title: Effect of sleep deprivation on labour epidural catheter placement.
abstract: BACKGROUND
  Epidural catheter insertion for labour analgesia is an invasive procedure with potential serious complications, often performed by a sleep-deprived clinician. The aim of this study was to examine the effects of sleep deprivation on physicians of variable levels of experience performing this procedural skill in the clinical setting.
  
  
  METHODS
  After institutional review board approval, anaesthetists of three levels of experience were recruited: novice residents (<30 epidurals, n=9), experienced residents (>100 epidurals, n=8), and attending anaesthetists (>500 epidurals, n=12). All participants were measured twice, rested and sleep deprived in a random order while performing a labour epidural for analgesia. Our primary outcome measures were scores achieved on the Imperial College Surgical Assessment Device (ICSAD) (measuring path length, number of movements, and time), task-specific checklist (CL), and global rating scale (GRS). Sleep deprivation was documented by the ActiGraph and Epworth sleepiness scale.
  
  
  RESULTS
  Subjects were adequately sleep deprived for their sleep deprivation observation. Data were analysed with a two-way mixed design analysis of variance. No significant difference in the effect of sleep deprivation on performance was detected between the groups on the ICSAD measures of movement (P=0.86), path length (P=0.79), and time (P=0.80), or for the CL (P=0.65), and GRS (P=0.86).
  
  
  CONCLUSIONS
  The performance of this procedural skill in a clinical setting does not seem to be affected by sleep deprivation irrespective of the level of experience.
authors.affiliation: Department of Anesthesiology, St Michael's Hospital, University of Toronto, 30 Bond St., Toronto, ON, Canada M5B 1W8. megan.hayter@utoronto.ca
authors.forename: M A
authors.initials: MA
authors.lastname: Hayter
authors.forename: Z
authors.initials: Z
authors.lastname: Friedman
authors.forename: R
authors.initials: R
authors.lastname: Katznelson
authors.forename: J G
authors.initials: JG
authors.lastname: Hanlon
authors.forename: B
authors.initials: B
authors.lastname: Borges
authors.forename: V N
authors.initials: VN
authors.lastname: Naik
mesh_terms: D015360:Analgesia, Epidural / Q000592:standards*; D016362:Analgesia, Obstetrical / Q000379:methods / Q000592:standards*; D000776:Anesthesiology; D002983:Clinical Competence; D005260:Female; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital / Q000523:psychology / Q000592:standards; D009864:Ontario; D010815:Physician Impairment; D011247:Pregnancy; D011597:Psychomotor Performance; D012892:Sleep Deprivation / Q000523:psychology*; D014940:Work Schedule Tolerance / Q000523:psychology