Total intravenous anaesthesia (TIVA) in children has for many years been seen as a niche method of anaesthetising children, reserved for enthusiasts and specific cases. The increased availability of programmable pumps and recognition of the value of TIVA in preventing postoperative nausea and vomiting (PONV), malignant hyperpyrexia (MH) and its excellent track record in minimising airway complication has led to a resurgence in interest in this technique. This chapter explains in detail the pharmacology of TIVA and the use of target-controlled infusions (TCI), focusing on propofol as the main agent used in TIVA, and elaborates on the development of newer pharmacokinetic models for delivering a consistency in concentration to children across the age spectrum. The chapter also looks remifentanil and its unique place in paediatric anaesthesia. We discuss the practicalities of using TCI in everyday cases as well as describe some specific benefits of the technique, especially in airway surgery, where TIVA and high-flow nasal oxygen are becoming an increasingly popular technique for airway examination and surgery. Finally, the chapter discusses areas in which TIVA use is challenging – neonates, teenagers and obesity – where extremes of weight and maturity make pharmacokinetic modelling difficult.