Inhalational versus Propofol-Based Total Intravenous Anaesthesia: Practice Patterns and Perspectives among Australasian Anaesthetists

Abstract

Increasing evidence suggests that total intravenous anaesthesia (TIVA) may be the preferred anaesthetic for cancer resection surgery. To assist the preparation of a randomised controlled trial (RCT) examining Volatile (versus TIVA) Anaesthesia and Perioperative Outcomes Related to Cancer (VAPOR-C) we developed an 18-question electronic survey to investigate practice patterns and perspectives (emphasising indications, barriers, and impact on cancer outcomes) of TIVA versus inhalational general anaesthesia in Australasia. The survey was emailed to 1,000 (of 5,300 active Fellows) randomly selected Australian and New Zealand College of Anaesthetists (ANZCA) Fellows. The response rate was 27.5% (n=275). Of the respondents, 18% use TIVA for the majority of cases. In contrast, 46% use TIVA 20% of the time or less. Respondents described indications for TIVA as high risk of nausea, neurosurgery, and susceptibility to malignant hyperthermia. Lack of equipment, lack of education and cost were not considered barriers to TIVA use, and a significant proportion (41%) of respondents would use TIVA more often if setup were easier. Of the respondents, 43% thought that TIVA was associated with less cancer recurrence than inhalational anaesthesia, while 46% thought that there was no difference. Yet, only 29% of respondents reported that they use TIVA often or very often for cancer surgery. In Australasia, there is generally a low frequency of TIVA use despite a perception of benefit when compared with inhalational anaesthesia. Anaesthetists are willing to use TIVA for indications where sufficient evidence supports a meaningful level of improvement in clinical outcome. The survey explores attitudes towards use of TIVA for cancer surgery and demonstrates equipoise in anaesthetists' opinions regarding this indication. The inconsistent use of TIVA in Australasia, minimal barriers to its use, and the equipoise in anaesthetists' opinions regarding the effect of TIVA versus inhalational anaesthesia on cancer outcomes support the need for a large prospective RCT.

The intraoperative use of non-opioid adjuvant analgesic agents: a survey of anaesthetists in Australia and New Zealand

“…Regrettably, surveys take time to fill in, and we feel that one questionnaire and one follow up e-mail to a thousand anaesthetists keeps the balance between an acceptable sample size and not harassing our already busy colleagues. Our response rate is similar to recently published surveys from the ANZCA clinical trials network [32–34] and we believe that our results are likely to be representative and are worth reporting. As survey research is vulnerable in that it may deliver socially desirable answers, we have attempted to minimize this by maintaining respondent anonymity [35].…”

Anesthetic technique and cancer outcomes: a meta-analysis of total intravenous versus volatile anesthesia

“…51 Surveys of current clinical practice report that anesthesiologists generally have a preference for volatile anesthesia. 52,53 In a survey of Australasian anesthesiologists, Lim et al reported that [ 80% of Limitations of this study include the retrospective nature of the majority of the studies. The studies also had different follow-up intervals and significant variability of baseline patient demographics.…”

Anesthetics and long-term survival after cancer surgery—total intravenous versus volatile anesthesia: a retrospective study

“…Although it did not include the most recent reports, a meta-analysis of 21,000 patients showed that both recurrence-free survival and overall survival rates were higher in the TIVA group than in the volatile anesthesia group [29]. Despite these data, one survey revealed that most anesthesiologists preferred inhalation anesthesia [30]. As many as 43% of respondents presumed that TIVA could reduce cancer recurrence; however, only 29% of them used TIVA for cancer surgery.…”