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General anesthesia and simulator driving skills

Durham, North Carolina

To the Editor:

I would like to commend Sinclair et al.¹ on their recent article but take issue with certain points.

In their introduction they quote Kortilla’s² work from 1977 and state no one has addressed fitness to drive following newer anesthetics. In 2000, we published two papers in the British Journal of Anesthesia. The first addressed the issue of using alcohol as a comparator for recovery from anesthesia³ and the second examined recovery after propofol.⁴

In Sinclair’s study mean ± 2 SD alcohol concentration ranges widely from 0.061 to 0.097% blood alcohol concentration (BAC). We also found a wide range of BAC using the oral dose and suggested an iv infusion to reduce this. At lower alcohol concentrations we found a similar impairment to Sinclair.

The use of a driving simulator is to be applauded but a lack of real life applicability can be seen when before alcohol the subjects had a mean of two crashes in a short 20 min run. This does not appear to be a real-life simulation.

Previous investigators demonstrated impairment in psychomotor performance for four postoperative days.⁵ Should driving be banned until psychomotor performance on all tests returns to normal? It could be argued that a small degree of impairment, similar to that seen with a BAC of 0.02% (or propofol 0.2 µg•mL^-1) would be acceptable to drivers. The impairment seen at this level must be compared with that measured in patients receiving antidepressants or antihistamines. This is an issue that needs full and widespread debate.

References

1 Sinclair DR, Chung F, Smiley A. General anesthesia does not impair simulator driving skills in volunteers in the immediate recovery period - a pilot study. Can J Anesth 2003; 50: 238–45.[Abstract/Free Full Text]

2 Kortilla K, Tammisto T, Ertama P, Pfaffli P, Blomgren E, Hakkinen S. Recovery, psychomotor skills, and simulated driving after brief inhalational anesthesia with halothane or enflurane combined with nitrous oxide and oxygen. Anesthesiology 1977; 46: 20–7.[Medline]

3 Grant SA, Millar K, Kenny GN. Blood alcohol concentration and psychomotor effects. Br J Anaesth 2000; 85: 401–6.[Abstract/Free Full Text]

4 Grant SA, Murdoch J, Millar K, Kenny GN. Blood propofol concentration and psychomotor effects on driving skills. Br J Anaesth 2000; 85: 396–400.[Abstract/Free Full Text]

5 Flatt JR, Birrell PC, Hobbes A. Effects of anaesthesia on some aspects of mental functioning of surgical patients. Anaesth Intensive Care 1984; 12: 315–24.[Medline]

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