A MULTIFACTORIAL APPROACH FOR IMPROVING THE SURGICAL PERFORMANCE OF NOVICE VITREORETINAL SURGEONS. Issue 10 (October 2021)

• Record Type: Journal Article
• Authors: Roizenblatt, Marina; Jiramongkolchai, Kim; Gehlbach, Peter Louis; Dias Gomes Barrios Marin, Vitor; Treiger Grupenmacher, Alex; Muralha, Felipe; Eid Farah, Michel; Belfort Junior, Rubens; Maia, Mauricio
• Is Part Of: Retina. Volume 41:Issue 10(2021)
• Publication Date: 2021-10
• Subjects: alcohol -- caffeine -- novice surgeon -- pars plana vitrectomy -- physical exercise -- propranolol -- sleep deprivation -- surgical performance; Retina -- Diseases -- Periodicals; Retinal Diseases; Vitreous Body; 617.735
• DOI: 10.1097/IAE.0000000000003147
• Languages: English
• ISSNs: 0275-004X

Abstract

Abstract : Purpose: To quantitatively analyze and compare the novice vitreoretinal surgeons' performance after various types of external exposures. Methods: This prospective, self-controlled, cross-sectional study included 15 vitreoretinal fellows with less than 2 years of experience. Surgical performance was assessed using the Eyesi simulator after each exposure: Day 1, placebo, 2.5, and 5 mg/kg caffeine; Day 2, placebo, 0.2, and 0.6 mg/kg propranolol; Day 3, baseline simulation, breathalyzer reading of 0.06% to 0.10% and 0.11% to 0.15% blood alcohol concentration; Day 4, baseline simulation, push-up sets with 50% and 85% repetition maximum; Day 5, 3-hour sleep deprivation. Eyesi-generated total scores were the main outcome measured (0–700, worst to best). Results: Performances worsened after increasing alcohol exposure based on the total score (χ 2 = 7; degrees of freedom = 2; P = 0.03). Blood alcohol concentration 0.06% to 0.10% and 0.11% to 0.15% was associated with diminished performance compared with improvements after propranolol 0.6 and 0.2 mg/kg, respectively ([INCREMENT]1 = −22 vs. [INCREMENT]2 = +13; P = 0.02; [INCREMENT]1 = −43 vs. [INCREMENT]2 = +23; P = 0.01). Propranolol 0.6 mg/kg was positively associated with the total score, compared with deterioration after 2.5 mg/kg caffeine ([INCREMENT]1 = +7 vs. [INCREMENT]2 = −13; P = 0.03). Conclusion: Surgical performance diminished dose dependently after alcohol. Caffeine 2.5 mg/kg was negatively associated with dexterity, and performance improved after 0.2 mg/kg propranolol. No changes occurred after short-term exercise or acute 3-hour sleep deprivation. Abstract : Alcohol intake was the only analyzed exposure associated with a dose-dependent alteration in novice surgeons' performance. Simulated vitreoretinal surgical dexterity deteriorated after 2.5 mg/kg caffeine ingestion and improved after 0.2 mg/kg propranolol ingestion. A short-term session of physical exercise or acute sleep deprivation was not associated with performance.