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Chapter 30: Special Problems or Issues in Anesthesiology

In order to reduce fatigue and sleep deprivation, resident work hours are regulated. Fatigue can be an important cause of performance errors. A performance error due to sleep vulnerability is most likely to occur at what time of day?

(A) between 0200 and 0700

(B) between 0700 and 1200

(C) between 1200 and 1700

(D) between 1700 and 2200

(E) between 2200 and 0200

The answer is A. The time between 0200 and 0700 (2 am and 7 am) represents the time when a person is most vulnerable to sleep (the second most vulnerable time is from 2 pm to 6 pm). In order the reduce the potential risk for performance errors due to sleep deprivation and fatigue, there are regulations set by the Accreditation Council for Graduate Medical Education (ACGME) that limit resident work hours.

Ref: Miller RD. Miller's Anesthesia, 8th ed. Philadelphia, PA: Elsevier; 2015.

Human performance in the operating room may be affected by many different factors. Best evidence shows which of the following is potentially the MOST detrimental to an anesthesiologist's performance in the operating room?

(A) reading in the operating room

(B) playing music in the operating room

(C) ingestion of a single alcoholic beverage 8 hours prior to working

(D) 4 hours of sleep within the last 24 hours

(E) occupational exposure (time-weighted average) to 25 ppm nitrous oxide

The answer is D. Ideally, typical adults require 7 to 8 hours of sleep each night. Sleep deprivation of just 2 hours less sleep per night can have a detrimental effect on performance. Unfortunately sleep debts are very common throughout society and are a source of not only medical errors but also other industrial accidents.

Reading may distract from overall vigilance in the OR; the degree to which this affects overall performance is not known. Often the issue with reading in the OR focuses on professionalism and the negative perceptions of surgeons and patients.

In general, noise can negatively affect performance. However, with respect to music in the OR, there is conflicting evidence as to whether music promotes a relaxed atmosphere or interferes with work in the OR.

There is no clear-cut evidence for a threshold at which occupational exposure to anesthetic waste gases impairs performance.

With respect to alcohol ...

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