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Intraocular pressure increases after complex simulated surgical procedures in residents: an experimental study

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Abstract

Background

Surgeons’ overload is one of the main causes of medical errors that might compromise patient safety. Due to the drawbacks of current options to monitor surgeons’ load, new, sensitive, and objective indices of task (over)load need to be considered and tested. In non-health-care scenarios, intraocular pressure (IOP) has been proved to be an unbiased physiological index, sensitive to task complexity (one of the main variables related to overload), and time on task. In the present study, we assessed the effects of demanding and complex simulated surgical procedures on surgical and medical residents’ IOP.

Methods

Thirty-four surgical and medical residents and healthcare professionals took part in this study (the experimental group, N = 17, and the control group, N = 17, were matched for sex and age). The experimental group performed two simulated bronchoscopy procedures that differ in their levels of complexity. The control group mimicked the same hand-eye movements and posture of the experimental group to help control for the potential effects of time on task and re-measurement on IOP. We measured IOP before and after each procedure, surgical performance during procedures, and perceived task complexity.

Results

IOP increased as consequence of performing the most complex procedure only in the experimental group. Consistently, residents performed worse and reported higher perceived task complexity for the more complex procedure.

Conclusions

Our data show, for the first time, that IOP is sensitive to residents’ task load, and it could be used as a new index to easily and rapidly assess task (over)load in healthcare scenarios. An arousal-based explanation is given to describe IOP variations due to task complexity.

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Acknowledgements

Research by LLDS was supported by the BBVA Foundation, Madrid, Spain (Grant No. 2015-2) and is currently supported by the Ramón y Cajal fellowship program (RYC-2015-17483). We thank IAVANTE staff (Andalusian Public Foundation for Progress and Health) for their help during data collection. We thank Dr. G. A. Koulieris (Inria, Université Côte d’Azur, France) for proofreading the paper.

Funding

This study was funded by the Campus of International Excellence (BioTic Granada) Research Programme (Research Project V7-2015 to CDP). The funding source had no role in the design or conduct of this study.

Author information

Authors and Affiliations

  1. Department of Optics, Faculty of Science, University of Granada, Granada, Spain

    Jesús Vera & Raimundo Jiménez

  2. Mixed University Sport and Health Institute (iMUDS), University of Granada, Granada, Spain

    Jesús Vera

  3. Mind, Brain, and Behavior Research Center – CIMCYC, University of Granada, Campus de Cartuja s/n, 18071, Granada, Spain

    Carolina Diaz-Piedra & Leandro L. Di Stasi

  4. College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA

    Carolina Diaz-Piedra & Leandro L. Di Stasi

  5. IAVANTE, Line of Activity of the Andalusian Public Foundation for Progress and Health, Ministry of Equality, Health and Social Policy of the Regional Government of Andalusia, Granada, Spain

    Jose M. Sanchez-Carrion

  6. Joint Center University of Granada - Spanish Army Training and Doctrine Command, Granada, Spain

    Leandro L. Di Stasi

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  1. Jesús Vera
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  2. Carolina Diaz-Piedra
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  4. Jose M. Sanchez-Carrion
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  5. Leandro L. Di Stasi
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Corresponding author

Correspondence to Carolina Diaz-Piedra.

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Disclosures

Drs. Vera, Diaz-Piedra, Jiménez, Sanchez-Carrion, and Di Stasi have no conflicts of interest or financial ties to disclose.

Appendix

Appendix

Before starting the procedure, participants read the following information:

For the Procedure A, A 5-year-old child scheduled for split thickness skin grafts (STSG). He was burned in a house fire 5 months ago and has 70% TBA burns. He has required multiple anesthetics for burn dressing changes and STSGs. His last anesthetic, 2 weeks ago, was discussed extensively in your department because the anesthesiologist had a very difficult time intubating the patient, due to a Grade 3 view with laryngoscopy. It is decided that the safest way to intubate this patient is with a fiberoptic bronchoscope.

On physical exam, the child has extensive burn scars and contractures. The scarring on his face and anterior neck severely restricts his ability to open his mount or extend his head.

For the Procedure B, A 42 years old female who presents with several episodes of blood-streaked sputum. She smoked for 10 years, but quit 5 years ago. On physical examination, she is afebrile and appears well. Her blood pressure is 110/75, pulse is 84, temperature is 98.4 F, and respiratory rate is 14. No abnormalities are noted on auscultation of the chest. No lymphadenopathy is present. Her chest radiographs are normal.

Please perform flexible bronchoscopy to identify the location of any lesions that you can visualize. Capture an image of each lesion identified by depressing the video capture button on the bronchoscope.

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Vera, J., Diaz-Piedra, C., Jiménez, R. et al. Intraocular pressure increases after complex simulated surgical procedures in residents: an experimental study. Surg Endosc 33, 216–224 (2019). https://doi.org/10.1007/s00464-018-6297-7

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