Background <p>Decision fatigue results from cumulative cognitive demands and may be particularly relevant in high-stakes clinical environments such as anesthesiology, where continuous rapid decision-making is required.</p> Aims <p>This study aimed to assess decision fatigue and emotional exhaustion among anesthesiologists and to examine their association within the context of clinical workload.</p> Methods <p>In this cross-sectional observational study, an online survey was distributed to physicians actively practicing anesthesiology in Türkiye. Data collection included demographic and occupational characteristics, the Decision Fatigue Scale, and the emotional exhaustion subscale of the Maslach Burnout Inventory.</p> Results <p>Ninety-seven anesthesiologists participated. Mean decision fatigue scores were 24.18 (standard deviation 7.5), and mean emotional exhaustion scores were 21.7 (standard deviation 7.1). A strong positive correlation was found between decision fatigue and emotional exhaustion (Spearman correlation coefficient 0.64, p &lt; 0.001). Higher decision fatigue scores were associated with working in training and research hospitals, reporting occupational burnout, and experiencing non-medical pressures influencing clinical decisions. Multiple regression analysis showed that perceiving decision-making as mentally burdensome, prolonged decision processes involving multiple options, and difficulty deciding under stress independently predicted higher decision fatigue.</p> Conclusions <p>Decision fatigue is closely associated with emotional exhaustion among anesthesiologists and reflects occupational cognitive workload. Reducing cognitive burden and preserving clinical autonomy may support physician well-being and patient safety.</p> Trial registration <p>ClinicalTrials.gov (Identifier: NCT07089160), registered in July 2025 (prospectively).</p>