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Anaesthetists stress is induced by patient ASA grade and may impair non‐technical skills during intubation
Author(s) -
Doleman B.,
Blackwell J.,
Karangizi A.,
Butt W.,
Bhalla A.,
Lund J. N.,
Williams J. P.
Publication year - 2016
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.12716
Subject(s) - medicine , intubation , heart rate , heart rate variability , anesthesia , physical therapy , blood pressure
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.