Abstract
Background
Neurosurgery is a challenging field associated with high levels of mental stress. The goal of this study was to investigate the hemodynamic response of experienced neurosurgeons during aneurysm clipping surgery and to evaluate whether neurosurgeons’ hemodynamic responses are associated with patients’ clinical statuses.
Methods
Four vascular neurosurgeons (all male; mean age 51 ± 10 years; post-residency experience ≥7 years) were studied during 42 aneurysm clipping procedures. Blood pressure (BP) and heart rate (HR) were assessed at rest and during seven phases of surgery: before the skin incision, after craniotomy, after dural opening, after aneurysm neck dissection, after aneurysm clipping, after dural closure and after skin closure.
Results
HR and BP were significantly greater during surgery relative to the rest situation (p ≤ 0.03). There was a statistically significant increase in neurosurgeons’ HR (F [6, 41] = 10.88, p < 0.001), systolic BP (F [6, 41] = 2.97, p = 0.01), diastolic BP (F [6, 41] = 2.49, p = 0.02) and mean BP (F [6, 41] = 3.36, p = 0.003) during surgery. The greatest mean HR was after aneurysm clipping, and the greatest BP was after aneurysm neck dissection. Systolic, diastolic and mean BPs were significantly greater during surgical clipping for unruptured aneurysms compared to ruptured aneurysms across all stages of surgery (p ≤ 0.002); however, after adjusting for neurosurgeon experience, the difference in BP as a function of aneurysm rupture was not significant (p > 0.08). Aneurysm location, intraoperative aneurysm rupture, admission WFNS score, admission Glasgow Coma Scale scores and Fisher grade were not associated with neurosurgeons’ intraoperative HR and BP (all p > 0.07).
Conclusions
Aneurysm clipping surgery is associated with significant hemodynamic system activation among experienced neurosurgeons. The greatest HR and BP were after aneurysm neck dissection and clipping. Aneurysm location and patient clinical status were not associated with intraoperative changes of neurosurgeons’ HR and BP.
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References
Allen K, Blascovich J (1994) Effects of music on cardiovascular reactivity among surgeons. JAMA 272:882–884
Brickman AM, Reitz C, Luchsinger JA, Manly JJ, Schupf N, Muraskin J, DeCarli C, Brown TR, Mayeux R (2010) Long-term blood pressure fluctuation and cerebrovascular disease in an elderly cohort. Arch Neurol 67:564–569
Gupta HO, Gupta S, Carter RL, Mohammed A, Meek RM (2012) Does orthopaedic surgical training induce hypertension? A pilot study. Clin Orthop Relat Res 470:3253–3260
Honkonen T, Ahola K, Pertovaara M, Isometsa E, Kalimo R, Nykyri E, Aromaa A, Lonnqvist J (2006) The association between burnout and physical illness in the general population—results from the Finnish Health 2000 Study. J Psychosom Res 61:59–66
Huang Y, Xu S, Hua J, Zhu D, Liu C, Hu Y, Liu T, Xu D (2015) Association between job strain and risk of incident stroke: a meta-analysis. Neurology 85(19):1648–1654
Kivimaki M, Batty GD, Ferrie JE, Kawachi I (2014) Cumulative meta-analysis of job strain and CHD. Epidemiology 25(3):464–465
Lee JY, Lantz AG, McDougall EM, Landman J, Gettman M, Sweet R, Sundaram CP, Zorn KC (2013) Evaluation of potential distractors in the urology operating room. J Endourol 27:1161–1165
Marrelli M, Gentile S, Palmieri F, Paduano F, Tatullo M (2014) Correlation between Surgeon’s experience, surgery complexity and the alteration of stress related physiological parameters. PLoS One 9(11), e112444
Maslach CJS, Leiter M (1996) Maslach Burnout Inventory manual, 3rd edn. Consulting Psychologists Press, Palo Alto
McAbee JH, Ragel BT, McCartney S, Jones GM, Michael LM 2nd, DeCuypere M, Cheng JS, Boop FA, Klimo P Jr (2015) Factors associated with career satisfaction and burnout among US neurosurgeons: results of a nationwide survey. J Neurosurg 123:161–173
McEwen BS (2006) Protective and damaging effects of stress mediators: central role of the brain. Dialogues Clin Neurosci 8:367–381
Nyberg ST, Fransson EI, Heikkila K, Ahola K, Alfredsson L, Bjorner JB, Borritz M, Burr H, Dragano N, Goldberg M, Hamer M, Jokela M, Knutsson A, Koskenvuo M, Koskinen A, Kouvonen A, Leineweber C, Madsen IE, Magnusson Hanson LL, Marmot MG, Nielsen ML, Nordin M, Oksanen T, Pejtersen JH, Pentti J, Rugulies R, Salo P, Siegrist J, Steptoe A, Suominen S, Theorell T, Vaananen A, Vahtera J, Virtanen M, Westerholm PJ, Westerlund H, Zins M, Batty GD, Brunner EJ, Ferrie JE, Singh-Manoux A, Kivimaki M (2014) Job strain as a risk factor for type 2 diabetes: a pooled analysis of 124,808 men and women. Diabetes Care 37:2268–2275
Rothwell PM, Howard SC, Dolan E, O'Brien E, Dobson JE, Dahlof B, Sever PS, Poulter NR (2010) Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension. Lancet 375:895–905
Shambo L, Umadhay T, Pedoto A (2015) Music in the operating room: is it a safety hazard? AANA J 83:43–48
Sharma MS, Thapa A, Chandra SP, Suri A, Singh M, Bahl VK, Sharma BS (2010) Intraoperative pulse and blood pressure recordings of neurosurgeons: a pilot study of cardiovascular performance. Neurosurgery 66:893–899
Song MH, Tokuda Y, Nakayama T, Sato M, Hattori K (2009) Intraoperative heart rate variability of a cardiac surgeon himself in coronary artery bypass grafting surgery. Interact Cardiovasc Thorac Surg 8:639–641
Stansfeld SA, Shipley MJ, Head J, Fuhrer R (2012) Repeated job strain and the risk of depression: longitudinal analyses from the Whitehall II study. Am J Public Health 102:2360–2366
Thomas NK (2004) Resident burnout. JAMA 292:2880–2889
Way TJ, Long A, Weihing J, Ritchie R, Jones R, Bush M, Shinn JB (2013) Effect of noise on auditory processing in the operating room. J Am Coll Surg 216:933–938
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Bunevicius, A., Bilskiene, D., Macas, A. et al. Hemodynamic response during aneurysm clipping surgery among experienced neurosurgeons. Acta Neurochir 158, 221–227 (2016). https://doi.org/10.1007/s00701-015-2682-3
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DOI: https://doi.org/10.1007/s00701-015-2682-3