Anaesthetists stress is induced by patient ASA grade and may impair non-technical skills during intubation

Doleman, Brett and Blackwell, J. and Karangizi, A. and Butt, W. and Bhalla, Ashish and Lund, Jonathan N. and Williams, John P. (2016) Anaesthetists stress is induced by patient ASA grade and may impair non-technical skills during intubation. Acta Anaesthesiologica Scandinavica, 60 (7). pp. 910-916. ISSN 1399-6576

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Abstract

Background

The aims of this study were to determine if patient ASA grade was associated with increased stress in anaesthetists with a subsequent effect on non-technical skills.

Methods

Stress was measured using a validated objective (heart rate variability or heart rate) and subjective tool. We studied eight consultant anaesthetists at baseline (rest) and during 16 episodes of intubation with an ASA 1 or 2 patient vs. an ASA 3 or 4 patient. The primary outcome for the study was objective and subjective stress between both patient groups. Secondary outcomes were non-technical skill ratings and the association between stress measurements.

Results

ASA 3 or 4 patients were associated with increases in objective stress when compared to baseline (mean 4.6 vs. 6.7; P = 0.004). However, ASA 1 or 2 patients were not associated with increases in stress when compared to baseline (mean 4.6 vs. 4.7; P = 1). There was no significant difference in subjective stress between the groups (P = 0.18). Objective stress negatively affected situational awareness (P = 0.03) and decision-making (P = 0.03); however, these did not decline to a clinically significant threshold. Heart rate variability (r = 0.60; P = 0.002) better correlated with subjective stress when compared to heart rate (r = 0.30; P = 0.15). Agreement between raters for Anaesthetic Non-Technical Skills (ANTS) scores was acceptable (ICC = 0.51; P = 0.003).

Conclusion

This study suggests that higher patient ASA grade can increase stress in anaesthetists, which may impair non-technical skills.

Item Type: Article
Additional Information: This is the peer reviewed version of the following article: Doleman B, Blackwell J, Karangizi A, Butt W, Bhalla A, Lund JN, Williams JP. Anaesthetists stress is induced by patient ASA grade and may impair non-technical skills during intubation. Acta Anaesthesiologica Scandinavica 2016, which has been published in final form at http://dx.doi.org/10.1111/aas.12716. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.
Schools/Departments: University of Nottingham, UK > Faculty of Medicine and Health Sciences > School of Medicine > Division of Medical Sciences and Graduate Entry Medicine
Identification Number: 10.1111/aas.12716
Depositing User: Eprints, Support
Date Deposited: 01 Feb 2017 10:00
Last Modified: 20 Mar 2017 04:53
URI: http://eprints.nottingham.ac.uk/id/eprint/40225

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