Mitigating Intraoperative Fatigue in Surgeons at High Altitude: A Stepped-Wedge Cluster Randomized Trial.

Area of Science:

• High-altitude medicine
• Surgical performance
• Hypoxia research

Background:

• Surgeons at high altitudes (e.g., Qinghai-Xizang Plateau) face hypobaric hypoxia, impairing cognitive function and causing fatigue.
• Traditional fatigue remedies like Coca-Cola lack scientific basis and may be harmful.
• Supplemental oxygen is underutilized despite recommendations for improved cerebral oxygen delivery.

Purpose of the Study:

• To compare the efficacy of supplemental oxygen versus Coca-Cola in mitigating intraoperative cognitive and physical fatigue in surgeons at high altitude.
• To investigate the influence of long-term high-altitude adaptation (Tibetan vs. Han surgeons) on fatigue mitigation.

Main Methods:

• A stepped-wedge cluster randomized controlled trial was conducted with 22 surgeons (11 Han, 11 Tibetan) at 3,650 m altitude.
• Surgeons received either Coca-Cola or supplemental oxygen during 528 surgeries.
• Cognitive fatigue (d2 Test of Attention) and physical fatigue (dynamometer) were assessed pre- and post-surgery.

Main Results:

• Supplemental oxygen significantly reduced cognitive fatigue compared to Coca-Cola (p=0.012).
• Oxygen showed a significant effect in reducing cognitive fatigue for Han surgeons (p=0.029), but not significantly for Tibetan surgeons (p=0.076).
• No significant difference in physical fatigue was observed between the two interventions (p=0.822).

Conclusions:

• Supplemental oxygen is more effective than Coca-Cola in reducing cognitive fatigue during high-altitude surgery.
• The benefits of supplemental oxygen are particularly pronounced in less-acclimatized Han surgeons.
• Adoption of supplemental oxygen can enhance surgeon performance and well-being in high-altitude environments.