Anestesia total intravenosa en neonatos: Consideraciones para uso seguro

Total intravenous anesthesia (TIVA) is well established in adults and its use has increased in pediatrics. However, in neonates it remains limited and challenging. Pharmacokinetic and pharmacodynamic differences due to organ immaturity, variations in body composition, and rapid neurodevelopment result in greater sensitivity to anesthetics, reduced clearance, and prolonged half-lives, leading to risks of overdosing and adverse events such as bradycardia and hypotension. This article reviews the physiological and pharmacological foundations of propofol and remifentanil use in neonates, as well as available pharmacokinetic models. It also provides practical recommendations for the safe use of TIVA in this population: drug concentrations, choice of equipment, infusion programming, EEG-based monitoring, and analgesic strategies. Despite the limited evidence available, TIVA in neonates may be considered a valid and safe alternative in selected scenarios, provided that appropriate technical and monitoring considerations are observed.