Biometric Analysis of Surgeons’ Physiologic Responses During Surgery

Abstract

Background Much has been written from the social science perspective surrounding surgeons’ stress and burn out. The literature is sparse in reference to scientific investigations of the hemodynamic effect of that stress. This prospective clinical study quantifies the physiologic impact of performing surgery upon the acute care surgeon. Methods Over 2.5 years, monitoring devices were affixed to surgeons prior to entering the operating room, and physiologic variables were documented every 30 minutes. Qualifying cases were projected as being greater than 2 hours with a baseline preoperative measurement obtained. Variables recorded included blood pressure (BP), heart rate (HR), rate pressure product (RPP), oxygen saturation (O2 sat), and end-tidal carbon dioxide (ET CO2). Results Statistically significant differences ( P < .05) were found between baseline data to the maximum recording during the surgical operation for: BP (min 101 ± 6.6 (mmHg)-max 117 ± 5.1 (mmHg)), HR (min 70.5 ± 6.2 (bpm)-max 83.7 ± 9.0 (bpm)), O2 sat (min 97 ± 2.0 (%)-max 100 ± 0.22(%)), and ET CO2 (min 34.1 ± 1.15 mmHg-max 38 ± 1.7 mmHg) ( P < .0001). The RPP ranged from 10.49 mmHg/min to 15.88 mmHg/min with a mean of 14.00 mmHg/min. Discussion The practice of surgery is considered demanding in training and lifestyle in comparison to other medical specialties. This data is among the first to demonstrate the negative physiological impact of surgery upon the metabolic demand of the surgeon. The longitudinal implications of increased physiologic demand over time may have cardiovascular and cerebrovascular consequences.

How Much Stress Does a Surgeon Endure? The Effects of the Robotic Approach on the Autonomic Nervous System of a Surgeon in the Modern Era of Thoracic Surgery

“…The sympathetic ANS component is activated by stress, with subsequent chronotropic and inotropic effects on the heart; vasocontraction, resulting in the elevation of blood pressure; and increases in the respiratory rate, characterized by shallow breaths. On the other hand, the parasympathetic branch has the opposite effect [17]. The study of ANS responses to surgical stress has been the subject of several papers in which surgeons, in comparison to medical physicians, are subjected to harder work in uncomfortable and exhausting positions and stressful situations [11].…”

“…Low HRV and a higher heart rate (HR) are associated with more stressful events and more stressful interventions [15,16]. A recent paper related blood pressure, heart rate, O2 saturation, and CO 2 production with the activation of the ANS during surgery [17].…”

Learning Curve of Robotic Lobectomy for the Treatment of Lung Cancer: How Does It Impact on the Autonomic Nervous System of the Surgeon?

“…Thus, we also considered hemodynamic, metabolic and respiratory responses to stress, regulated by the autonomic nervous system. In particular, stress activates the ANS sympathetic component with chronotropic and inotropic effects on the heart, vasocontraction and increasing of blood pressure, as well as of the respiratory rate, characterized by shallow breaths [ 24 ]. In this light, heart rate, heart rate variability, blood pressure, O2 saturation, and time of desaturation have been considered in various papers as markers of stress linked to surgical acts and regulated by noradrenergic pathways of sympathetic innervation on the cardiovascular and respiratory systems.…”

“…In this light, heart rate, heart rate variability, blood pressure, O2 saturation, and time of desaturation have been considered in various papers as markers of stress linked to surgical acts and regulated by noradrenergic pathways of sympathetic innervation on the cardiovascular and respiratory systems. [ 20 , 21 , 22 , 23 , 24 ]. In accordance with our cardiologic division, we used a wearable device (Healer R2) for monitoring the ANS sympathetic component.…”

“…The impact of surgical stress could be measured by heart rate and heart rate variability (HRV), considered as a consequence of the autonomic nervous system (ANS) activity, regulating the time interval (milliseconds) between heartbeats [ 20 , 21 , 22 ]. Some papers relate blood pressure, heart rate, O 2 saturation and CO 2 production with the activation of the ANS during surgery [ 22 , 23 , 24 ], and low HRV and a higher heart rate (HR) are associated with more stressful events or more stressful interventions.…”