BACKGROUND: Although hemodynamic changes in anesthetized patients remain well documented, no study has quantified the effect of operating stress on the neurosurgeon.
OBJECTIVE: We present a study of intraoperative (IOP) pulse and blood pressure (BP) recordings obtained from neurosurgeons and compare them with rest and exercise values.
METHODS: This prospective, single-blind comparative analysis used an ambulatory BP device to record IOP, rest and exercise BP, and pulse. The Student t test and χ2 test were used for statistical analysis.
RESULTS: Five neurosurgeons performed 10 aneurysm clippings and 1 vestibular schwannoma excision. The average IOP pooled systolic, diastolic, and mean BPs and pulse rates were 140, 103, and 116 mm Hg and 94 bpm, respectively. Corresponding rest and exercise values were 116, 75, and 89 mm Hg and 76 bpm and 130, 99, and 109 mm Hg and 128 bpm, respectively. Average IOP mean and diastolic BPs were significantly elevated compared with rest readings (P = .032, P = .023). Episodes of severe IOP BP (systolic BP/diastolic BP > 180/110 mm Hg) accounted for 28% of all readings and were significantly increased over rest values (P < .001). The incidence of abnormal IOP BP (systolic BP/diastolic BP > 140/90 mm Hg) was also significantly greater than exercise and rest values (P < .001).
CONCLUSION: Neurosurgery can induce a significant hemodynamic stress malresponse in the operating surgeon that appears to be greater than that induced by vigorous exercise. The correlation of this occupational hazard to long-term health and longevity remains to be studied.
On the Cover Close-up view of the Sistine Chapel fresco by Michelangelo Buonarroti (1475–1564) titled “Separation of Light from Darkness” (1512), in which Michelangelo illustrated the first act performed by God in the creation of the universe based on the passage from the Book of Genesis 1:3–5. Artistic overlay outlines a concealed ventral view of the brainstem and the spinal cord. Inset: Entire fresco as seen directly above the altar on the Sistine Chapel ceiling.
Department of Neurosurgery, India Institute of Medical Sciences, New Delhi, India (Manish Singh Sharma) (Thapa) (Chandra) (Suri) (Singh) (Bhawani S. Sharma)
Department of Cardiology, India Institute of Medical Sciences, New Delhi, India (Bahl)
Reprint requests: Manish Singh Sharma, MCh, Departments of Neurosurgery, India Institute of Medical Sciences, New Delhi, 110029, India. E-mail: firstname.lastname@example.org
Received, February 4, 2009.
Accepted, August 2, 2009.