general anaesthesia. TIVA with modern depth of anaesthesia monitoring (such as BIS monitoring, which Centre for Surgery uses as standard) is associated with a lower risk of awareness than inhaled gas anaesthesia alone, because the depth of anaesthesia can be monitored and adjusted with greater precision.
The Five Key Benefits of TIVA at a Glance
TIVA vs Inhaled Gas Anaesthesia
For patients trying to understand the distinction, the simplest way to frame it is this: inhaled gas anaesthesia uses gases breathed into the lungs to maintain unconsciousness; TIVA uses intravenous drugs delivered directly into the bloodstream. Both produce a safe state of general anaesthesia, but the patient experience during recovery, and the risk profile for side effects such as nausea, differ meaningfully in favour of TIVA — particularly for the types of procedures and patient profiles seen in cosmetic surgery practice.
What the evidence actually shows
This is one of the most heavily studied questions in anaesthesia, and it is worth setting out what the data supports rather than relying on assertion. A 2024 systematic review and meta-analysis in EClinicalMedicine pooled 317 randomised controlled trials covering 51,107 patients[1] and found that, compared with inhaled anaesthesia, TIVA produced:
- 39% less postoperative nausea and vomiting (RR 0.61, across 145 trials and 23,172 patients)
- 60% less emergence delirium — the confusion and agitation some patients experience on waking (RR 0.40)
- Better quality-of-recovery scores in the days afterwards
- In older patients, less postoperative cognitive dysfunction — a finding also supported by a Cochrane review of 28 trials[2]
What the evidence does not show
Two honest caveats, because a page that only reports the favourable findings is not much use to you.
TIVA does not reduce mortality. The same 51,107-patient analysis found no difference in in-hospital, 30-day or one-year mortality between the two techniques.[1] Both are very safe. The case for TIVA rests on the quality of your recovery, not on survival.
Anti-sickness drugs close much of the gap. A meta-analysis of 14 trials in the European Journal of Anaesthesiology compared TIVA against inhaled anaesthesia plus a single antiemetic, and found no overall difference in nausea between them — with slightly more late nausea in the TIVA group. In other words, an anaesthetist using gas and giving an antiemetic can achieve much of what TIVA achieves.[3]
Our preference for TIVA is therefore a considered one rather than an absolute: it produces a cleaner emergence, it avoids the need to rely on rescue medication, and it suits day-case cosmetic surgery where getting patients comfortable and home the same day is the goal. It is not the only defensible approach, and any anaesthetist telling you otherwise is overstating the evidence.
As covered in our detailed post on types of anaesthesia used in plastic surgery, there is a spectrum of anaesthetic options available from local anaesthetic through to general anaesthesia — and the choice of anaesthetic for any given procedure depends on the nature of the surgery, its expected duration, and the patient’s individual characteristics. For procedures requiring general anaesthesia, TIVA is our method of choice for the reasons described above.
Our post on twilight sedation in cosmetic surgery covers the intermediate option — conscious sedation — for patients undergoing procedures that do not require full general anaesthesia.
Who Administers the Anaesthetic?
At Centre for Surgery, anaesthesia is administered by a consultant anaesthetist, a GMC-registered doctor who specialises in anaesthesia.
This is important to state clearly because the level of anaesthetic expertise provided in cosmetic surgery settings varies considerably. Some providers use anaesthetic practitioners (non-doctors) or operate without a dedicated anaesthetist present throughout the procedure. At Centre for Surgery, a consultant anaesthetist is present and actively monitoring throughout every general anaesthetic — this is a non-negotiable standard of care, not an optional extra.
Understanding who will be looking after you during surgery is one of the most important questions to ask at your consultation. As covered in our post on 10 questions to ask your surgeon before cosmetic surgery, the qualifications and experience of your anaesthetist matter as much as those of your surgeon.
What Should I Do Before a TIVA Anaesthetic?
The pre-operative requirements for TIVA are the same as for general anaesthesia by any method. You will be asked to fast from food for at least six hours before your procedure, and from clear fluids for two hours. You will need to disclose all medications you are taking at your pre-operative assessment, as some drugs interact with anaesthetic agents. You should not smoke on the day of surgery, and you should avoid alcohol for at least 24 hours beforehand.
Your anaesthetist will review your medical history, your medications, and any relevant factors — including previous anaesthetic experiences and any history of PONV — at your pre-operative assessment. This allows any potential risks to be identified and managed before you arrive for surgery. As covered in our post on essential preparations before your plastic surgery, the pre-operative period is an active part of ensuring the best possible outcome.
Is TIVA Safe?
TIVA is a well-established, extensively studied anaesthetic technique with an excellent safety record. Propofol has been in widespread clinical use since the late 1980s and is one of the most comprehensively understood anaesthetic drugs in medicine. The Target Controlled Infusion systems used to deliver TIVA have been validated across large patient populations and are in routine use in NHS and independent hospitals throughout the UK and internationally. The safety comparison with inhaled anaesthesia is reassuring in both directions: as noted above, the 51,107-patient meta-analysis found no difference in mortality or in organ-related complications between the two techniques.[1] Neither is the safer choice — TIVA is the more comfortable one.
As with all forms of general anaesthesia, TIVA carries inherent risks — these are low in healthy patients undergoing elective cosmetic surgery but are never zero. Your consultant anaesthetist will discuss the specific risks relevant to your procedure and your individual health status at your pre-operative assessment — our guides to pre-surgery questions and preparing for plastic surgery cover what that appointment involves. The wider picture is set out in our guide to whether cosmetic surgery is safe and our page on risks and complications. Choosing a CQC-regulated provider where procedures are performed by consultant specialists significantly reduces anaesthetic risk. As covered in our post on what a CQC Good rating means for cosmetic surgery patients, CQC regulation sets the standards for safe care environments and clinical governance that patients should look for in any cosmetic surgery provider.
Frequently Asked Questions
What does TIVA feel like?
Going to sleep with TIVA is typically described as very smooth and fast. You may feel a brief cool or tingling sensation as the propofol enters your vein, followed rapidly by unconsciousness. There is no smell of gas and no unpleasant taste. Waking up is equally smooth — most patients feel clear-headed and calm within minutes of the infusion stopping.
Will I feel sick after TIVA?
TIVA is specifically associated with a significantly lower risk of post-operative nausea and vomiting compared to inhaled gas anaesthesia. Propofol has anti-emetic properties. While some degree of nausea is still possible depending on the procedure and individual factors, most TIVA patients experience little or no nausea during recovery.
Is TIVA used for all procedures at Centre for Surgery?
TIVA is used for all procedures requiring general anaesthesia at Centre for Surgery. Shorter or less invasive procedures may be performed under local anaesthetic or twilight sedation rather than general anaesthesia — your surgeon and anaesthetist will discuss the most appropriate option for your specific procedure at consultation.
Does TIVA cost more than inhaled gas anaesthesia?
For procedures that need a general anaesthetic, TIVA is our standard approach and is included in the price quoted for your procedure, along with consultant anaesthetist care. If your procedure is normally carried out under local anaesthetic and you would prefer to have TIVA, a supplement applies. Your coordinator will confirm this in your written quote before you book.
Can I request TIVA if my surgery is being done elsewhere?
Yes — patients can request TIVA at any provider, though not all providers routinely offer it. It is worth asking specifically whether TIVA will be used, who will administer the anaesthetic, and what their qualifications are. Our post on how to avoid botched cosmetic surgery covers the questions to ask when evaluating any provider.
References
Sources identified via PubMed. Each entry links to the original paper.
- Kampman JM, Hermanides J, Hollmann MW, Gilhuis CN, Bloem WA, Schraag S, et al. Mortality and morbidity after total intravenous anaesthesia versus inhalational anaesthesia: a systematic review and meta-analysis. EClinicalMedicine 2024;72:102636. doi:10.1016/j.eclinm.2024.102636
- Miller D, Lewis SR, Pritchard MW, Schofield-Robinson OJ, Shelton CL, Alderson P, et al. Intravenous versus inhalational maintenance of anaesthesia for postoperative cognitive outcomes in elderly people undergoing non-cardiac surgery. Cochrane Database of Systematic Reviews 2018;8:CD012317. doi:10.1002/14651858.CD012317.pub2
- Schaefer MS, Kranke P, Weibel S, Kreysing R, Kienbaum P. Total intravenous anaesthesia versus single-drug pharmacological antiemetic prophylaxis in adults: a systematic review and meta-analysis. European Journal of Anaesthesiology 2016;33(10):750–760. doi:10.1097/EJA.0000000000000520
Anaesthesia at Centre for Surgery
Centre for Surgery uses TIVA as standard for all procedures requiring general anaesthesia, administered by a consultant anaesthetist who is present and actively monitoring throughout your procedure. Our CQC-regulated Baker Street clinic operates to the clinical governance standards expected of NHS surgical facilities, with the same level of anaesthetic expertise and monitoring.
For further information about your planned procedure and what to expect on the day, our post on what to expect from enquiry to consultation covers the full patient journey in detail. Finance options are available through our partner Chrysalis Finance, subject to status, — visit our Finance Options page for details.
Phone: 020 7993 4849 | Email: contact@centreforsurgery.com | Address: 95-97 Baker Street, London W1U 6RN
