Pharmacokinetic/Pharmacodynamic (PK/PD) Modeling of Total Intravenous Anesthesia (TIVA) with Target-Controlled Infusion (TCI) Versus Volatile Anesthesia: A Retrospective Comparison of Recovery Profiles and Drug Utilization

Background: The choice between Total Intravenous Anesthesia with Target-Controlled Infusion (TIVA-TCI) and volatile anesthesia has implications for recovery quality and pharmacoefficiency. Pharmacokinetic/pharmacodynamic (PK/PD) modeling offers a framework to quantitatively compare these techniques.
Methods: Retrospective cohort analysis of 312 adult patients undergoing elective surgery at King Hussein Medical Center (January 2023–December 2025): TIVA-TCI with propofol/remifentanil (n=158) vs. volatile anesthesia with sevoflurane/desflurane (n=154). Recovery milestones, drug utilization, and PK/PD model predictability were compared.
Results: TIVA-TCI was associated with significantly shorter times to extubation (8.4±3.2 vs. 12.6±4.8 minutes, p<0.001), eye-opening (6.8±2.8 vs. 10.2±4.2 minutes, p<0.001), and PACU discharge readiness (58.4±16.8 vs. 81.2±22.4 minutes, p<0.001). PK/PD modeling revealed superior predictability for TIVA-TCI (R²=0.84 vs. 0.67, p<0.001; coefficient of variation 18% vs. 32%, p<0.001). Drug costs were lower with TIVA-TCI (24.80±6.40 vs. 32.50±8.20 per case, p<0.001). PONV incidence was significantly reduced (12.0% vs. 28.6%, p<0.001).
Conclusion: TIVA-TCI with propofol/remifentanil provides faster, more predictable recovery and favorable pharmacoeconomics compared to volatile anesthesia. These findings support preferential use of TIVA-TCI in procedures where rapid, predictable emergence is prioritized.