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Choice of general anesthetic for major surgery can continue to be based on patient and clinician preference, according to the largest-ever trial comparing the two main techniques used in the NHS.

The VITAL trial, led by the University of Warwick and The Royal Marsden NHS Foundation Trust, involved 2,507 patients across 49 NHS hospitals and compared total intravenous anesthesia (TIVA), delivered through a continuous infusion of the drug propofol, with the more traditional method of using volatile anesthetic gases, such as sevoflurane or isoflurane, inhaled through a mask during surgery. The findings are published in the journal JAMA.

Both approaches are used routinely to keep patients unconscious during the more than 1.5 million major noncardiac operations carried out in the U.K. each year. Some anesthesiologists have argued that TIVA offers a smoother recovery, with less sickness and pain, while others have pointed to rare risks such as a patient briefly regaining awareness during surgery. Until now, no large-scale U.K. trial had settled which technique, if either, was better for patients or the health service.

Patients ages 50 and older undergoing major planned surgery were randomly allocated to receive either TIVA or inhalational anesthesia. The results found no meaningful difference between the two groups in the number of days patients were alive and out of hospital 30 days after surgery, the trial's main measure of recovery.

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