What is the clinical evidence from this study?

Study design: Observational. Population: Healthy neurosurgeons (n=4). Intervention: Microsurgical clipping of aneurysms vs. Baseline. Primary outcome: Heart rate variability (HRV).

March 23, 2016

Ruptured blebs and racing hearts: autonomic cardiac changes in neurosurgeons during microsurgical clipping of aneurysms

Key Result

Microsurgical clipping of aneurysms caused a reduction in total power and an increased LF/HF ratio in 4 neurosurgeons, indicating significant parasympathetic and sympathetic autonomic responses.

Study Design

Type

Observational (n=4)

Structured PICO

What are the autonomic cardiac changes and stress levels in neurosurgeons during microsurgical clipping of aneurysms?

Population

4 healthy neurosurgeons whose ECGs were analyzed during 21 microsurgical clippings of aneurysms.

Exposure

Continuous real time monitoring of Lead II ECG intraoperatively across five surgical stages

Outcome

Heart rate variability (HRV) across five surgical stages (Baseline, sylvian fissure dissection, perianeurysmal dissection, clipping of the aneurysm, and haemostasis)surrogate

Intraoperative ECG monitoring of neurosurgeons reveals significant autonomic stress involving both sympathetic and parasympathetic systems during aneurysm clipping.

Abstract

INTRODUCTION: In this study, we intend to evaluate the autonomic changes occurring in neurosurgeons and thus the stress during microsurgical clipping of aneurysms. AIMS AND OBJECTIVES: The aim of the current study is to evaluate the heart rate variability (HRV) of the neurosurgeons during microsurgical clipping of aneurysm by using continuous real time monitoring of the ECG intraoperatively. MATERIAL AND METHODS: Lead II ECG was recorded using Bioharness(®) (Zephyr Technologies, Annapolis, MD) in 4 healthy neurosurgeons who performed 29 microsurgical clipping of aneurysms. ECG from 21 surgeries was analysed (LabChart(®) software, ADInstruments, Dunedin, New Zealand) across five stages: Baseline (BL), sylvian fissure dissection (SFD), perianeurysmal dissection (PAD), clipping of the aneurysm (CLIP) and haemostasis (HEMO). RESULTS: There was a reduction in TP and an increased LF/HF ratio in spite of suppression of both LF and HF powers. Contrary to the common understanding that the sympathetic limb of the autonomic system mostly mediates responses during stress and anxiety, we found that there was a significant contribution of the parasympathetic system too.

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