Is aneurysm surgery too exciting for our own good?

Abstract

Bunevicius and colleagues present an observational study on hemodynamic changes recorded from four experienced vascular neurosurgeons during 42 aneurysm clippings (ref). With this rather novel approach studying surgeons instead of patients, they found that heart rates and blood pressures rose during surgery and peaked after aneurysm neck dissection and clipping relative to at rest. They also observed that clipping un-ruptured aneurysms was associated with greater hemodynamic responses than clipping ruptured aneurysms. Although they are to be congratulated for conducting an interesting and different study, it may hardly come as a surprise to the reader that aneurysm surgery can be more stressful than resting in a chair. It also seems reasonable that un-ruptured aneurysms trigger greater hemodynamic responses since only perfect results are acceptable when patients undergo prophylactic neurovascular surgery, while treatment results in patients with subarachnoid hemorrhage are not entirely up to the surgeon. Although too much stress may increase tremor, impair judgment and therefore be undesirable for our patients during complex microneurosurgical procedures, the authors also speculate that aneurysm surgery may pose an occupational threat to our own health. Despite stressful surgeries, the mortality rates of surgeons luckily do not appear to be higher than in other medical specialties, and there is no excess of ischemic heart disease [1, 17]. In Norway, the life expectancy of male doctors is among the highest of all professions; only priests, college/university teachers and architects beat us by a fewmonths (www.ssb.no). US data also confirm that the life expectancy is higher for physicians than for example lawyers and other examined professionals [3]. But are neurovascular surgeons perhaps special? Although neurovascular surgery is both technically and mentally demanding, dealing with as well as controlling stress is part of the drill. Many neurovascular surgeons thrive on stress and may therefore represent a selection of individuals who are more comfortable with stressful situations. With human responses there is often a response shift with repeated exposures over time. With experience many neurovascular surgeons may therefore become more resistant to the adverse reactions from stress, as also suggested in the current study. This is presumably good for our patients. Among the four experienced neurovascular surgeons included in the present study, recorded hemodynamic responses were quite modest with observed heart rates 180/ 110 mmHg) 28 % of the time during observation. Also, abnormal blood pressure was more common during surgery than during vigorous physical exercise [14]. Even so, based on what we know from these two studies, aneurysm surgery does not seem to trigger extreme hemodynamic responses compared to other procedures or life situations. Similar hemodynamic responses have for example been seen during hallux valgus surgery, but with larger responses in trainees than in trainers [5]. Also in healthy men watching (Scottish!) football hemodynamic responses similar to performing aneurysm * Ole Solheim ole.solheim@ntnu.no