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

Doleman, Brett; Blackwell, J.; Karangizi, A.; Butt, W.; Bhalla, Ashish; Lund, Jonathan N.; Williams, John P.

Abstract

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.

• Journal Article Type: Article
• Acceptance Date: Feb 7, 2016
• Online Publication Date: Mar 4, 2016
• Publication Date: Aug 1, 2016
• Deposit Date: Feb 1, 2017
• Publicly Available Date: Feb 1, 2017
• Journal: Acta Anaesthesiologica Scandinavica
• Print ISSN: 0001-5172
• Electronic ISSN: 1399-6576
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 60
• Issue: 7
• Pages: 910-916
• DOI: https://doi.org/10.1111/aas.12716
• Public URL: https://nottingham-repository.worktribe.com/output/975480
• Publisher URL: http://onlinelibrary.wiley.com/doi/10.1111/aas.12716/abstract
• Additional Information: This is the peer reviewed version of the following article: Doleman B, Blackwell J, Karangizi A, Butt W, Bhalla A, Lund JN, Williams JP. Anaesthetists stress is induced by patient ASA grade and may impair non-technical skills during intubation. Acta Anaesthesiologica Scandinavica 2016, which has been published in final form at http://dx.doi.org/10.1111/aas.12716. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.