What Is the Driving Performance of Ambulatory Surgical Patients after General Anesthesia?
| Autor: | David R. Sinclair, Reginald Edward, Leonid Kayumov, Frances Chung, Colin M. Shapiro, Henry J. Moller |
|---|---|
| Rok vydání: | 2005 |
| Předmět: |
Adult
Male Automobile Driving medicine.medical_specialty Microsleep Midazolam Sedation Nitrous Oxide Poison control Anesthesia General medicine Humans Attention Computer Simulation Prospective Studies Propofol Fatigue Pain Measurement Pain Postoperative Psychomotor function business.industry Electroencephalography Perioperative Circadian Rhythm Fentanyl Alertness Anesthesiology and Pain Medicine Ambulatory Surgical Procedures Anesthesia Anesthetic Ambulatory Physical therapy Female medicine.symptom business Anesthetics Intravenous Psychomotor Performance Adjuvants Anesthesia medicine.drug |
| Zdroj: | Anesthesiology. 103:951-956 |
| ISSN: | 0003-3022 |
| Popis: | Background: Ambulatory surgical patients are advised to refrain from driving for 24 h postoperatively. However, currently there is no strong evidence to show that driving skills and alertness have resumed in patients by 24 h after general anesthesia. The purpose of this study was to determine whether impaired driver alertness had been restored to normal by 2 and 24 h after general anesthesia in patients who underwent ambulatory surgery. Methods: Twenty patients who underwent left knee arthroscopic surgery were studied. Their driving simulation performance, electroencephalographically verified parameters of sleepiness, subjective assessment of sleepiness, fatigue, alertness, and pain were measured preoperatively and 2 and 24 h postoperatively. The same measurements were performed in a matched control group of 20 healthy individuals. Results: Preoperatively, patients had significantly higher attention lapses and lower alertness levels versus normal controls. Significantly impaired driving skills and alertness, including longer reaction time, higher occurrence of attention lapses, and microsleep intrusions, were found 2 h postoperatively versus preoperatively. No significantly differences were found in any driving performance parameters or electroencephalographically verified parameters 24 h postoperatively versus preoperatively. Conclusions: Patients showed lower alertness levels and impaired driving skills preoperatively and 2 h postoperatively. Based on driving simulation performance and subjective assessments, patients are safe to drive 24 h after general anesthesia. GENERAL anesthetic agents impair psychomotor function. 1– 4 Some of these medications impair skills related to driving among volunteers for 8 h. 3,5 Despite inadequate studies of driving skills beyond 8 h after anesthesia, patients are advised to refrain from driving for 24 h after general anesthesia. Many of the general anesthetic agents that impair skills related to driving and contributed to our current recommendations about driving after general anesthesia are not used in ambulatory anesthesia. 6,7 Newer, shorter-acting agents provide faster recovery and earlier return to normal daily activity. Some general anesthetic agents have been shown to permit prompt return of driving skills among volunteers. 8 In a study of 12 volunteers, there was no significant difference in postanesthetic driving skills at 2, 3, and 4 h after anesthesia and the corresponding control sessions. However, healthy volunteers differ from patients, who may experience perioperative anxiety, sleep deprivation, and postoperative pain. In addition, many patients may receive preoperative sedative medication and postoperative analgesics or antiemetics. The omission of these medications from this study of volunteers highlights the need to study ambulatory surgical patients. Furthermore, postoperative sedation from the anesthetic agents may lead to decreased alertness and drowsiness, an important cause of vehicle crashes. 9 Driving impairment due to postanesthetic drowsiness has never been studied. We hypothesized that impaired driving skills and decreased alertness would resolve by 24 h after general anesthesia among certain ambulatory surgical patients. |
| Databáze: | OpenAIRE |
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