TOPLINE

Older adults who underwent major noncardiac surgery and received total intravenous anesthesia (TIVA) with propofol infusion did not show significant differences in recovery, survival, or complication rates after surgery relative to those who received inhaled anesthetics.

METHODOLOGY

• Researchers conducted an open-label randomized clinical trial to compare TIVA with inhalational anesthesia for recovery after major noncardiac surgery in patients aged 50 years or older. 
• They included 2508 patients (mean age, 67 years) across 49 UK hospitals between January 2022 and April 2024. 
• Patients were randomly assigned to receive maintenance anesthesia with either a propofol infusion or an inhaled volatile agent (1253 in the TIVA group; 1254 in the inhalational group; 54%-56% men). All other aspects of perioperative care were left to the discretion of the clinicians. 
• The primary outcome was a composite of days alive and at home at 30 days. 
• Secondary outcomes included days alive and at home at 90 days, mortality through 6 months, quality of recovery, and patient satisfaction. Adverse events and other safety outcomes were also assessed. 

TAKEAWAY

• At 30 days, the mean number of days alive and at home was 22.5 days for patients who received a propofol infusion and 22.4 days for those who received inhaled agents, with no significant difference between the groups. 
• No significant differences were observed between the groups in terms of days alive and at home at 90 days; mortality at 30 days, 90 days, or 6 months; or scores for quality of recovery at 3 days. 
• Fewer patients who received propofol infusion vs inhaled agents reported thirst (74% vs 78%), hoarseness (48% vs 54%), and nausea or vomiting (27% vs 36%) on day 1. 
• Major complications occurred in 12.4% of patients overall, with no significant differences in rates between the groups. Two cases of certain or probable unintentional awareness under anesthesia were reported, and both occurred in the propofol infusion group. 

IN PRACTICE

The findings “support that anesthetic choice should be individualized — guided by patient preference, predicted tolerance of postoperative symptoms, clinician expertise, and environmental considerations,” the researchers reported.

SOURCE

The study was led by Shaman Jhanji, MD, PhD, of Royal Marsden NHS Foundation Trust in London, England. It was published online on August 12 in JAMA.

LIMITATIONS

Blinding was not feasible for the study. The trial was conducted only in UK hospitals, limiting generalizability to hospitals in other countries. Most patients were well and underwent elective surgery, which may have restricted applicability of findings to cases of emergency surgery or in patients who were frail or had cognitive impairment.

DISCLOSURES

The study received funding from the UK National Institute for Health and Care Research Health Technology Assessment Programme. One author reported receiving personal fees from Mode Sensors. Another author disclosed receiving personal fees from Invizius.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.