How Much Difference Does Choice Of Anesthetic Make, For Surgery Recovery?

Having a major surgery can be quite nerve-wracking (this writer had one six months and one week ago at time of writing, and yes, I was very anxious about it), and most certainly, we want everything to go perfectly. Anything that can be made better, safer, easier, we want it.

So, given the complexities associated with anesthetic (and the fact that in the first instance, the anesthetic itself is also something from which we need to recover), what difference does the choice of anesthetic make to recovery thereafter?

The VITAL difference?

Researchers (Dr. Louise Hiller et al.) did a big (n=2,507) randomized (but not controlled) trial, in patients aged 50 and older across 49 hospitals, comparing total intravenous anesthesia (TIVA) with inhaled anesthetic gases during major planned noncardiac surgery.

You may be wondering: why was there no control?

And the answer is: for some mysterious reason, the ethics board would not let them give real anesthetic to just half the patients undergoing major surgery, and placebo anesthetic to the others undergoing major surgery.

The main results, in few words: there was no meaningful difference between the groups in the number of days patients were [alive and] out of hospital 30 days after surgery.

The secondary results, in even fewer words: the rates of major complications, delirium, and death were similar at 30 days, 90 days, and 6 months after surgery.

The only meaningful difference found was that patients receiving TIVA reported less thirst, hoarseness, nausea, and vomiting on the day after surgery, suggesting some benefits for early postoperative comfort.

Writer’s anecdote: that’s also what I had (TIVA), and when I woke up, I was a bit cold in the first few minutes (fully expected, and it’s because literally a cold liquid has been put in my bloodstream so of course I’m cold), but otherwise had no side effects at all.

You can find the paper itself, here: Total Intravenous vs Volatile Inhalational Anesthesia for Major Noncardiac Surgery: A Randomized Clinical Trial

And if you’re curious as to how anesthesia works: How Does Anesthesia Work? ← usual answer from the scientific community is “it works very well, thank you”, since really we mostly don’t know how anesthesia works, just that it works, though we do (in most recent times) have some knowledge of some aspects at least.

Want to learn more?

It’s good to be well-prepared before any surgery, so consider: What To Eat, Take, & Do Before & After A Surgery

We also recommend checking out: Nobody Likes Surgery, But Here’s How To Make It Much Less Bad: The Insider’s Guide To Making Hospital As Comfortable As Possible

…and that featured expert’s book: Calm For Surgery – by Dr Chris Bonney

Take care!