Most anesthesiologists and anesthesia residents have heard the old truism that anesthesia is “95% routine and 5% terrifying.” The problem, of course, is that the portions of an anesthetic procedure that can be dangerous for patients are often unannounced, or at least are heralded only by subtle signs. Further, they are often preceded by periods of relative calm, when, superficially at least, there is not much activity on our side of the curtain.

Anesthesiologists have different opinions about reading in the operating room (OR), some of them quite firmly held. One camp feels that reading in the OR is absolutely a distraction. When reading, they say, the attention of the anesthesiologist is diverted from the patient. The anesthesiologist so engaged might miss some of the warning signs leading up to a critical event, possibly missing the window to intervene or losing valuable seconds of response time. Moreover, reading in the OR sends the wrong message to other members of the care team—if the anesthesiologist is obviously so bored that he or she has to read, how important can their task really be?

Others might counter that individual anesthesiologists are highly trained at multitasking, and when providing an anesthetic to an otherwise healthy patient there is no reason to prohibit a physician from spending time as he or she finds appropriate. Further, they note, there are no data available that suggest reading in the OR is contrary to our primary role as the guardians of patient safety.

Although it is true that there is not a great deal of data on this topic, there is a body of work assessing anesthesiologist vigilance, somnolence, and related matters that may allow reasoned, although non-evidence-based, conjecture.

Anesthesia is often compared to other fields that demand high performance for long periods of time. The field of aviation, in particular, is often compared to anesthesia. In aviation, it has been noted that serious errors often occur because of minor distractions. This led to the adoption of a policy prohibiting conversations and distractions in the cockpits of commercial aircraft flying below 10,000 feet.

At the same time, some studies have found that a significant amount of the anesthesiologist’s time in the OR is dedicated to tasks other than observing the patient—suggesting that there may be a certain, consistent amount of downtime during the provision of an anesthetic.