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Doleman, Brett, Blackwell, J., Karangizi, A., Butt, W., Bhalla, Ashish, 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
RIS ID:	https://nottingham-repository.worktribe.com/output/975480
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:	https://doi.org/10.1111/aas.12716
Depositing User:	Eprints, Support
Date Deposited:	01 Feb 2017 10:00
Last Modified:	04 May 2020 20:01
URI:	https://eprints.nottingham.ac.uk/id/eprint/40225

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