Portal de Periódicos da CAPES

Driving advice after isoflurane anaesthesia

2014; Wiley; Volume: 69; Issue: 9 Linguagem: Inglês

10.1111/anae.12809

1365-2044

Alison J. Pollard, R. Marr,

Anesthesia and Pain Management

Changes to the Summary of Product Characteristics (SPC) for isoflurane in August 2013, state that “patients should be advised that performance of activities requiring mental alertness, such as operating a motor vehicle or hazardous machinery, may be impaired for 2–4 days after anaesthesia with isoflurane” 1. Previously, the SPC stated that driving or working machinery should be avoided for at least 24 hours. The reason for this change is listed as “Marketing Authorisation Holder details changed to reflect the company change from Abbott to AbbVie.” 2. It is unclear on what justification the change to the SPC was made. In contrast, the SPC information for sevoflurane states “patients should be advised that performance of activities requiring mental alertness, such as operating a motor vehicle or hazardous machinery, may be impaired for some time after general anaesthesia” 3. Propofol's SPC also opts for the more vague “Patients should be advised that performance at skilled tasks, such as driving and operating machinery, may be impaired for some time after general anaesthesia”4. Desflurane's SPC states that “patients should be advised that the ability to perform tasks such as driving or operation of machinery may be impaired after general anaesthesia, and it is advisable to avoid such tasks for a period of 24 hours” 5. At present in our hospital, we advise patients not to drive/cook/operate machinery for 24 hours after anaesthesia. We are very concerned that this change to the SPC of isoflurane has not been well publicised and has potentially serious medicolegal implications for anaesthetists, should a patient, for example, be involved in a traffic collision when driving three days after surgery. The Royal College of Anaesthetists website states “current advice is that it is not usually safe to drive or drink alcohol until at least 24 hours after a general anaesthetic” 6. The Association of Anaesthestists of Great Britain and Ireland states “advice should be given not to drink alcohol, operate machinery or drive for 24 h after a general anaesthetic” 7, which is based on previously published work 8. We are uncertain as to whether we should review our advice to patients and urge both the AAGBI and the Royal College to issue new statements that take into consideration the revised isoflurane SPC advice.