title: Objective and subjective impairment from often-used sedative/analgesic combinations in ambulatory surgery, using alcohol as a benchmark.
abstract: Impairment caused by different sedative/analgesic combinations commonly used in ambulatory settings was compared to that of alcohol at blood alcohol concentrations (BACs) higher than or equal to 0.10%. Impairment was measured via subjective (mood) and objective (psychomotor performance) assays. Twelve healthy human volunteers (10 males and 2 females; age range 21-34 yr) participated in this prospective, double-blind, randomized, cross-over study. Each subject was exposed to five drug conditions across 5 wk. Each of the following drug conditions were adjusted for body weight (per 70 kg):fentanyl 50 micrograms and propofol 35 mg (FP), fentanyl 50 micrograms and midazolam 2 mg (FM), fentanyl 50 micrograms, midazolam 2 mg, and propofol 35 mg (FMP), alcohol 56 g (orally administered), and placebo (PLC). With the exception of alcohol, the other drugs were administered via the intravenous route. Tests for psychomotor performance, subjective effects, and short-term memory were done at baseline, and at different intervals until 240 min postinjection. Psychomotor impairment caused by alcohol at 15 min postingestion (at a BAC of 0.11% +/- 0.03% [mean +/- SE]) was used as a benchmark with which impairment caused by other sedative/analgesic combinations was compared. All the study drug combinations produced impairment (i.e., impairment greater than that seen with PLC), similar to that observed with alcohol at a BAC of 0.11%. We have demonstrated that some sedative/analgesic drug combinations used in anesthesia for ambulatory procedures produce impairment similar to or greater than that observed with a large dose of alcohol.
authors.affiliation: Department of Anesthesia and Critical Care, University of Chicago, IL 60637, USA.
authors.forename: P
authors.initials: P
authors.lastname: Thapar
authors.forename: J P
authors.initials: JP
authors.lastname: Zacny
authors.forename: M
authors.initials: M
authors.lastname: Choi
authors.forename: J L
authors.initials: JL
authors.lastname: Apfelbaum
mesh_terms: D000328:Adult; D000339:Affect / Q000187:drug effects*; D000556:Ambulatory Surgical Procedures; D000700:Analgesics / Q000008:administration & dosage / Q000494:pharmacology*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D000431:Ethanol / Q000494:pharmacology*; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000494:pharmacology; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000494:pharmacology*; D008297:Male; D008570:Memory, Short-Term / Q000187:drug effects; D008874:Midazolam / Q000008:administration & dosage / Q000494:pharmacology; D015742:Propofol / Q000008:administration & dosage / Q000494:pharmacology; D011446:Prospective Studies; D011597:Psychomotor Performance / Q000187:drug effects*
chemical_list: D000700:Analgesics; D006993:Hypnotics and Sedatives; D000431:Ethanol; D008874:Midazolam; D005283:Fentanyl; D015742:Propofol