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Impairment in Anesthesiology: Awareness and Education

The reader may wonder why a chapter on impairment is included in a treatise on education. The issue of impairment, particularly by chemical dependence, is typically a disease of younger physicians, and often these individuals are detected during residency or fellowship training. Faculty in academic anesthesiology programs are involved continually with the evaluation and monitoring of resident performance and may be able to see changes compared with prior performance, leading to earlier diagnosis and referral for treatment. Education about impairment and chemical dependence is critically important for the specialty of anesthesiology. Although the incidence of chemical dependence is unlikely to decline below a threshold of 1% to 2% per year, the more informed anesthesia residents and faculty become about the topic, the greater the likelihood that an impaired trainee will be detected before catastrophic consequences to health or career occur. What does impairment mean? Physicians can become impaired in their lives by many things. Problems such as neurologic illness, dementia, psychiatric illness, sexual impropriety, and disruptive behavior can negatively impact a physician’s life and practice. Physicians can abuse or become addicted to alcohol, drugs that are initially legitimately prescribed for them, drugs they divert from their practices, or illicit drugs. For anesthesiologists, the most commonly diverted drugs are opioids, such as fentanyl and its derivatives, and increasingly sevoflurane and propofol. In this paper, chemical dependence will be