Using alcohol as a standard to assess the degree of impairment induced by sedative and analgesic drugs used in ambulatory surgery.
BACKGROUND
There is a need for a standard by which to compare the degree of subjective and behavioral impairment caused by anesthetic drugs, because anesthesiologists may not be able to gauge how extreme or important a statistically significant change in psychomotor functioning is. This study examined the psychomotor and subjective effects of alcohol at blood concentrations equal or greater than 0.10% as a standard with which to compare those effects caused by sedative and analgesic agents commonly used in ambulatory surgery.


METHODS
Twelve healthy human volunteers (11 men and 1 nonpregnant woman), with an average age of 28 yr (range 24-34 yr) and an average alcohol consumption of four drinks per week, were selected in this institutional review board-approved study. Each subject was exposed to five drug conditions (70 mg/70 kg propofol intravenously, 2 mg/70 kg midazolam intravenously, 50 micrograms/70 kg fentanyl intravenously, 0.8 g/kg alcohol orally, and placebo orally and intravenously) in a double-blind randomized fashion over five weekly sessions. Testing was done at baseline and at different intervals until 240 min after drug administration. Testing included psychomotor performance (Maddox Wing, eye-hand coordination, auditory reaction time test, and digit symbol substitution test), subjective effects (strength of drug effect scale, drug liking scale, and visual analog scale), and short-term memory. Psychomotor performance was used as an index of objective impairment, and mood was used as an index of subjective impairment.


RESULTS
After consumption of the alcoholic beverage, a blood alcohol level of 0.11 +/- 0.003% (mean +/- SE) was obtained at 15 min after injection. The study drugs not only produced statistically significant impairment (i.e., impairment greater than that seen with placebo) but also, at one or more times after injection, produced impairment similar to that observed with alcohol at a blood alcohol concentration of 0.11%. Midazolam produced a similar degree of impairment to that of alcohol for a longer duration than did fentanyl and propofol.


CONCLUSIONS
This study provides evidence that degree of impairment caused by sedative and analgesic drugs used in ambulatory surgery is similar to that obtained with a dose of alcohol that produces a blood alcohol concentration of 0.11%. We suggest that anesthesiologists can use alcohol as a standard by which to assess degree of impairment produced by drugs used for sedation/analgesia.
Thapar
P
P
Department of Anesthesia and Critical Care, University of Chicago, Illinois 60637.
Zacny
J P
JP
Thompson
W
W
Apfelbaum
J L
JL
D000284:Administration, Oral; D000328:Adult; D000556:Ambulatory Surgical Procedures; D004311:Double-Blind Method; D000431:Ethanol / Q000009:adverse effects* / Q000097:blood; D005260:Female; D005283:Fentanyl / Q000009:adverse effects*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008570:Memory, Short-Term / Q000187:drug effects; D008874:Midazolam / Q000009:adverse effects*; D015742:Propofol / Q000009:adverse effects*; D011446:Prospective Studies; D011597:Psychomotor Performance / Q000187:drug effects*; D012015:Reference Standards
D000431:Ethanol; D008874:Midazolam; D005283:Fentanyl; D015742:Propofol