Background: Fatigue in anesthesia is a significant concern, impacting patient safety and practitioner well-being due to the demanding nature of the work and irregular, extended hours. This pilot study evaluates the effect of different shift types on fatigue and cognitive performance in junior anesthetists, using the Stroop Color and Word Test (SCWT) as a surrogate for cognitive performance. Methods: A prospective observational crossover pilot study was conducted with eight trainees at a tertiary hospital. Participants completed sixty-three post-shift surveys and the SCWT after various shift types, including 8h-Short Day, 12h-Long Day, 12h-Night Shift, 24h-Weekday Call, and 24h-Weekend Call. Subjective fatigue (Relative Perceived Exhaustion, RPE), perceived workload, sleep duration, and SCWT performance (Inverse Efficiency Score, IES) were measured. Linear mixed-effects regression was used to assess associations between shift type and performance, adjusting for learning effects. Results: Shift type was independently associated with cognitive performance as measured by IES (P < 0.001). Twelve-hour Long Day and 24-hour Weekend Call shifts were linked to significantly higher (worse) IES scores compared to 8-hour Short Day shifts (mean differences: 223 (95% CI 19 - 428) and 809 (95% CI 490 - 1127), respectively), indicating reduced efficiency. Higher RPE correlated with higher IES (P = 0.005). No significant association was found between IES and self-reported busyness or sleep duration. Conclusions: Extended shifts are associated with increased fatigue and reduced cognitive performance in anesthetists. The SCWT/IES and RPE are feasible tools for assessing fatigue-related performance, supporting the need for evidence-based rostering and fatigue management strategies in anesthesia.
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