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First Author: P.Bulir CZECH REPUBLIC
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The aim of this study was to monitor heart rate of cataract surgeons during different steps of cataract surgery.
Eye Department, Hospital Liberec, Czech republic
Heart rate and its changes depends on many factors: physical and mental activity, gender, training, stress or disease. Aim of this study was to compare heart rate of experience surgeon during different parts of cataract surgery. The second aim of this study was to compare heart rate of certain parts of surgery with results of trainee surgeon who had recently started with cataract surgery. For monitoring of heart rate was used Garmin Hand HR monitor 250. Brest belt with wireless transfer to monitor was placed on examined surgeon chest and depending on stage of procedure operating theatre staff was collecting data: duration, average heart rate, maximal heart rate. Procedure was divided to 5 PARTS: 1. starting CCI, instilling OVD, making paracentesis 2. making CCC 3. hydrodissection and fakoemulsification 4. aspiration of cortex, polishing of capsule 5. instilling OVD, implantation, I/A, hydratation of CCI. One minute before and one minute after surgery was surgeon monitored too forced to calm down in siting position. Data collected by Garmin Hand HR monitor were transferred to PC extracted by Garmin Training Centre Software. ANOVA (Analysis of Variation) and Student unpaired t-test were used for statistically analysis.
The first monitored surgeon was male 36years old, 6000 accomplished cataract procedures. He was monitored by 19 cataract procedures. Duration median 7:56 min (SD: 2:14, n=19). Average/Maximum Heart rate of PART 1-5 median: 1-66/73, 2-66/70, 3-67/75, 4-68/74, 5-70/76. There is no statistically significant difference of either average (p=0.47) or maximum (p=0.089) heart rate during different parts of cataract procedure monitored by this first surgeon. The heart rate is decreasing from start of surgery. The lowest heart rate is monitored during capsulorhexis. Than is getting up. Significantly (p=0.014) the highest is the first minute of resting after surgery. The second monitored surgeon was female 29 years old, in learning process of cataract surgery, monitored by 9 procedures. Average/Maximum Heart rate of PART 1-5 median: 1-120/123, 2-119/122, 3-129/143, 4-128/141, 5-130/143. By the trainee surgeon is statistically significant difference of average (p=0.0003) and maximum (p<0.0001) heart rate during different parts of cataract procedure. There is difference between average and maximum heart rate in PART 1-2 and significant increase after exchange in to the position of surgeon with lector to finish surgery in PART 3-5 under supervision. There is significant (p<0.0001) decrease of heart rate during first minute after surgery.
Heart rate can be used as an indicator of stress during different physical or mental activity. Many cataract surgeons believes that there are parts of cataract surgery which are more demanding on focusing and parts where they can be more relaxed. Regarding our results there was no significant difference comparing certain steps of the surgery monitored by experienced surgeon. On the other hand there was a significant change of heart rate by cataract surgery trainee. Heart rate plot shows lowest heart rate of surgeons during continuous curvilinear capsulorhexis. Author believe that though this part is one of most stressful part of surgery low heart rate is caused by low breathing rate, partial apnoea leading to induced bradycardia during this step of cataract surgery. So in this case amount of stress doesn"t always equal to high heart rate.