arise,awake doctors

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All stressed doctors...Go through these facts!

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  • 1. ANAESTHESIA ANDFATIGUE: THE GLOBAL SCENARIO DR UNNIKRISHNAN P NEUROANAESTHESIA

2. Unmet needs; who willanswer?.RULES SCIENCE TECHNOLOGY CHANGE 3. Sounds familiar ? How many clinicians have got Nobelprize?A dream is what keeps you awake. -Abdul Kalam 4. Sleep has become our dream..CREATIVITY DEBACLES OCCUR DEVELOPS WHENAFTER HECTIC WE START SCHEDULES ENJOYING OUR WORK 5. Fatigue andDoctors- Canscience help us?. 6. Precious thingsThe fact that sleep is essential to human biology and neurocognitive function is well appreciated. Factors that disrupt or otherwise deny sleep are known to degrade both psychomotor and mental-task performance. 7. Hello..hello Im not hearing Fatigue caused by lack of adequatesleep results in diminished cognitivefunction, impaired vigilance, decay inproblem-solving ability, degradation inmemory, and eroded motivation.4 8. SLEEP[LESSNESS] is injurious tohealthMedical culture has traditionally fostered unsatisfactory ways of behaving. Long hours of either high intensity or boring work have been seen as the norm. Protest against them has been viewed as lazy or unprofessional. National Confidential Enquiry into Perioperative Deaths (NCEPOD) studies that it is inappropriate for the most interesting and complex cases to take place at night, where the risks will be still further increased. 9. After 36 hrs of service I vebecome very efficient insleeping.ECG interpretation accuracy is reduced amongst sleep-deprived house staff intubation skill diminished in emergency room physicians working the night shift compared with similar staff during the day 10. Ive given something tosomebody..?anaesthesia Gaba DM Howard SK and Jump B, Production pressure in thework environment: Californian anesthesiologists attitudes andexperiences, Anesthesiology 1994; 81: 488-500Gravenstein JS, Cooper JB, and Orkin FK, Work and rest cyclesin anesthesia practice, Anesthesiology 1990report that more than 50% ofanaesthesia providers admit that theyhad made errors in medical judgementwhich were attributed to fatigue 11. Mile stones.small and big! 15.7% of respondents reported fallingasleep during the anesthetic care of apatient, and 48.8% of respondentsreported observing a colleagueengaged in sleep-related behaviorduring care [Chuck Biddle, CRNA,John Aker et alAANA]A fatal case report of ananesthesiologist who fell asleep whilst 12. Come onjoin hands with usSurgeons who had limited opportunity for sleep had significantly higher rates of complications than those who had a longer sleep opportunity (odds ratio 1.72; 95% CI 1.02-2.89). 13. 3 idiots..among them 1 is doing Sx;2 are sleepingspontaneous microsleeps, which may last secs, or even mins, and the individual may be unaware and can be unresponsive to external stimuli. Extreme pressure for sleep can result in shut down 14. Im getting enough kick withoutspending a penny17 hours of wakefulness results in a decrease inperformance equal to that produced by a bloodalcohol level of 50 mg% and, after 24 hour withoutsleep, this decrement was equal to that producedby 100 mg% of blood alcohol.The greatest risk occurs where significant sleeploss is combined with circadian rhythm disturbance. 15. Need to address fatiguescientifically A significant factor identified as avoiding serious outcome was providing relief for fatigued anaesthetists Based on .The Australian Incident Monitoring Scheme (AIMS) reported 152 incidents (2.7% of all reports) up to 1997 16. HmmmmmStudies have shown that adaptation does not occur despite prolonged exposure to night work1. Many individuals cannot reset their body clock to allow for effective daytime sleep after night duties. Daytime sleep is typically shorter and of inferior quality compared with sleep at night40 17. Relievedsomebody is listening!! William Clayton Petty, MD, observedthat, Fatigue can induce a state inanesthesia providers that will causemore medical errors. It is time we stopgiving lip service to this problem andtake positive steps towards solving it. 18. .How Research can help? 19. Can give inputs in formulating tools The AMA 2006 Safe Hours Audit revealedthat many doctors worked a similar numberof hours, but often had very different riskratings.To produce more biocompatible schedulesAMA has developed an on-line fatigueassessment tool. Doctors who use theassessment tool will receive an on-lineassessment of the fatigue risks of theirroster. Doctors who are assessed as being atrisk are encouraged to raise this with hospital 20. Who will answer?h 21. ?h 22. Who will answer?h 23. We need light..(work)bright light exposure has been successful inshifting rhythms in controlled laboratory situationsbut workplace studies have yet to be conducted.Pharmacological studies of night workers aregaining support from drug manufacturers. All ofthese studies have been in acute laboratorysituations. Long-term studies have not beenreported and are clearly needed because of theside effects and abuse potential of drugs. 24. Research into DRUGS alertness-enhancing drugs [not recommended at present]amphetamine analogues such as modafinil alertness-promoting properties fewer side effects little effect on recovery sleep Melatonin has been shown to promote natural sleep and may cause a circadian shift to a new 25. Further research into sleep &circadian rhythm inrelation tofatigueandthe effect of circadian (and other body)rhythms on the responses of organisms tooutside influences such as drugsBoth the pharmacokinetics andpharmacodynamics of drugs can beinfluenced by their time of administrationit has now been clearly demonstrated thatthe response to noxious stimuli is notconstant over the 24 hour period. Althoughthe temporal relationship is complex meansthere is a diurnal variation in pain perception 26. napping has been shown to be ofpositive benefit to improve subsequentalertness and performanceI think slapping has a better effect onyou. 27. ReferencesAssociation of Anaesthetists of Great Britainand Ireland Fatigue and Anaesthetists Expanded Web Version 1995-2012 Australian Medical AssociationLimited.Privacy Statement Howard SK, Rosekind MR et al, Fatigue inAnesthesia, Anesthesiology 2002,: 97;1281 1294 ANZCA Professional Document (PS43) Statement on Fatigue and the Anaesthetist(2001) Australian and New Zealand Collegeof Anaesthetists Robinson JS, Howells TH, and Smith WDA,Fatigue in the practice ofanaesthesia(letter), Anaesthesia1978:33;62-3 28. Our weak defence againsthazards posed by inhalationalanaesthetics Despite the huge improvement in the infrastructure for providing anaesthesia to patients, why are we not taking measures in preventing us from getting a share from it Why we are not implementing effective scavenging methods in O.T.? Whether N2O is having a significant influence on male fertility pattern..? 29. Visit me@www.thelaymedicalman.blogspot.com 30. Who will answer?h

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