Authors: Van Zundert AA et al.
Anesthesia & Analgesia. 142(1):45–55, January 2026.
Summary
This randomized, single-center, crossover simulation study evaluated how spectrally shifted ambient lighting—specifically blue and green lighting commonly used in modern interventional and minimally invasive procedural suites—affects critical task performance relevant to anesthetic and perioperative care. The investigators focused on color discrimination, medication identification accuracy, and task completion time, comparing blue and green lighting conditions with standard white light.
Three hundred operating room staff and volunteers were enrolled, with 266 meeting eligibility criteria after screening for normal color vision using the Ishihara and Farnsworth D-15 tests. Participants were randomized to alternating blue–green or green–blue lighting sequences and completed both the Farnsworth D-15 Test (FT), assessing color discrimination, and a Drug Label Matching Test (DLMT), assessing medication identification, under each lighting condition. Performance metrics under blue and green lighting were compared with white light, and participants reported which label features they relied on for decision-making.
Under white light, color discrimination performance was perfect, with all participants successfully completing the Farnsworth D-15 Test. In contrast, under both blue and green lighting, color discrimination failed completely, with no participants able to successfully complete the test. Task completion times were also significantly longer under spectrally shifted lighting. Drug label matching performance declined to a lesser degree but remained significantly impaired under blue and green light, with longer completion times and a more than threefold increase in the odds of error compared with white light. Importantly, reliance on color as a drug identification cue dropped sharply under blue and green lighting, while reliance on drug names, grouping strategies, and memory increased substantially.
These findings demonstrate that spectrally shifted lighting profoundly disrupts color-based perception and meaningfully degrades medication identification performance, even when multiple noncolor cues are available on labels. Although drug identification did not fail universally, the increased error rates and prolonged task times highlight a clinically relevant safety concern in anesthetic and interventional environments that rely on blue or green ambient lighting.
What You Should Know
Blue and green ambient lighting essentially eliminates reliable color discrimination, as confirmed by complete failure of the Farnsworth D-15 Test.
Medication identification is slower and more error-prone under spectrally shifted lighting, with significantly higher odds of drug-matching errors compared with white light.
Clinicians compensate by shifting away from color cues toward text, grouping, and memory-based strategies, which may increase cognitive load and risk under pressure.
Interventional suites using blue or green lighting should consider mitigation strategies such as improved lighting controls, machine-readable drug labels, or augmented visualization tools to reduce medication error risk.
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