New clinical trial to compare the impact of anesthesia methods on post-surgery outcomes

A new clinical trial will compare two types of anesthetic to determine how soon after surgery they allow patients to return home.

The Volatile vs Total intravenous Anesthesia for major non-cardiac surgery (VITAL) trial is led by Warwick Clinical Trials Unit at the University of Warwick and will compare two methods of delivering anesthesia to a patient: inhalation and intravenous. Launched this week at the Anesthesia Research 2020 meeting, it is funded the National Institute for Health Research and was developed by the UK Perioperative Medicine Clinical Trials Network.

Their results could help determine which method is more effective at helping patients return home after surgery without complications.

More than 1.5 million patients require general anesthesia for major surgery each year in the NHS. Inhalational anesthesia is most commonly used, and involves the patient breathing anesthetic gas through a breathing tube whilst asleep.

Some patients receive an alternative called total intravenous anesthesia, or ‘TIVA’. During a TIVA anesthetic, the patient breathes oxygen through a breathing tube and the anesthetic is given via injection into a vein.

Previous research and some anecdotal evidence from anesthetic doctors has suggested that patients recover more quickly after TIVA, and that patients prefer this technique. However, research so far has been limited and small scale. Both techniques are currently in routine use and the choice of which to use is made by the clinician (anesthetist) in charge of patient care. All anesthetists are trained in both techniques.

The VITAL trial aims to recruit 2,500 patients undergoing major non-cardiac surgery in 40 NHS hospitals. Each patient will be randomized to receive either TIVA or inhalational anesthesia during their surgery, and the researchers will record how much time they have spent at home in the 30 days following their operation. Participants will also be asked about their experience and satisfaction of their type of anesthetic, while the research team will also conduct a cost effectiveness analysis.

The VITAL trial will be partnering with the Perioperative Quality Improvement Programme (PQIP), a national study run by the Health Services Research Centre at the Royal College Anesthetists, to use the same data collection procedures and improve the efficiency of the trial.

Improving outcomes after surgery is a public health research priority for patients, clinicians and the NHS. The lack of robust evidence comparing these two routinely used general anesthetic techniques means that neither can be recommended as standard.

Prompt recovery and discharge from hospital will enhance physical recovery, limiting immobility and physical deconditioning. These aspects are of growing importance as older patients now undergo major surgery more often than ever before. Our findings will help clinicians choose the technique for optimal patient recovery.

Participants will undergo surgery with general anesthesia as planned just like other patients. There are no additional delays or risks to participants. As with all clinical trials, participants will be closely monitored and followed up for 6 months post-surgery.”

Dr Joyce Yeung, Chief Investigator, Warwick Medical School