Is your surgeon awake?

Jan 14 2011 - 11:08pm

Surgeons should not be allowed to perform elective procedures if they have been awake the night before.

A trio of physicians argued this point in a December article published in the New England Journal of Medicine. The doctors argued that until hospitals devise rules to keep surgeons out of the operating room if they have had little or no sleep, they at least shuold tell the patient that the doctors are sleep-deprived.

"I think certainly all of us agree we would want to avoid anything affecting the safety of the patient," said Glen Morrell, a general surgeon at Davis Hospital and Medical Center in Layton. "The article suggests surgeons have at least six hours of uninterrupted sleep at night. Some of the physicians disagreed."

Morrell said he personally can perform well on four hours of sleep and said he would be more concerned about a surgeon not sleeping for several nights, as opposed to one night.

In the article, physicians argue postponing procedures can be complicated and expensive. For instance, who will pay for operating room downtime or how hard will it be for patients and doctors to reschedule? But other physicians argue that the costs could be offset by reductions in medical errors.

"It's always struck me that there's something wrong with patients having elective procedures when it's known the surgeon has been up all night," lead author Dr. Michael Nurok said in the article. "There's an ethical obligation to inform patients."

Morrell agrees.

"It's always wise for patients to be involved in their care. They are their best advocate," he said. "I've had patients ask me if I'm well rested or if I had a good night's sleep. I welcome that. It's very legitimate for them to ask that question of their surgeon."

Morrell said a typical general surgeon works an average of 10 to 12 hours each day with an on-call responsibility of 24 hours. If surgeons have a weekend on-call schedule, they begin to take emergency calls from 7 a.m. Friday to 7 a.m. Monday.

"Most of the time you can get between four and six hours when you're on call. Sometimes you can even get up to eight hours," Morrell said. "It's also fairly common to get some sleep in between things. I think there needs to be more research on this topic, and I welcome it."

Surgeons aren't the only ones who may not be getting enough sleep. Truck drivers and college students are also among those at high risk for sleep deprivation.

The average person needs between six and nine hours of sleep every night, said Kurt Park, director of respiratory care and neurology services at Ogden Regional Medical Center.

Sleep loss affects the mind by decreasing memory performance, decreasing learning ability and poorly regulating mood, Park said.

"It renders us incapable of putting emotional events into the proper perspective and responding appropriately," he said. "It's estimated that 47 million adults in the U.S. are sleep-deprived."

Park said there are an estimated 100,000 car wrecks resulting in 71,000 injuries and 1,550 fatalities each year due to sleepy driving.

Symptoms of sleep deprivation include fatigue, irritability, depression, reduced attention, concentration and memory, more frequent illnesses, workplace mishaps and car crashes, Park said.

According to the National Sleep Foundation, long-term clinical consequences of sleep deprivation can lead to high blood pressure, heart attack, heart failure, obesity, stroke, psychiatric problems and even fetal and childhood growth retardation.

The foundation also reports 56 percent of the adult population admitted daytime drowsiness as a significant problem.

Another culprit? Daylight savings time.

"Daylight savings time increases the symptoms of seasonal affective disorder," Park said. "The dark months of winter throw off your body's timing. Sunlight signals your brain that it is time for your body to be awake and alert. As a result you are more likely to be sleepy and sluggish during the daytime hours."

Park said to get a good night's sleep, check your environment. It should be quiet, dark and at a comfortable temperature. Use the bedroom for sleeping, not for watching TV or paying bills. Follow a regular schedule for going to bed and waking up, even on weekends, and limit naps to no more than an hour and take them no later than mid-afternoon.

"Don't exercise before bed," Park said. "Watch what you eat and drink and when. Avoid late or big evening meals, alcohol and caffeine six hours before bedtime and don't smoke. Take a warm bath or drink some warm milk. Listen to quiet music or read."

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