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Sleep-Deprived Surgeons

Sat, 11/14/2009 - 11:10am

Sleep deprivation can negatively impact a surgeon’s performance. A recent study examined the effect available pharmacological stimulants have in countering the consequences of long work hours.

November 18, 2009

Sleep deprivation of surgeons can lead to negative effects of the surgical performance and has the potential to hinder patient safety. While we all like our cup of Joe in the morning (and in the midst of a long work shift), sometimes pure coffee just does not cut it.

In a study performed by Patrice Crochet, MD, et al at the Imperial College London in London, England, researchers investigated whether commonly available pharmacological stimulants can counter the effects of fatigue on technical and neurological skills.

In the study, 18 surgical novices trained on a laparoscopic simulator to proficiency. In a single-blinded, cross-over study, study subjects were acutely sleep-deprived three times each. The deprivation was followed by administration of either:

  1. A placebo
  2. Caffeine
  3. Caffeine/Taurine

The outcomes measures were laparoscopic skill, cognitive performance (reaction time and Stroop) and subjective sleepiness scores. Rested baselines were gathered following completion of testing sessions.

After conducting the testing sessions, researchers found that the subjects made more errors and took longer on laparoscopic task when sleep deprived with the placebo than when rested, 65.5 vs. 58.5 errors and taking 40.7 vs. 35.4 seconds, respectively.

Subject sleep deprived with the placebo also had poorer reaction times of 360 vs. 294 msec, Stroop performance, 24043 vs. 18498, and subjective sleepiness of 6 vs. 1.

When the subjects were given caffeine to counter the sleep deprivation, reaction times improved when compared to those with the placeb, with times of 299 vs. 360 msecs. Sleepiness also improved 3 vs. 6 when subjects received caffeine compared to the placebo.

However, the researchers found that caffeine plus taurine led to even greater improved laparoscopic skills performance. Total errors were 74 vs. 58.5 and time was 34.8 vs. 35.4. These results were similar to rested scores, the researchers state.

Sleep deprivation knowingly affects laparoscopic psychomotor skills, neurocognitive functions and subject measures of sleepiness. These factors can significantly hinder a surgeon’s ability to perform on patients the highest level. Yet, there are times when surgeons cannot prevent sleep deprivation on the job.

Researchers in this study conclude that, while further research is required, stimulants such as caffeine and taurine can help counter deterioration of performance due to sleep-deprived surgeons.

Source: "Caffeine and taurine reverse the deterioration in laparoscopic and cognitive skill following sleep deprivation." Patrice Crochet, MD, Rajesh Aggarwal, MD, Amit Mishra, Pramudith Sirimanna BA, Ara Darzi MD, FACS. Imperial College London, London, England

 

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