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Fatigue and the Anaesthetist

Fatigue is a state of physical or mental weariness characterized by a lessened capacity for work and a reduced efficiency of accomplishment. It may result from a period of intense or prolonged exertion or alternatively may occur after time spent on unchallenging or monotonous tasks. In clinical practice, it is associated with long hours of wakefulness, sustained mental effort, and shift working. Fatigue negatively affects performance and is associated with increased risks to patient safety and to the well-being of the anaesthetist. The increase in shift working for trainees as a consequence of the European Working Time Directive (EWTD) and the increasing likelihood of a 24-h consultant-delivered service have increased concerns that fatigue may become more prevalent in front-line anaesthetists with predictable implications for safety and clinical effectiveness.

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Perioperative systemic lidocaine significantly reduces opioid requirements in the ambulatory setting without affecting time to discharge. Postoperative pain is the most common reason for delay in discharge and unplanned hospital admission after ambulatory surgery. 1–3 Because postoperative pain is to a large extent an inflammatory phenomenon, administration of systemic local anesthetics, which have inflammatory modulatory properties, 4 could significantly reduce pain and therefore allow more rapid discharge. 5 Lidocaine has an excellent safety record when administered by low-dose infusion. 5–7 However, whereas decreased hospital stay after inpatient surgery has been demonstrated, the effect of intraoperative and early postoperative lidocaine infusion on duration of stay after ambulatory surgery is not known. Although it see...