Department of Biosurgery and Surgical Technology, Imperial College London, London, UK.
Br J Surg. 2011 Nov;98(11):1666-72. doi: 10.1002/bjs.7600. Epub 2011 Jul 14.
Sleep deprivation affects surgical performance and has the potential to endanger patient safety. Pharmacological stimulants may counter this consequence of long working hours. This study aimed to investigate whether commonly available stimulants can counter the effects of fatigue on technical and neurocognitive skill.
This was a single-blind crossover study of surgical novices trained to proficiency on the Minimally Invasive Surgical Trainer-Virtual Reality laparoscopic simulator. Participants were acutely sleep-deprived three times each, followed by administration of either placebo, 150 mg caffeine, or 150 mg caffeine combined with 2 g taurine before simulated laparoscopy. Outcome measures were: laparoscopic psychomotor skill, cognitive performance and the Stanford Sleepiness Scale (range 1-7). Rested baselines were gathered following completion of test sessions.
Baseline performance was recorded for 18 participants in the rested state. Sleep-deprived participants receiving the placebo took longer (median 41 versus 35 s; P = 0·016), were less economical with movement (3·25 versus 2·95 m; P = 0·016) and made more errors (66 versus 59; P = 0·021) on the laparoscopic task compared with the rested state. Caffeine restored psychomotor skills to baseline for time taken (37 versus 35 s; P = 0·101), although the number of errors remained significantly greater than in the rested state (63 versus 59; P = 0·046). Sleep-deprived subjects receiving placebo had slower reaction times (377 versus 299 ms; P = 0·008) and a higher score on the Stanford Sleepiness Scale (6 versus 2 points; P = 0·001) than rested surgeons. Negative effects of sleep deprivation on reaction time were reversed when caffeine (307 ms versus 299 ms in rested state; P = 0·214) or caffeine plus taurine (326 versus 299 ms; P = 0·110) was administered. Subjective sleepiness was also improved, but not to baseline levels.
Sleep deprivation affects laparoscopic psychomotor skills, reaction time and subjective measures of sleepiness in novice surgical subjects. Caffeine and taurine restore simulated laparoscopic performance to rested levels, but do not reduce errors.
睡眠剥夺会影响手术表现，有可能危及患者安全。药理学兴奋剂可能会抵消长时间工作的这一后果。本研究旨在探究常见的兴奋剂是否能对抗疲劳对技术和神经认知技能的影响。
这是一项针对接受微创手术训练器-虚拟现实腹腔镜模拟器训练至熟练程度的手术新手的单盲交叉研究。参与者在三次急性睡眠剥夺后，分别接受安慰剂、150mg 咖啡因或 150mg 咖啡因加 2g 牛磺酸治疗，然后进行模拟腹腔镜检查。结果测量：腹腔镜心理运动技能、认知表现和斯坦福嗜睡量表（范围 1-7）。在模拟检查完成后，收集休息时的基线数据。
18 名参与者在休息状态下记录了基线表现。接受安慰剂的睡眠剥夺参与者用时更长（中位数 41 秒比 35 秒；P = 0.016），动作不经济（3.25 米比 2.95 米；P = 0.016），错误更多（66 次比 59 次；P = 0.021），相比休息状态，腹腔镜任务完成得更差。咖啡因使心理运动技能恢复到基线时间（37 秒比 35 秒；P = 0.101），尽管错误数量仍然显著高于休息状态（63 次比 59 次；P = 0.046）。接受安慰剂的睡眠剥夺受试者的反应时间更慢（377 毫秒比 299 毫秒；P = 0.008），斯坦福嗜睡量表评分更高（6 分比 2 分；P = 0.001），比休息状态的手术医生更高。当给予咖啡因（休息状态下的 307 毫秒比 299 毫秒；P = 0.214）或咖啡因加牛磺酸（326 毫秒比 299 毫秒；P = 0.110）时，睡眠剥夺对反应时间的负面影响得到逆转。主观嗜睡也得到改善，但未恢复到基线水平。
睡眠剥夺会影响新手手术医生的腹腔镜心理运动技能、反应时间和主观嗜睡测量。咖啡因和牛磺酸可将模拟腹腔镜表现恢复到休息水平，但不能减少错误。
