Increased Cardiovascular and Anxiety Outcomes but Not Endocrine Biomarkers of Stress During Performance of Endoscopic Sinus Surgery A Pilot Study Among Novice Surgeons

Objective: To compare psychophysiological responses among novice surgeons during performance of endoscopic sinus surgery (ESS). Design: Randomized study. Setting: Academic institution. Participants: Fifteen novice surgeons. Main Outcome Measures: The psychophysiological effects of performing ESS were assessed among 15 novice surgeons at 30 minutes before (T-30), at the beginning of (T0), at 15 minutes (T15), and 45 minutes (T45) during, and at 30 minutes after (T + 30) surgery. Participants were randomized to perform ESS with a computer-assisted surgery system, to perform ESS without a computer-assisted surgery system, or to be evaluated on a nonsurgical day (control day). Measured were the State-Trait Anxiety Inventory score, Visual Analog Anxiety Scale score, heart rate, blood pressure, and plasma cortisol and prolactin levels. Results: Anxiety as measured by the State-Trait Anxiety Inventory score was not modified by the experimental conditions. The mean (SEM) Visual Analog Anxiety Scale score increased (P <.05) during ESS at T0 (2.45 [0.32]), T15 (3.46 [0.50]), and T45 (3.17 [0.46]) compared with the control day (1.19 [0.19], 1.32 [0.26], and 1.20 [0.19], respectively). The mean (SEM) systolic blood pressure (in millimeters of mercury) increased (P <.05) during ESS at T0 (127 [2]), T15 (126 [3]), and T45 (125 [2]) compared with the control day (120 [3], 119 [4], and 116 [3], respectively). The mean (SEM) heart rate (in beats per minute) increased during ESS but was significant only at T15 (73 [4]) compared with the control day (64 [3]). The mean (SEM) plasma cortisol level (in micrograms per deciliter) increased 29% above baseline during performance of ESS and reached a maximum peak at T45 (12.6 [1.2]) compared with the control day (9.7 [1.1]), while prolactin levels did not change. The Visual Analog Anxiety Scale score, heart rate, blood pressure, and endocrine biomarkers of stress were not significantly modified during performance of ESS with a computer-assisted surgery system. Conclusion: This study demonstrates for the first time that cardiovascular and anxiety changes during performance of ESS are not associated with increased levels of prototypical endocrine stress hormones.