High Rates of Exhaustion in Anesthesia Residents Could Compromise Patient Safety

High Rates of Exhaustion in Anesthesia Residents Could Compromise Patient Safety
A large number of anesthesia residents are exhausted, and with a greater chance of being depressed, they are compromising patient safety. Wikimedia Commons

Anesthesiologists might have one of the most important jobs when it comes to patient safety. Without them, surgery would be much more painful than it is right now. However, a new study finds that residents in anesthesiology training programs have high rates of exhaustion and depression, which means they could be compromising patient safety.

Researchers at Northwestern University, in Chicago, surveyed anesthesiology residents throughout the country and received 1,508 responses. They responded to questions regarding frequency of burnout and depression, in order to assess whether they were at a higher risk for medical errors, according to a press release.

They found that 41 percent of the residents were considered at risk for exhaustion, 22 percent had possible depression, and 17 percent were at risk for both. These results were based on high scores in the areas of emotional exhaustion, depersonalization, and low scores of personal accomplishment. The researchers also found that exhaustion and depression were more likely in female residents, and in residents who worked more than 70 hours per week, and who drank more than five alcoholic drinks per week. Residents who smoked also had a higher risk for depression.

Also, when compared to people in the same age group, the residents were almost twice as likely to screen positive for depression and even suicidal thoughts.

What's more, these negative effects on the resident rubbed off on patients as well. When rated on a 30-point "best practice" score, performance was two points lower for those with exhaustion, and four points lower for those with exhaustion and depression. Also, one-third of the residents with exhaustion and depression risk said they made more than one mistake with medication within the last year.

It's imperative that anesthesiologists are attentive to their patients' needs — going under a knife is not a joke. If a patient doesn't receive enough anesthesia, they may experience anesthesia awareness, a situation in which they become conscious during surgery. During anesthesia awareness, patients can experience a range of things including, auditory recall, a sense of dreaming, and very rarely, pain. However, the emotional scars left from the experience are much more troubling; including an inability to communicate, helplessness, terror, and pain. Because of this, a patient can be plagued by long-lasting effects — the most common one being post-traumatic stress disorder (PTSD).

According to the American Society of Anesthesiologists, only one or two out of every 1,000 patients experiences anesthesia awareness, however, a 2007 study says otherwise.

For the study, 2,681 consecutive patients scheduled to undergo anesthesia were asked if they felt aware during surgery, the study's authors determined that 46 cases could be considered awareness. Of the cases the researchers found that 20 patients (43 percent) had experienced pain and 30 (65 percent) had experienced an acute emotional reaction during the awareness. This led to 15 patients (33 percent) experiencing late psychological symptoms. Six of the patients experienced symptoms for more than two months and one patient was diagnosed with post-traumatic stress disorder.

Another study tested 16 participants who had experienced anesthesia awareness and 10 post-general anesthesia controls using the Clinician Administered PTSD Scale, and questionnaire about their experience before, during, and after surgery. They found that nine of the 16 participants and none of the controls met criteria for PTSD. They averaged 17.9 years post-surgery, and related their post-operative distress to feeling unable to communicate, unsafe, terrified, abandoned, and betrayed.

One woman, Linda Campbell, described her post-traumatic experiences earlier this year in The Atlantic. Campbell had an emergency appendectomy when she was four years old after it burst. However, Campbell's case is a little different because she was given an older gas anesthetic. Still, she left the hospital in a very different way than she went in. She would have temper tantrums, uncontrollable episodes of vomiting, and disturbing dreams at night.

"They were about people being cut open, lots of blood, lots of violence," she told The Atlantic.

As she got older, she was able to control her panic attacks, which were triggered whenever she experienced typically normal things, including car horns, sudden bright lights, wearing tight-fitted pants or snug collars, and lying flat in bed. One day an anesthesiologist suggested that she was aware during the surgery, and it made her recall what had happened.

"I started having these flashes," she said, remembering the day she spoke to the anesthesiologist. "The flashes were me being on the table. The flashes were of the room. The flashes were of the bright lights over me." At some point she said the room went black.

"That's all I remember, I don't see anything. I don't feel anything. It's absolute, abject terror. And the feeling that I'm dying," she said.

It took Campbell a while to accept what had happened to her. She said the whole idea of it "seemed over-the-top," and that it took her years to begin to say "I think this is what happened to me." She still struggles with the idea that there is no way to prove what happened to her.

"Anesthesia awareness is an intrapersonal event," she said. "No one else sees it. No one else knows it. You're the only one."

Sources:

de Oliveira G, Chang R, Fitzgerald P, et al. The Prevalence of Burnout and Depression and Their Association with Adherence to Safety and Practice Standards: A Survey of United States Anesthesiology Trainees. Anesthesiology & Analgesia. 2013.

Samuelsson P, Brudin L, Sandin R. Late Psychological Symptoms after Awareness among Consecutively Included Surgical Patients. Anesthesiology. 2007.

Osterman J, Hopper J, Heran W, et al. Awareness under anesthesia and the development of posttraumatic stress disorder. General Hospital Psychiatry. 2001.

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