Correspondence
They note that the AAGBI’s Guideline for Day Surgery [2] suggests that patients avoid alcohol, driving, and operating machinery for 24 h after a general anaesthetic. This recommendation is based on the work of Chung et al. [3] who examined the simulated driving performance of patients in Canada, 2 h and 24 h after GA. Significant defects in driving performance were found at 2 h, but not at 24 h, after a GA utilising sevoflurane or desflurane for maintenance of anaesthesia. No patients in the study received isoflurane and, pharmacologically, it is not unreasonable to postulate that its residual effects may be apparent for a longer time than after sevoflurane or desflurane. Assuming that task performance under the influence of residual anaesthetic is comparable to task performance under the influence of alcohol, it is interesting to note the work of the economists Levitt and Dubner in their book Superfreakonomics [4]. One section of the book focuses on the imagined choice between driving and walking home from a party while intoxicated with alcohol. Levitt’s analysis of data from the USA suggested that, per mile, walking home while under the influence of alcohol was eight times more lethal to the individual concerned than driving. Clearly this is not an endorsement of drink-driving, given the potential danger to other road users and pedestrians.
Anaesthesia 2014, 69, 1287–1297
Should we also advise our patients to avoid walking down the street after a GA? A. Maddock Western Infirmary, Glasgow, UK Email: [email protected] No competing interests and no funding declared. Previously posted on the Anaesthesia correspondence website: www.anaesthesiacorrespon dence.com.
References 1. Pollard A, Marr R. Driving advice after isoflurane anaesthesia. Anaesthesia 2014; 69: 1062–3. 2. Verma R, Alladi R, Jackson I, et al. Day case and short stay surgery: 2. Anaesthesia 2011; 66: 417–34. 3. Chung F, Kayumov L, Sinclair DR, Edward R, Moller HJ, Shapiro CM. What is the driving performance of ambulatory surgical patients after general anesthesia? Anesthesiology 2005; 103: 951–6. 4. Levitt SD, Dubner SD. Superfreakonomics. New York: William Morrow, 2009. doi:10.1111/anae.12889
A new definition of ‘anaesthesia’ I congratulate Professor Pandit on his recent editorial on the spectrum of brain states that comprise intraoperative awareness, and their complex multi-modal assessment [1]. In support of both his new definition of anaesthesia and his wish to ‘broaden the public view of anaesthetists’ skills’, it may be necessary to elaborate further on using the
term ‘anaesthesia’ in cases where local, regional or neuraxial ‘anaesthesia’ is used for surgery without any co-administration of drugs altering a patient’s mental state. Also, ‘anaesthesia’ can refer to the act itself, as well as to the mental state per se. Perhaps Pandit’s pragmatic definition of ‘anaesthesia’, therefore, should apply only to ‘general anaesthesia’ – or, in keeping with his spirit of reform, be more broadly defined as ‘any reversible drug-induced neurophysiological state (local or general) that makes a given surgical procedure acceptable to the patient throughout its duration, or the act of rendering such a state’. I think that his would better encompass the requisite range of skills that the regular readership of this journal collectively deploy to achieve ‘anaesthesia’, and of which the public should certainly be made more aware. S. Prineas Moorfields Eye Hospital, London, UK Email: [email protected] No external funding and no competing interests declared. Previously posted on the Anaesthesia correspondence website: www.anaesthesia correspondence.com.
Reference 1. Pandit J. Monitoring (un)consciousness: the implications of a new definition of ‘anaesthesia’. Anaesthesia 2014; 69: 801–7. doi:10.1111/anae.12855
Visit the Anaesthesia Correspondence website at http://www.anaesthesiacorrespondence.com and comment on any article or letter in this issue of the Journal. © 2014 The Association of Anaesthetists of Great Britain and Ireland
1297
They note that the AAGBI’s Guideline for Day Surgery [2] suggests that patients avoid alcohol, driving, and operating machinery for 24 h after a general anaesthetic. This recommendation is based on the work of Chung et al. [3] who examined the simulated driving performance of patients in Canada, 2 h and 24 h after GA. Significant defects in driving performance were found at 2 h, but not at 24 h, after a GA utilising sevoflurane or desflurane for maintenance of anaesthesia. No patients in the study received isoflurane and, pharmacologically, it is not unreasonable to postulate that its residual effects may be apparent for a longer time than after sevoflurane or desflurane. Assuming that task performance under the influence of residual anaesthetic is comparable to task performance under the influence of alcohol, it is interesting to note the work of the economists Levitt and Dubner in their book Superfreakonomics [4]. One section of the book focuses on the imagined choice between driving and walking home from a party while intoxicated with alcohol. Levitt’s analysis of data from the USA suggested that, per mile, walking home while under the influence of alcohol was eight times more lethal to the individual concerned than driving. Clearly this is not an endorsement of drink-driving, given the potential danger to other road users and pedestrians.
Anaesthesia 2014, 69, 1287–1297
Should we also advise our patients to avoid walking down the street after a GA? A. Maddock Western Infirmary, Glasgow, UK Email: [email protected] No competing interests and no funding declared. Previously posted on the Anaesthesia correspondence website: www.anaesthesiacorrespon dence.com.
References 1. Pollard A, Marr R. Driving advice after isoflurane anaesthesia. Anaesthesia 2014; 69: 1062–3. 2. Verma R, Alladi R, Jackson I, et al. Day case and short stay surgery: 2. Anaesthesia 2011; 66: 417–34. 3. Chung F, Kayumov L, Sinclair DR, Edward R, Moller HJ, Shapiro CM. What is the driving performance of ambulatory surgical patients after general anesthesia? Anesthesiology 2005; 103: 951–6. 4. Levitt SD, Dubner SD. Superfreakonomics. New York: William Morrow, 2009. doi:10.1111/anae.12889
A new definition of ‘anaesthesia’ I congratulate Professor Pandit on his recent editorial on the spectrum of brain states that comprise intraoperative awareness, and their complex multi-modal assessment [1]. In support of both his new definition of anaesthesia and his wish to ‘broaden the public view of anaesthetists’ skills’, it may be necessary to elaborate further on using the
term ‘anaesthesia’ in cases where local, regional or neuraxial ‘anaesthesia’ is used for surgery without any co-administration of drugs altering a patient’s mental state. Also, ‘anaesthesia’ can refer to the act itself, as well as to the mental state per se. Perhaps Pandit’s pragmatic definition of ‘anaesthesia’, therefore, should apply only to ‘general anaesthesia’ – or, in keeping with his spirit of reform, be more broadly defined as ‘any reversible drug-induced neurophysiological state (local or general) that makes a given surgical procedure acceptable to the patient throughout its duration, or the act of rendering such a state’. I think that his would better encompass the requisite range of skills that the regular readership of this journal collectively deploy to achieve ‘anaesthesia’, and of which the public should certainly be made more aware. S. Prineas Moorfields Eye Hospital, London, UK Email: [email protected] No external funding and no competing interests declared. Previously posted on the Anaesthesia correspondence website: www.anaesthesia correspondence.com.
Reference 1. Pandit J. Monitoring (un)consciousness: the implications of a new definition of ‘anaesthesia’. Anaesthesia 2014; 69: 801–7. doi:10.1111/anae.12855
Visit the Anaesthesia Correspondence website at http://www.anaesthesiacorrespondence.com and comment on any article or letter in this issue of the Journal. © 2014 The Association of Anaesthetists of Great Britain and Ireland
1297
