Somerset doctors praised for great effort in promoting anaesthetics trial

Two consultant anaesthetists in Somerset have been praised for their outstanding contribution to an important research study that’s aiming to find the best way of using anaesthetic during major surgery.

The ‘Volatile Vs Total Intravenous Anaesthesia’ study, also known as VITAL, aims to answer whether total intravenous anaesthesia – given through the patient’s veins – is a better option than the more commonly used volatile anaesthesia – which is inhaled through a breathing tube while they’re asleep.

Dr Agnieszka Kubisz-Pudelko from Yeovil District Hospital and Dr Tom Teare from Musgrove Park Hospital have been working closely with our research team to recruit patients who need major surgery into the study, where they’ll be randomly assigned one of the two options of anaesthetic.

Dr Kubisz-Pudelko explains: “We’re honoured to be taking part in this exciting study alongside 39 other NHS trusts in England, where we’re looking to test whether the way we maintain anaesthesia – intravenous or inhalational – during a procedure is related to the patient’s outcome, as well as looking at its cost effectiveness.

“Over 1.5 million people need a general anaesthetic for major surgery every year in the NHS, and we want to recruit 2,500 of these patients into the study, a good representative sample that should give us a picture of which option works best.

“During a total intravenous anaesthetic, the patient breathes oxygen through a tube, but is kept asleep by drugs given into a vein.

“Many anaesthetic doctors believe patients recover more quickly using this technique, and a number of smaller studies that have already run suggest that patients prefer this option too.

“The evidence for this type of anaesthetic has been really positive so far and has given us a good indication, but it was from very small clinical trials, so we’re hoping the VITAL study will bring more clear evidence.

“We know from this previous research that using total intravenous anaesthesia can influence the level of post-operation quality of recovery, such as a shorter time waking up and experiencing the same symptoms as a hangover, but we don’t know the long term effects yet – this study will hopefully help us to find out.

“If we know which technique works better, it could mean we can help our patients return home earlier after surgery, as well as giving them a more positive all-round experience. Our findings should help doctors to select the best method to improve care and reduce harm for many patients.”

Dr Joyce Yeung, chief investigator of the VITAL study, which is based at the University of Warwick, recently wrote to our trust to praise the work done by Dr Kubisz-Pudelko, Dr Teare, and our research team.

She said: “As with all portfolio studies, we are reliant on the enthusiasm and dedication of our local principal investigators, and we’d like to highlight the work that Dr Kubisz-Pudelko and Dr Teare have undertaken in Somerset.

“Dr Kubisz-Pudelko, Dr Teare, and the enthusiastic research team have been a great asset to the trial, not only recruiting patients, but also helping and advising other centres and proving to be an exemplar of practice in the UK.

“The team has put a lot of effort and time into VITAL and the current excellent recruitment into the trial is thanks to the dedicated of principal investigators like Dr Kubisz-Pudelko and Dr Teare.”

Lucy Pippard, one of our clinical research nurses involved in running the study at YDH, explains how it works in practice and how patients can get involved.

“We regularly screen both our theatre lists and those patients discussed at our colorectal multidisciplinary team meetings, based on a set type of operation that’s suitable for the study,” she said.

“Once we’ve identified a patient, we give them information about the study, either during their clinic appointment or via a letter in the post, and from there we go through the standard consent process, if they’re interested in taking part.

“Before their surgery, the patient will be randomised into one of the two anaesthetic options, and then we’ll monitor their recovery.”

Linda Howard, one of our clinical research assistant practitioners who’s also part of the team running the study at YDH, added: “So far, we’ve recruited 132 patients into the study across both hospitals, and it has been very well received by those who’ve chosen to take part.

“We know that the choice of anaesthetic used is traditionally a personal preference by the anaesthetist themselves, but as this study will randomly assign the method of anaesthetic, we’re asking our colleagues to consider being open to possibilities and potential outcomes, especially as it could provide robust evidence to support the work of their field.

“Patients have told us that as both methods are perfectly safe, they are happy to help us determine which could help them to recover from surgery more quickly.

“As we know this can be quite a complicated subject for patients, Dr Kubisz-Pudelko and Dr Teare are committed to contacting those who are thinking about becoming involved in the study directly to explain how it works and answer any questions they may have.”

Karen Roberts, one of our clinical trials officers who’s involved in the study at MPH, said: “Patient involvement in this study has been extraordinary, with so many of the eligible patients we approach really keen to take part.

“Patients are willing to talk to the research team on a regular basis, completing all the study follow up questionnaires over a period of six months.

“I’ve found that patients are truly grateful for the additional contact in the days following their surgery, with many telling us that they feel helpful in giving something back to the NHS.”

Dr Teare adds: “As a National Institute of Healthcare Research (NIHR) study, VITAL also allows our trust to be a leader in developing the next generation of clinical researchers, for example one of our postgraduate anaesthetic doctors, Dr Peggy Fooks, is our associate principal investigator.

“This is a nationally approved training position where postgraduate doctors in training get to work within a research team to contribute and learn about clinical trials, with the aim of leading their own studies in the future.”