SAMBA Talks eNewsletter - May, 2006

Volume 5, Issue 12

S A M B A T A L K S - PAGE 2

May, 2006

JOIN THE DISCUSSION - TOP

Need advice about a problem case in ambulatory anesthesia? Want suggestions about a difficult situation in your ambulatory surgery center? Have a reply to questions others have raised about ambulatory anesthesia issues?

If you answered "yes" to any of these questions, or would like to share with other professionals a comment or opinion on a topic related to ambulatory anesthesia then please "Join the Discussion" here.

To enter the Discussion with a question, reply, or other comment, please contact us. Your submission will be published in this section of the next available issue of SAMBA TALKS. Include your name (or initials), city, and state, if you would like these published. Please note that because of the high volume of questions we receive, there is often a delay of 1 to 2 months before the questions can be published.

Questions and responses from previous months are now available at the eNewsletter Discussion Archive. If you have any comments regarding the previous questions, please submit them to SAMBA Discussion, and they will be published here next month.

Please note: The information presented in the replies below does not represent SAMBA policy. The replies are solely the opinions of the individuals who wrote them.

?? - LAST MONTH'S QUESTION WITH REPLIES - ?? - TOP

DRIVING AFTER COLONOSCOPY

When should a patient be allowed to drive after receiving propofol anesthesia for a colonoscopy?

-- Naguib R. Khan, MD, Los Angeles, CA

Albeit a very interesting question, there appears to be no definitive answer. What guidelines exist for patients who take an antihistamine or oral narcotics and then choose to drive? Even the recently publicized side effects after the use of Ambien are a cause for concern. The propofol package insert acknowledges the need to avoid driving etc...but gives no specific timeframe. Discharge instructions provided to most patients in ambulatory surgery centers politely "recommend" patients avoid driving for 24 hours. The question is why? Maybe there is no specific guideline about a return to driving or other "psychomotor dependent" activities simply because of the variability among patients. Some patients may receive additional medications as part of their anesthetics - narcotics, benzodiazepines or volatile anesthetics. Still other patients may be on prescription medications that could possibly impact their recovery (i.e.- TCA). In one study, mental impairment could be demonstrated up to 4 days post-op (1). In another, psychomotor testing and blood levels were used to establish criteria similar to those of drunk driving laws (2). Obviously, it is not feasible or practical to draw blood levels for each patient or do psychomotor testing on all patients.

What of the man who leaves the bar only to rely on his own judgment to determine whether to drive himself home? The problem is it is the very beverage they have just consumed that impairs that decision making process? While the designated driver at an outing to the pub, unfortunately, tends to be optional, post surgical patients are required, in most cases by law, to have an escort get them home. Once home, most patients presumably are left alone by their escorts only when they collectively deem it safe to do so...eventually, the patient chooses to drive or even go back to work sometime after that escort has departed and "when they feel up to it". Does everyone wait 24 hours? Does anyone wait 24 hours? Giving each patient "permission" to drive in a somewhat less conservative time frame can have a huge downside since the weakest link can always break the chain. That is, the laws of practicality clash with the ever-present laws of medical liability. Leaving a 24-hour limit probably remains the safest way to protect patients, the doctors that treat them and the public.

--Robert Goldstein, MD, New Rochelle, New York

References

Flatt JR, Birrell PC, Hobbes A. Effects of anesthesia on some aspects of mental functioning of surgical patients. Anesth Critical Care 1984; 12: 315-324
Grant, S.A., Murdoch, J., Millar, K. and Kenny, G.N.C. Blood propofol concentration and psychomotor effects on driving skills. British Journal of Anesthesia, 2000; 85: 396-400

Our center uses a purely legal approach to this problem. We tell our patients not to drive or make any legal decisions until the next day. We tell them they may feel fine but still be "under the influence" just as if they had several alcoholic drinks. While patients done early in the day will certainly be over the effects of the drug by evening, it is just simpler to have a blanket statement, plus it offers protection from our friends the lawyers should an accident occur.

-- Kurt Slotabec, MD, Bradenton, FL

?? -- THIS MONTH'S QUESTION -- ?? - TOP

I'm not sure if you can offer me assistance. I am designing a new office location. I would like to create an ambulatory surgery center with the ability to use general anesthesia with intubated, ventilated patients. I don't know what the requirements are for this, or whom to speak with to determine how to create this in my new office.

-- Elliot Baron, DDS, Red Bank, NJ

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