Two cases show dangers when patients drive home
Two cases from the Canadian Medical Protective Association, a mutual defense organization for 95% of Canadian physicians, illustrate the danger of patients driving home after ambulatory surgery1:
• A 44-year-old man was a healthy American Society of Anesthesiologist Classification 1 (ASA I) patient with no medical history, no mental illness, no history of alcohol use, or history of a motor vehicle accident. He did have a history of occasional use of marijuana. During the initial consultation for an arthroscopy, the surgeon informed the patient that he would have to arrange transportation home on the day of the procedure and that an adult would be required to accompany him home.
On the day of the procedure, the patient presented without an escort and said a friend who had agreed to accompany him was now unavailable. The nursing staff reaffirmed the need for a safe means of transportation home, but the patient was anxious to proceed with surgery. The surgeon and the anesthesiologist were informed, and both decided that the procedure could be performed under local anesthesia. Intraoperatively, he became agitated and required sedation. He was given midazolam 2 mg IV and fentanyl 50 mcg IV as well as increments of propofol to a total dose of 50 mg IV. He remained conscious and alert at all times.
In the post-anesthesia care unit (PACU), he was able to eat and walk before he was allowed to leave. While driving himself home, the patient had an accident by driving off the road. This accident left him quadriplegic. In court, the patient stated that he stopped off the road to doze for a short time and resumed driving shortly before the accident. No evidence of alcohol or drug use was noted by the police. The anesthesiologist was found by the court to be negligent in allowing the patient to drive home after sedation, and the orthopedic surgeon was not found guilty.
• In the second case, a 35-year-old woman was scheduled to undergo dilation and curettage for an early pregnancy under local anesthesia. She was a healthy ASA 1 patient with no medical history, no mental illness, no history of alcohol use, and no history of a motor vehicle accident.
On the day of surgery, the prearranged sitter did not arrive to take care of her young children. The husband had to stay home to attend to the children. The patient arrived for her surgery by herself, and she was upset and crying. The gynecologist ordered oral lorazepam 1 mg as a pre-medication.
The patient underwent a dilation and curettage under local anesthesia with no other medication. In the PACU, a PACU nurse who knew her personally offered her a ride home. The patient refused and drove home alone. Subsequently, she had a car accident with serious injury. She sued the gynecologist who performed the surgery and the pre-op nurse who gave her the pre-medication (not the PACU nurse). The gynecologist and the nurse were found to be negligent for allowing the patient to drive herself home after sedation. A second car was involved in the accident, and the injured parties in the second car also sued and were compensated.
Reference
- Chung F, Assmann N. Car accidents after ambulatory surgery in patients without an escort [Report]. Anes Analg 2008; 106:817-820.
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