VITAL Finds No Recovery Benefit With TIVA

TIVA Does Not Improve 30-Day Recovery After Major Noncardiac Surgery

A randomized clinical trial in JAMA found that total intravenous anesthesia (TIVA) did not improve days alive and at home at 30 days compared with volatile inhalational anesthesia among adults aged 50 years or older undergoing elective major noncardiac surgery.

The pragmatic, multicenter, open-label VITAL (Volatile vs Total Intravenous Anesthesia for Major Non-Cardiac Surgery) trial was conducted at 49 UK National Health Service hospitals from January 2022 through April 2024. Investigators randomized 2508 participants 1:1 to maintenance of general anesthesia with propofol-based TIVA or volatile inhalational agents, while other perioperative care remained at clinicians’ discretion. The primary outcome was days alive and at home at 30 days.

Mean days alive and at home at 30 days were 22.5 with TIVA and 22.4 with inhalational anesthesia (incidence rate ratio, 1.00; 95% CI, 0.99-1.02; adjusted P=.68). No significant between-group differences were detected in days alive and at home at 90 days, mortality at 30 days, 90 days, or 6 months, or Quality of Recovery–15 scores at day 3.

Exploratory patient-satisfaction analyses found lower reported rates of thirst (74% vs 78%), hoarseness (48% vs 54%), and nausea and vomiting (27% vs 36%) with TIVA. A total of 312 participants (12.4%) developed a postoperative complication of Clavien-Dindo grade II or higher: 154 in the TIVA group and 158 in the inhalational group. Delirium rates were similar between groups. The 2 cases of certain or probable unintentional awareness under anesthesia both occurred in the TIVA group.

The authors noted that blinding was not feasible. Generalizability to emergency surgery or non-UK settings remains uncertain because the trial included elective surgery within the UK National Health Service, and most participants were classified as well and underwent intra-abdominal procedures. The investigators concluded that the exploratory comfort differences did not translate into lower complication rates or better longer-term recovery.

Source: Jhanji S, Booth K, Hiller L, et al. Total intravenous vs volatile inhalational anesthesia for major noncardiac surgery: a randomized clinical trial. JAMA. Published online August 12, 2026. doi:10.1001/jama.2026.11065