Fatigue and the Anaesthetist
Anaesthesia requires:
- High level of knowledge
- Sound judgment
- Fast and accurate responses to rapidly evolving scenarios
- Extended periods of vigilance
Fatigue
Fatigue may:
- Impair:
- Vigilance
- Accuracy
- Judgment
- Communication
- Reduce psychomotor performance
17 hours equivalent to a BAC of 0.05%, and 24 hours equivalent to 0.1%. - Contribute to adverse events and critical incidents
Highest risk between 0300 and 0700, and 1300 and 1600. - Be unrecognised by individuals
Minimisation
Effects may be minimised by:
- Naps
- 2 hour nap prior to night duty
- 30 minute nap during night duty
- Naps are followed by a period of “sleep inertia”
15-30 minute period of impaired performance after waking.
- Sleep as soon as possible after night duty
- Proper nutrition and hydration
Out-of-hours procedures for:
- Continuation of prolonged or complex elective procedures that were started during the day
- Life, limb, or organ-threatening cases
- Procedures where delay may result in significant harm
- Obstetrics
Responsibilities
Anaesthetists should:
- Organise their life so fatigue does not impact on clinical duties
- Ensure they have 8 hours off duty prior to starting their next clinical commitment
- Not proceed with clinical duties if fatigue may interfere with safe patient care
Clinical commitments after out-of-hours work should be covered by a colleague or postponed until adequate rest has been taken.
Organisations should:
- Provide a safe working environment
- Not commence procedures after 10pm unless they are life-, limb-, or organ-threatening
- Minimise long shifts:
- Over 12 hours is not recommended
- Planned shifts should always be below 16 hours
- Provide rest facilities
- Provide safe commuting options in case of fatigue
e.g. Reimburse taxi fare.