What Is the Driving Performance of Ambulatory Surgical Patients After General Anesthesia?

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.

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Dynamic Cortical Connectivity during General Anesthesia in Surgical Patients

Anesthesiology ◽

10.1097/aln.0000000000002677 ◽

2019 ◽

Vol 130 (6) ◽

pp. 885-897 ◽

Cited By ~ 18

Author(s):

Phillip E. Vlisides ◽

Duan Li ◽

Mackenzie Zierau ◽

Andrew P. Lapointe ◽

Ka I. Ip ◽

...

Keyword(s):

Functional Connectivity ◽

General Anesthesia ◽

Temporal Dynamics ◽

Transition Probabilities ◽

Surgical Patients ◽

Phase Lag ◽

Cortical Connectivity ◽

Single Measure ◽

Connectivity Patterns ◽

Weighted Phase Lag Index

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Functional connectivity across the cortex has been posited to be important for consciousness and anesthesia, but functional connectivity patterns during the course of surgery and general anesthesia are unknown. The authors tested the hypothesis that disrupted cortical connectivity patterns would correlate with surgical anesthesia. Methods Surgical patients (n = 53) were recruited for study participation. Whole-scalp (16-channel) wireless electroencephalographic data were prospectively collected throughout the perioperative period. Functional connectivity was assessed using weighted phase lag index. During anesthetic maintenance, the temporal dynamics of connectivity states were characterized via Markov chain analysis, and state transition probabilities were quantified. Results Compared to baseline (weighted phase lag index, 0.163, ± 0.091), alpha frontal–parietal connectivity was not significantly different across the remaining anesthetic and perioperative epochs, ranging from 0.100 (± 0.041) to 0.218 (± 0.136) (P > 0.05 for all time periods). In contrast, there were significant increases in alpha prefrontal–frontal connectivity (peak = 0.201 [0.154, 0.248]; P < 0.001), theta prefrontal–frontal connectivity (peak = 0.137 [0.091, 0.182]; P < 0.001), and theta frontal–parietal connectivity (peak = 0.128 [0.084, 0.173]; P < 0.001) during anesthetic maintenance. Additionally, shifts occurred between states of high prefrontal–frontal connectivity (alpha, beta) with suppressed frontal–parietal connectivity, and high frontal–parietal connectivity (alpha, theta) with reduced prefrontal–frontal connectivity. These shifts occurred in a nonrandom manner (P < 0.05 compared to random transitions), suggesting structured transitions of connectivity during general anesthesia. Conclusions Functional connectivity patterns dynamically shift during surgery and general anesthesia but do so in a structured way. Thus, a single measure of functional connectivity will likely not be a reliable correlate of surgical anesthesia.

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