Fatigue in anaesthesiology: Call for a change of culture and regulations

Fatigue affects everyone. We all remember feeling as though we are jetlagged in the middle of a busy night, desperately trying to stay awake at 4 a.m. If an emergency happens adrenaline kicks in and we wake up; it’s the more routine work in which we know sleep deprivation takes its toll. The nature of our work as anaesthesiologists and intensivists can make fatigue particularly problem atic. Our patients are often unconscious, so conversation with them does not help keep us alert. We use potentially lethal cocktails of drugs, which we often draw up and administer ourselves, and sometimes machines or moni tors malfunction. A few moments’ lack of vigilance or misinterpretation of physiological parameters can very quickly have disastrous results. These problems are compounded by the increasing challenge of interpreting and responding to a changing situation when we are tired. For example, the failure to recognise a patient’s allergies or the miscalculation of a drug dose can lead to adverse events for patients. Moreover, communication becomes poorer as fatigue sets in, so it can be more challenging to use the team’s wisdom to resolve a clinical problem.1