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.

Cardiovascular effects of etorphine in rats.

1. Cardiovascular effects of intravenously administered etorphine were investigated in mechanically ventilated normotensive rats under pentobarbitone anaesthesia. 2. Etorphine (0.1-2 micrograms kg-1) induced a dose-related bradycardia and hypotension which was prevented by pretreatment with naloxone (0.1 mg kg-1). 3. After bilateral vagotomy etorphine (1 microgram kg-1) produced a pressor effect which was prevented by prazosin (0.5 mg kg-1), but unaltered by adrenalectomy. 4. The bradycardia due to etorphine was abolished by bilateral vagotomy, but only partially reduced by atropine (1 mg kg-1) and still evident after propranolol (1.5 mg kg-1). 5. Etorphine was without effect on blood pressure in the pithed rat, although there was a small bradycardia which was not seen after naloxone. 6. The data presented indicate that etorphine produces an opioid receptor-mediated stimulation of both vagal (partially cholinergic) and sympathetic outflow and a direct cardiodepressant effect.