Total Intravenous vs Volatile Inhalational Anesthesia for Major Noncardiac Surgery: A Randomized Clinical Trial.
Shaman Jhanji, Katie Booth, Louise Hiller et al.
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In 30 seconds
This randomized clinical trial compared total intravenous anesthesia (TIVA) with volatile inhalational anesthesia in 2508 older adults (aged 50+) undergoing major noncardiac surgery. The primary outcome, days alive and at home at 30 days, was similar between TIVA (22.5 days) and inhalational anesthesia (22.4 days), with an incidence rate ratio of 1.00 (95% CI, 0.99-1.02; adjusted P = .68).
Key findings
- Days alive and at home at 30 days were 22.5 for TIVA vs 22.4 for inhalational anesthesia.
- No significant differences in mortality at 30 days, 90 days, or 6 months between groups.
- Lower rates of thirst, hoarseness, and nausea were reported in the TIVA group.
- Major complications occurred in 12.4% of patients overall, with no significant between-group differences.
Why it matters
Understanding the effectiveness of anesthesia types in older adults is crucial, as postoperative recovery can significantly impact their overall health and healthcare utilization. This study provides evidence that TIVA does not offer a clear advantage over inhalational anesthesia in this population.