Volatile vs Total intravenous Anaesthesia for major non-cardiac surgery: A pragmatic randomised trial - VITAL

VITAL is a clinical trial to test whether total intravenous anaesthesia (TIVA) is better than inhalational anaesthesia for patients undergoing major non-cardiac surgery in the NHS. The two main anaesthetic techniques are inhalational anaesthesia (patient inhales volatile anaesthetic gases) and TIVA (patient receives intravenous infusion of anaesthetic drug). Inhalational anaesthesia is historically more popular, but many anaesthetists are changing to TIVA on the basis of low-quality data on cancer recurrence and greenhouse gas effects. The VITAL trial will provide robust generalisable data comparing each technique in terms of patient recovery, survival and safety. VITAL will test whether TIVA is superior to inhalational anaesthesia in terms of days alive and at home at 30 days (DAH30), survival and quality of recovery amongst patients undergoing major non-cardiac surgery. VITAL will also evaluate the safety of TIVA, in particular accidental awareness under anaesthesia and assess the cost-effectiveness of TIVA. We have partnered with the Perioperative Quality Improvement Programme (PQIP), a large national cohort study recruiting patients undergoing major non-cardiac surgery. VITAL will use the PQIP data collection procedures to maximise efficiency and reduce research burden. VITAL will look to recruit 2500 patients undergoing major non-cardiac surgery in 40 NHS hospitals. As well as clinical outcomes, VITAL will include a SWAT(Study Within A Trial): Rapid qualitative study of patient consent to examine ways of co-recruiting and consenting patients to complementary studies and explore patient, carer and staff views and experiences with different recruitment approaches.

VITAL is funded by NIHR-HTA and has a website containing more information:

  • Chief Investigators: Dr Joyce Yeung, University of Warwick & Dr Shaman Jhanji, The Royal Marsden NHS Foundation Trust