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Hemodynamic response to phacoemulsification among surgeons during high volume cataract surgery

Session Details

Session Title: Special Cases

Session Date/Time: Monday 07/10/2013 | 17:00-18:30

Paper Time: 17:33

Venue: Elicium 1 (First Floor)

First Author: : A.Murugesan INDIA

Co Author(s): :    H. Aravind   R. A   H. Anandan        

Abstract Details

Purpose:

To investigate the individual hemodynamic response to the stress of performing routine Phacoemulsification (PE) among normal, healthy ophthalmic surgeons in a high-volume setup

Setting:

Aravind eye hospital - A tertiary eye care referral centre in Southern India performing large volumes of cataract surgery

Methods:

Fourteen qualified ophthalmologists trained in performing PE were recruited across different age groups, gender and levels of experience. Each of them was examined by a general physician and pre-existing systemic complaints were recorded. The blood glucose, total cholesterol and hemoglobin for all participants were noted. For surgeons over 40 years of age a baseline electrocardiogram was also recorded. The baseline blood pressure and heart rate of the surgeons was recorded in a calm, non-operating room setup on three different occasions by an examiner. In the operating room (OR) the surgeons were explained the procedure and a consent was obtained. They were then connected to an electronic multi-monitor under their sterile surgical gowns. The surgeons underwent continuous electronic monitoring of their hemodynamic parameters while performing multiple PEs during the course of the operating day. Each surgery was divided into five serial stages – Wound construction, Capsulorrhexis, Phacoemulsification, Irrigation-aspiration and IOL implantation. The heart rate (HR) corresponding to each stage and blood pressure (BP) at the end of each surgery were recorded by the anesthesiologist. Since the third stage was the longest, the maximum and minimum heart rate were noted and their average taken for calculation.

Results:

The difference of the heart rate from the established baseline to the particular step in surgery was calculated for every individual and averaged for the total number of surgeries performed in that single day. Mean pulse difference from baseline peaked during stage 3 (Phacoemulsification stage) consistently for all surgeons. However the change in BP over the course of multiple surgeries analyzed using repeated measures ANOVA was not significant. The group was stratified based on age, gender, experience and number of surgeries performed on that particular day. The analysis showed no statistical significance but it was possible to see the difference between individual surgeons over their performance curves.

Conclusions:

Surgeons" stress in PE is reflected in excitement of the cardiovascular system. Though it varies among individuals, PE stage seems uniformly hemodynamically significant. A planned support system, trained staff and OR tranquility ensure minimal mental stress

Financial Interest:

NONE