Does β-blockade affect surgical performance?. A double blind trial of oxprenolol

Foster, G. E.; Makin, C. A.; Evans, D. F.; Hardcastle, J. D.

doi:10.1002/bjs.1800670902

Cited by 16 publications

(6 citation statements)

References 5 publications

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“…Oxprenolol given prior to pistol shooting competitions was shown to be associated with greater subjective calmness and improved shooting performance relative to placebo (9 1) but acebutolol failed to improve performance in rifle shooting (92). Oxprenolol has also been shown to abolish the tachycardia seen in surgeons whilst operating, but in this study (93) there was no alteration of subjective feelings and no changes in tests of tremor and suturing accuracy whilst reaction time was significantly slowed. In general, observed beneficial effects in situational anxiety relate primarily to somatic symptoms, with psychic benefits being less prominent or absent.…”

Section: Phobic Statescontrasting

confidence: 48%

Beta-Blockers in the Treatment of Neurological and Psychiatric Disorders

Peet¹,

Yates²

1981

J Clin Pharm Ther

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SUMMARY β‐blockers, originally introduced into clinical practice for the treatment of cardiovascular disorders, are being increasingly advocated in the treatment of diverse neurological and psychiatric conditions. Thus, propranolol and certain other β‐blockers have been shown to be effective, and may be the drugs of choice, in the treatment of benign essential tremor and the prevention of recurrent migraine attacks. These drugs also have a useful role to play in the treatment of anxiety and alcohol withdrawal states, although β‐blockers have not come into general use in these conditions. The action of propranolol and related drugs in these neurological and psychiatric conditions is generally considered to be mediated by blockade of peripheral β‐adrenergic receptors, although other effects, either central or peripheral, may also be involved. The use of β‐blockers in the treatment of psychosis remains controversial. Current evidence does not support the use of propranolol in schizophrenia, but further studies in mania are warranted.

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Section: Phobic Statescontrasting

confidence: 48%

Beta-Blockers in the Treatment of Neurological and Psychiatric Disorders

Peet¹,

Yates²

1981

J Clin Pharm Ther

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“…They further concluded that the autonomic response to stress could be blocked by oxprenalol without affecting performance adversely. The recent studies of Foster et al (1979) have shown a similar type of response in surgeons while operating and again report that while oxprenalol reduced the heart rate response it did not affect tremor or manual dexterity.…”

Section: Discussionmentioning

confidence: 61%

“…This subjective inability to recognise autonomic blockade has recently been confirmed in studies of the effect of 3 blockade on the performance of surgeons (Foster et al 1979).…”

Section: Stress Responsementioning

confidence: 83%

Human endurance--mind or muscle?

Taylor¹

1978

Br J Sports Med

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Two investigations have been carried out. The first studied the effects of autonomic blockade on the cardiovascular response to a step test, a 50% maximum isometric grip test and a Valsalva manoeuvre: the step test was of 5 minutes duration and the other two for as long as possible. J3 adrenergic blockade by propanolol diminished the blood pressure and pulse rate response to both the step test and isometric grip. The pulse rate response to the step test was also affected by cholinergic blockade with atropine. The response to the Valsalva test showed a cholinergic blockade effect of pulse rate alone and a blood pressure reponse alone on ccadrenergic blockade by phenoxybenzamine.The second studied psychological stressing on physical and mental ability. A potential 'punishment' situation increased the blood pressure and pulse rate response to isometric grip while decreasing the time for which it could be maintained. A potential 'reward' situation increased both the maximum grip and the time for which 50% grip could be maintained.It is concluded that psychological factors can affect performance dependent on whether the situation is perceived as one of 'reward' or 'punishment'. A factor in the mediation of the adverse response is an inappropriate response of the autonomic nervous system.

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“…Receiving low-dose propranolol was also associated with shortened time to task completion compared with low-dose caffeine. Foster et al reported a potential confounding effect (ie, increase in time of surgeon’s reaction time after receiving 40 mg of oxprenolol, a different class of β-blocker) but no association with accuracy or tremor.…”

Section: Discussionmentioning

confidence: 99%

Association of Weight-Adjusted Caffeine and β-Blocker Use With Ophthalmology Fellow Performance During Simulated Vitreoretinal Microsurgery

et al. 2020

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IMPORTANCE Vitreoretinal surgery can be technically challenging and is limited by physiologic characteristics of the surgeon. Factors that improve accuracy and precision of the vitreoretinal surgeon are invaluable to surgical performance.OBJECTIVES To establish weight-adjusted cutoffs for caffeine and β-blocker (propranolol) intake and to determine their interactions in association with the performance of novice vitreoretinal microsurgeons. DESIGN, SETTINGS, AND PARTICIPANTSThis single-blind cross-sectional study of 15 vitreoretinal surgeons who had less than 2 years of surgical experience was conducted from September 19, 2018, to September 25, 2019, at a dry-laboratory setting. Five simulations were performed daily for 2 days. On day 1, performance was assessed after sequential exposure to placebo, low-dose caffeine (2.5 mg/kg), high-dose caffeine (5.0 mg/kg), and high-dose propranolol (0.6 mg/kg). On day 2, performance was assessed after sequential exposure to placebo, low-dose propranolol (0.2 mg/kg), high-dose propranolol (0.6 mg/kg), and high-dose caffeine (5.0 mg/kg).INTERVENTIONS Surgical simulation tasks were repeated 30 minutes after masked ingestion of placebo, caffeine, or propranolol pills during the 2 days.MAIN OUTCOMES AND MEASURES An Eyesi surgical simulator was used to assess surgical performance, which included surgical score (range, 0 [worst] to 700 [best]), task completion time, intraocular trajectory, and tremor rate (range, 0 [worst] to 100 [best]). The nonparametric Friedman test followed by Dunn-Bonferroni post hoc test was applied for multiple comparisons. RESULTSOf 15 vitreoretinal surgeons, 9 (60%) were male, with a mean (SD) age of 29.6 (1.4) years and mean (SD) body mass index (calculated as weight in kilograms divided by height in meters squared) of 23.15 (2.9). Compared with low-dose propranolol, low-dose caffeine was associated with a worse total surgical score (557.0 vs 617.

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Does β-blockade affect surgical performance?. A double blind trial of oxprenolol

Cited by 16 publications

References 5 publications

Beta-Blockers in the Treatment of Neurological and Psychiatric Disorders

Beta-Blockers in the Treatment of Neurological and Psychiatric Disorders

Human endurance--mind or muscle?

Association of Weight-Adjusted Caffeine and β-Blocker Use With Ophthalmology Fellow Performance During Simulated Vitreoretinal Microsurgery

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