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Does fatigue affect experienced providers' performance during obstetric anesthesia simulation?
Abstract Number: T 23
Abstract Type: Original Research
Intro: Fatigue affects performance, and work hours for physicians in training have been reduced in the last 10 years due to concerns about diminished performance during sleep deprivation.1,2 Little data regarding performance while fatigued is available for experienced physicians, who have no restrictions on duty hours. Obstetric anesthesia cases often occur overnight and many providers work prolonged shifts. We sought to determine whether fatigue affects experienced anesthesiologists’ performance during a simulated emergency cesarean delivery under general anesthesia.
Methods: Attending anesthesiologists from a single private practice center were recruited to perform a simulated general anesthetic for emergency cesarean delivery on two separate days, one post-call (FATIGUED state) and one not post-call (RESTED state). Order of simulation completion was randomly assigned. General sleep patterns and fatigue were assessed using the Epworth Sleep and Stanford Sleepiness scales, respectively.3,4 Amount of sleep the night prior to simulation was collected via sleep diary. Simulations were recorded and scored by two blinded attending anesthesiologists using a previously validated scoring tool.5 Hours slept, Stanford sleepiness scale scores, and performance scores in FATIGUED and RESTED groups were compared using the unpaired t–test with P value < 0.05 required to reject the null hypothesis.
Results: Baseline sleep patterns for all participants were normal per the Epworth sleep scale, and no one reported a sleep disorder. Stanford sleepiness scale scores were significantly greater for the FATIGUED versus RESTED group (4.27 vs 1.69, P < 0.005). Sleep in the FATIGUED group was significantly reduced compared to RESTED group (2.34 hr vs. 6.85 hr, P < 0.0001). Performance between groups was not different based on order of completion (P = 0.93), indicating learning between simulations did not bias results. Performance scores were not different between the FATIGUED and RESTED groups (137.6 vs 127, P = 0.059).
Discussion: In this study fatigue was not associated with diminished performance during simulated general anesthesia for emergency cesarean delivery. However a trend toward diminished performance was present and our study may have been underpowered to detect it. Therefore we are planning a larger study to address the issue. An alternative explanation is that the decreased performance seen in fatigued resident physicians in previous studies1 is mitigated by experience.
1. Philibert: Sleep. 2005 Nov;28(11):1392
3. Johns: Sleep. 1991;14 (6): 540
4. Hoddes: Psychophysiology 1972;9:150
5. Scavone: Anesthesiology 2006;105:260