To the Editor
While I agree with Lt. Col. Bostek’s observation that ‘[reading] results in a lack of vigilance that could (my emphasis) lead to problems,’ I believe that reading and other activity actually may improve vigilance for some people and in some circumstances. These non-anesthesia activities reduce my susceptibility to boredom, fatigue and sensory extinction, probably averting the ‘white line hypnosis’ that I may get driving for long stretches on the freeway.
Of course, non-anesthesia activity and distractions must be timed judiciously in the maintenance phase of anesthesia. This allows adequate time for appropriate surveillance of surgical progress, anesthetic management and record keeping. My anesthetic duty today was caring for a healthy patient undergoing excision of a third ventricular colloid cyst. While my neurosurgical colleague worked along, I read the entire APSF
Newsletter, drafted this reply and one other letter, and worked on a draft of a QA project. Throughout, I felt that I was completely aware of my patient’s status and the progress of the surgeon. Just as one can drive a car and carry on a conversation, it is not too difficult to choose the appropriate times and cases to use non-anesthesia activity to improve our awareness and alertness. When the surgeon started to close today, I ceased my non-anesthetic activity. Closure took a while and I found my attention wandering and I felt less alert than I had been earlier.
At ease, Lt. Colonel! You can pay attention without standing at attention.
Norman Hey, M.D., FRCPC