Large UK trial finds no recovery difference between two general anesthesia methods
A trial of 2,507 patients across 49 NHS hospitals compared total intravenous anesthesia using propofol with inhaled anesthetic gases for major noncardiac surgery. The study found no meaningful difference between the groups in days alive and out of hospital at 30 days, or in major complications, delirium, and death at 30 days, 90 days, and six months. Patients receiving intravenous anesthesia reported less thirst, hoarseness, nausea, and vomiting the day after surgery, but the researchers say anesthetic choice can remain based on patient and clinician preference.
The VITAL trial, run by the University of Warwick and The Royal Marsden NHS Foundation Trust, enrolled 2,507 adults aged 50 or older having planned major noncardiac surgery at 49 NHS hospitals. It compared propofol infusion (TIVA) with inhaled sevoflurane or isoflurane. Results appeared in JAMA.
The primary recovery measure was days alive and outside hospital at 30 days. Major complications, delirium, and death at 30 days, 90 days, and six months were similar. A companion economic analysis in Anaesthesia reported comparable NHS costs and six-month quality of life. Limitations included lack of blinding, NHS-only setting, and no assessment of longer-term cancer or environmental outcomes.
This finding may reassure patients and clinicians that either anesthetic approach is reasonable for major noncardiac surgery, potentially reducing pressure to change practice solely based on recovery claims. Hospitals could maintain local protocols and focus resources on other quality improvements. Patients might benefit from slightly less early nausea, thirst, hoarseness, and vomiting with TIVA, though the trial suggests no broader recovery advantage. Because results come from NHS adults, effects elsewhere may differ.