Effects of a hot ambient operating theatre on manual dexterity, psychological and physiological parameters in staff during a simulated burn surgery

Abstract

Objectives Hot environmental conditions can result in a high core-temperature and dehydration which can impair physical and cognitive performance. This study aimed to assess the effects of a hot operating theatre on various performance, physiological and psychological parameters in staff during a simulated burn surgery. Methods Due to varying activity levels, surgery staff were allocated to either an Active (n = 9) or Less-Active (n = 8) subgroup, with both subgroups performing two simulated burn surgery trials (CONTROL: ambient conditions; 23±0.2˚C, 35.8±1.2% RH and HOT: 34±0˚C, 28.3±1.9% RH; 150 min duration for each trial), using a crossover design with four weeks between trials. Manual dexterity, core-temperature, heart-rate, sweat-loss, thermal sensation and alertness were assessed at various time points during surgery. Results Pre-trials, 13/17 participants were mildly-significantly dehydrated (HOT) while 12/17 participants were mildly-significantly dehydrated (CONTROL). There were no significant differences in manual dexterity scores between trials, however there was a tendency for scores to be lower/impaired during HOT (both subgroups) compared to CONTROL, at various time-points (Cohen's d =-0.74 to-0.50). Furthermore, alertness scores tended to be higher/ better in HOT (Active subgroup only) for most time-points (p = 0.06) compared to CONTROL , while core-temperature and heart-rate were higher in HOT either overall (Active; p<0.05) or at numerous time points (Less-Active; p<0.05). Finally, sweat-loss and thermal sensation were greater/higher in HOT for both subgroups (p<0.05).

An Experimental Simulation of Heat Effects on Cognition and Workload of Surgical Team Members

“…Consistent with global workspace theory of limited internal resources to use for physical and cognitive demands, the pattern of findings suggest that the duration of heat exposure impacts cognitive accuracy and slows response time on all cognitive functions except relatively simple cognitive tasks 24,35 . Heated surgery drains physical resources via dehydration, manual dexterity impairment, higher core temperature, and heart rate—as higher subjective alertness is maintained 17 . Where job resources are limited, 36 internal resources can increase state alertness to maintain surgical performance until increased effort can no longer compensate for physical resource depletion.…”

“…26,37 Heated surgery drains physical resources via dehydration, manual dexterity impairment, higher core temperature and heart rate -as higher subjective alertness is maintained. 17 Where job resources are limited, 38 internal resources can increase state alertness to maintain surgical performance until increased effort can no longer compensate for physical resource depletion. Consistent with these findings, interactions of heat and time in this study show observable decrements in cognitive performance after heat exposure of 60 minutes or longer.…”

“…12 Heat slows executive functioning after 60-minutes or longer exposures, 8,9,13 but effects of heat on surgical teams during procedures remain unclear. 14 Research shows heat has mixed effects on simple cognitive tests, 15 increases subjective workload, 16 impairs manual dexterity, 17 and sometimes has no performance effects in short operative tasks. 18 However, burn surgery in heated operating rooms (30-388C) can last multiple hours.…”

Building sustainable and resilient surgical systems: A narrative review of opportunities to integrate climate change into national surgical planning in the Western Pacific region

“…Hot temperatures can impair surgeons’ performance by decreasing manual dexterity and increasing self-rated physical demand and frustration levels. 112 , 113 Although OR air-conditioning systems provide an effective means of climate change adaptation, they could paradoxically worsen climate change and harm health through energy use and air pollutant production. 68 , 110 The energy-efficient OR building design considerations aforementioned in the infrastructure section could also reduce air conditioner use and improve workability.…”

Analysis of body heat tolerance of workers in a simulated warm environment based on linear mixed model

“…This way, the heat strain indicators such as body temperature and heart rate are continuously monitored [21]. The experiment study on thermal comfort and body heat tolerance is frequently employed to investigate cognitive and physiological responses to different thermal conditions in diverse populations [22][23][24]. Lu et al studied different people's body's physiological responses to heat in three climate conditions: warm-dry, warm-humid, and mild air temperatures.…”