Assessment of sleep deprivation and fatigue among general surgery residen's: Is it necessary to reduce residents' work hours?

General surgery residents are in chronic partial sleep deprivation during their training years at hospital. Chronic sleep deprivation adversely affects their mood, behavior, social relationship, learning ability, decision making, and patient care. Adverse effects of sleep deprivation on carefulness and precision, promptitude, hand skills, and dexterity of surgeons have been shown in different studies. The aim of present study was to estimate the degree of sleepiness among general surgery residents and obtaining their views about consequences of sleep deprivation and fatigue. This cross sectional study was performed on general surgery resiaents in Sina, Imam Khomeini, and Shariati Hospitals in Tehran, using a 38-item quantitative structured questionnaire. Epworth Sleepiness Scale [ESS] was used for assessment of sleepiness degree. Forty eight general surgery residents were entered to the study. Average weekly work hours were/40-160 for first and second year residents and 100-120 for third and fourth year residents. Mean ESS score was 11.6 +/- 0.69 [range, 3-21], which indicated moderate sleepiness. Twenty percent of residents were in the severe range of sleepiness. From the studied residents, 52.1% believed that sleep deprivation anti fatigue had a major impact on their personal life, and 3 1.3% of them believed these 6ictors had major impact on their work, Extended work hours, sleep deprivation, and fatigue lead to sleepiness of general surgery residents and this problem adversely affects their quality of 4fe and performance. Based on the results of this study, revision and modification of general surgery residents' work hours are suggested

Hydrocortisone in post-dural puncture headache

Headache after spinal anesthesia is a common complication is patients undergoing this procedure. In this study we evaluated the efficacy of intravenous hydrocortisone in the treatment of headache after spinal anesthesia in women who have undergone cesarean section. Sixty patients with headache after spinal anesthesia were included. Patients randomly allocated into two groups, 30 patients received only conventional therapy [complete bed rest, hydration, acetaminophen and pethidine]. Other 30 patients received conventional therapy plus intravenous hydrocortisone [200 mg first, then 100 mg TID for 48 hours]. Mean [ +/- SD] of headache intensity at 0, 6, 24, and 48 hours after beginning of treatment was measured using visual analog scale. There was no significant difference in headache intensity between two groups before beginning of treatment. After 6 hours, the mean of headache intensity in 30 patients treated conventionally was 6.63 [ +/- 1.35] while it was 2.77 [ +/- 1.07] in other patients received intravenous hydrocortisone too [p <0.001]. After 24 hours, mean headache intensity was 3.87 [ +/- 1.63] in conventionally treated group versus 0.73 [ +/- 0.74] in hydrocortisone group [p <0.001]. After 48 hours, mean headache intensity was 1.87 [ +/- 0.93] in conventionally treated group versus 0.63 [ +/- 0.61] in hydrocortisone group [p = 0.001]. This study showed the therapeutic effects of intravenous hydrocortisone in reducing headache after spinal anesthesia in women who underwent cesarean section. Its mechanism of action is yet to be determined