Impact of sleep deprivation on anaesthesia residents' non-technical skills: a pilot simulation-based prospective randomized trial

Background

Sleep deprivation is common in anaesthesia residents, but its impact on performance remains uncertain. Non-technical skills (team working, situation awareness, decision making, and task management) are key components of quality of care in anaesthesia, particularly in crisis situations occurring in the operating room. The impact of sleep deprivation on non-technical skills is unknown. We tested the hypothesis that in anaesthesia residents sleep deprivation is associated with impaired non-technical skills.

Methods

Twenty anaesthesia residents were randomly allocated to undergo a simulation session after a night shift [sleep-deprived (SLD) group, n =10] or after a night of rest [rested (R) group, n =10] from January to March 2015. The simulated scenario was a situation of crisis management in the operating room. The primary end point was a composite score of anaesthetists' non-technical skills (ANTS) assessed by two blinded evaluators.

Results

Non-technical skills were significantly impaired in the SLD group [ANTS score 12.2 (interquartile range 10.5-13)] compared with the R group [14.5 (14-15), P <0.02]. This difference was mainly accounted for by a difference in the team working item. On the day of simulation, the SLD group showed increased sleepiness and decreased confidence in anaesthesia skills.

Conclusions

In this randomized pilot trial, sleep deprivation was associated with impaired non-technical skills of anaesthesia residents in a simulated anaesthesia intraoperative crisis scenario.

Trial registration

NCT02622217.

Human vigilance in railway and long-haul flight operation

Human operators in transport operations are often confronted with monotony, boredom, and irregular work schedules. This situation has become increasingly more acute because of the growing automation of systems. This paper presents methodology and preliminary results for two field studies on the vigilance of train drivers and long-range aircrews. The aim of these studies was to identify factors that can modify vigilance and to elaborate several specific solutions for reactivation. The method is based on the collection of physiological data in the field and on task observation of the operators. The recorded physiological data (EEG, EOG, EKG) permit an evaluation of vigilance and mental workload. The rest-activity cycles are estimated by actometry. The use of EEG and EOG are discussed in relation to monotony and sleep deprivation. For pilots, results show a high occurrence of decreased vigilance, particularly during phases of low workload (i.e., when cruising). Furthermore, it was shown that these periods of lowered vigilance can occur at the same time for two crew members. A great number of incidents of decreased vigilance were also observed for the train drivers. These incidents occurred even though the operators sometimes had high levels of activity. A direct relation was also noted between sleep duration and the onset of rest. These studies provide several means for maintaining vigilance during activities and improving the system of work schedule rotation.