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Anaesthetists stress is induced by patient ASA grade and may impair non‐technical skills during intubation

2016; Wiley; Volume: 60; Issue: 7 Linguagem: Inglês

10.1111/aas.12716

1399-6576

Brett Doleman, James Blackwell, A. Karangizi, Wasi Haider Butt, Ashish Bhalla, Jonathan N. Lund, John P. Williams,

Musculoskeletal pain and rehabilitation

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.