Ségolène Arzalier-Daret1, Clément Buléon2, Marie-Laure Bocca3, Pierre Denise3, Jean-Louis Gérard4, Jean-Luc Hanouz5. 1. Pôle de réanimations-anesthésie (niveau 6), CHU de Caen, avenue Côte-de-Nacre, 14033 Caen cedex 9, France; Pôle des formations et de recherche en santé, laboratoire de simulation médicale NorSims, faculté de médecine, UNICAEN, université Caen-Normandie, 2, rue des Rochambelles, 14032 Caen cedex, France. Electronic address: arzalier-s@chu-caen.fr. 2. Pôle de réanimations-anesthésie (niveau 6), CHU de Caen, avenue Côte-de-Nacre, 14033 Caen cedex 9, France; Pôle des formations et de recherche en santé, laboratoire de simulation médicale NorSims, faculté de médecine, UNICAEN, université Caen-Normandie, 2, rue des Rochambelles, 14032 Caen cedex, France. 3. Inserm, U1075 COMETE, pôle des formations et de recherche en santé, faculté de médecine, UNICAEN, université Caen-Normandie, 2, rue des Rochambelles, 14032 Caen cedex, France. 4. Pôle de réanimations-anesthésie (niveau 6), CHU de Caen, avenue Côte-de-Nacre, 14033 Caen cedex 9, France. 5. Pôle de réanimations-anesthésie (niveau 6), CHU de Caen, avenue Côte-de-Nacre, 14033 Caen cedex 9, France; Inserm, EA4650, UNICAEN, université Caen-Normandie, esplanade de la Paix, CS 14032, 14032 Caen cedex 5, France.
Abstract
BACKGROUND:Sleep deprivation has been associated with an increased incidence of medical errors and can jeopardise patients' safety during medical crisis management. The aim of the study was to assess the effect of sleep deprivation on the management of simulated anaesthesia crisis by residents in anaesthesiology. METHODS: A randomised, comparative, monocentric crossover study involving 48 residents in anaesthesia was performed on a high fidelity patient simulator. Each resident was evaluated in a sleep-deprived state (deprived group, after a night shift duty) and control state (control group, after a night of sleep). Performance was assessed through points obtained during crisis scenario 1 (oesophageal intubation followed by anaphylactic shock) and scenario 2 (anaesthesia-related bronchospasm followed by ventricular tachycardia). Sleep periods were recorded by actigraphy. Two independent observers assessed the performances. The primary endpoint of the study was the score obtained for each scenario. RESULTS: Resident's crisis management performance is associated with sleep deprivation (scenario 1: control=39 [33-42] points vs. deprived=26 [19-40] points, P=0.02; scenario 2: control=21 [17-24] vs. deprived=14 [12-19], P=0.01). The main errors observed were: error in drug administration and dose, delay in identification of hypotension, and missing communication with the surgical team about situation. CONCLUSIONS: The present study showed that sleep deprivation is associated with impairment of performance to manage crisis situations by residents in anaesthesia.
RCT Entities:
BACKGROUND:Sleep deprivation has been associated with an increased incidence of medical errors and can jeopardise patients' safety during medical crisis management. The aim of the study was to assess the effect of sleep deprivation on the management of simulated anaesthesia crisis by residents in anaesthesiology. METHODS: A randomised, comparative, monocentric crossover study involving 48 residents in anaesthesia was performed on a high fidelity patient simulator. Each resident was evaluated in a sleep-deprived state (deprived group, after a night shift duty) and control state (control group, after a night of sleep). Performance was assessed through points obtained during crisis scenario 1 (oesophageal intubation followed by anaphylactic shock) and scenario 2 (anaesthesia-related bronchospasm followed by ventricular tachycardia). Sleep periods were recorded by actigraphy. Two independent observers assessed the performances. The primary endpoint of the study was the score obtained for each scenario. RESULTS: Resident's crisis management performance is associated with sleep deprivation (scenario 1: control=39 [33-42] points vs. deprived=26 [19-40] points, P=0.02; scenario 2: control=21 [17-24] vs. deprived=14 [12-19], P=0.01). The main errors observed were: error in drug administration and dose, delay in identification of hypotension, and missing communication with the surgical team about situation. CONCLUSIONS: The present study showed that sleep deprivation is associated with impairment of performance to manage crisis situations by residents in anaesthesia.
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