Introduction: Total intravenous anesthesia is used more and more in the neurosurgical patient, which has been considered a complex technique per se, which together with the changes that occur in the patient with neurological pathology make it even more complex. Objectives: The present review aims to evaluate in a practical way the main pharmacokinetic models and correlate them with the changes that occur in neurosurgical patients. Methodology: PubMed, Science Direct was searched using intravenous anesthesia, spinal surgery, neurosurgery as search terms. Results: The articles reviewed show that anesthetic management plays a crucial role in providing optimal surgical conditions and at the same time being able to carry out intraoperative neurophysiological monitoring, while allowing early neurological evaluation. Derived from the above, the use of total intravenous anesthesia is increasingly frequent, however, in the neurosurgical patient the use of enzyme-inducing drugs can modify metabolism like anticonvulsant drugs, in addition to hormonal function and mainly the state of Alerts the patient, modifies the concentration of the drug necessary to generate an adequate anesthetic state. Conclusions: Total intravenous anesthesia in neurosurgery implies understanding the changes caused with each of the anesthetic agents and the modifications derived from the neurological pathology, in view of which it is essential to monitor the effect generating minimal impact on the systemic and cerebral hemodynamics in order to provide the same closer today to a "personalized anesthesia"
