Abstract
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. 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. 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). This study suggests that higher patient ASA grade can increase stress in anaesthetists, which may impair non-technical skills.
Highlights
Stress is a physiological and psychological response to external stimuli
There was a significant correlation between low frequency (LF)/high frequency (HF) ratio and State Trait Anxiety Inventory er (STAI)
There was no significant correlation between heart rate and STAI (r=0.30; p=0.15)
Summary
Stress is a physiological and psychological response to external stimuli. A degree of stress can optimise performance when this reaches a certain threshold, performance deteriorates.[1]During the conduct of anaesthesia, there are many potential sources of mental stress. Stress is a physiological and psychological response to external stimuli. A degree of stress can optimise performance when this reaches a certain threshold, performance deteriorates.[1]. During the conduct of anaesthesia, there are many potential sources of mental stress. The American Society of Anaesthesiologists (ASA) grade can be used to riskstratify patients in the perioperative period, with higher ASA grades er associated with increases in mortality.[4] With an ageing population and a rise in co-morbid conditions, there is an increase in the proportion of patients of. The aims of this study were to determine if patient co-morbidity could increase stress in anaesthetists with a subsequent effect on nontechnical skills
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