Monday, July 11, 2011

How To Wake Up Your Anesthesiologist

Anesthesiology can be exhausting work. The long hours, the lengthy monotonous cases (you actually want to have monotony in the OR, not surprises), and the isolation behind the ether screen can lead one to feeling tired, and yes, drowsy, at work. I have to admit that I've caught myself  "resting" my eyes" during a case. The issue is pervasive enough that the latest copy of the ASA Newsletter has an article devoted to the subject of sleeping anesthesiologists and how to prevent it.

The article doesn't really document anything new. Yes, we all should get at least seven, preferably eight, hours of sleep a night. If you don't, you'll build a deficit of sleep that can only be paid back with longer sleep periods on weekends. Sleep deprivation can lead to irritability, impaired memory, decline in motivation, and cognitive deterioration. It cited a study out of Finland which interviewed 328 anesthesiologists. The researchers found that anesthesiologists had the highest workload cases while on call of any medical specialty, including surgeons. Surgeons may scoff at this finding, but if you think about it, a surgeon may book one emergency case in the middle of the night. When he's done, he'll probably go home and sleep until the next morning. The on call anesthesiologist will still have to deal with the other emergency cases that have been scheduled by other surgeons. Because of this high stress level, the Finnish researchers found that 25% of the anesthesiologists had suicidal ideation, more than twice the rate of the general public. Yikes!

So what do the authors of this article recommend? Some suggestions are pretty commonsensical while others are impractical to the point of laughable. Yes, we should try to devote eight hours of sleep each night. If not, be aware that you may not be working at 100% of your mental capacity. They recommend "strategic caffeine" to stay alert. Haven't you ever wondered why doctors are always walking around with a cup of Starbucks or some other caffeinated beverage in their hands? Strategic napping was also suggested. Uh huh. The idea is you would take a few minutes nap while a colleague covers for you. The one critical part of this suggestions is that the handover of the patient from one physician to another be as complete and thorough as possible for the sake of the patient's safety. Somehow I don't think this last one has real world practicality.

For me, when I catch myself starting to nod off, the quickest and surest method of waking up is to stand up immediately. I know it's hard to do that when you've got that comfortable anesthesiologist's chair that's all nice and warmed up. But by standing, it is virtually impossible to stay drowsy. As a bonus, if I walk around a bit, it's good for my circulation, helps prevent DVT's, and reassures the surgeon that somebody is behind the drapes monitoring the patient.

One surgeon told me his method for waking up his anesthesiologist. He claimed it never fails. At the beginning of the case, he told me that the magic words to waking up the anesthesiologist is "skin stapler". I thought that was pretty funny and laughed at the preposterousness of that idea. No anesthesiologist who is studiously monitoring his patient would fall for that. Then halfway through the case, he casually mentioned "skin stapler". Sure enough, like Pavlov's dog, my head popped up over the ether screen to check on the case. When I saw that the surgical wound was still wide open, I knew he had got me. I looked at the surgeon who could barely contain his laughter. Then I slumped back into my chair and continued to read my iPad, I mean monitor my patient.

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