Título / Title

A COMPARISON OF JUNIOR AND SENIOR VITREORETINAL SURGEON PERFORMANCE ON A SURGICAL SIMULATOR FOLLOWING CAFFEINE, Β-BLOCKERS, OR BOTH

Introdução / Purpose

To investigate whether surgeon experience impacts the association of microsurgical performance with caffeine and β-blockers weight-adjusted intake.

Material e Método / Methods

Novice and senior vitreoretinal surgeons (<2 and >10 practice years, respectively) were recruited. An Eyesi-simulator task sequence was repeated over 2 days, 30 minutes after the following exposures. Day 1: placebo, 2.5-mg/kg caffeine, 5.0-mg/kg caffeine, and 0.6-mg/kg propranolol. Day 2: placebo, 0.2-mg/kg propranolol, 0.6-mg/kg propranolol, and 5.0-mg/kg caffeine. Outcomes were total score (0-700, worst-best), simulation time (minutes), intraocular trajectory (centimeters), and tremor-specific score (0-100, worst-best).

Resultados / Results

We recruited 15 novices (9 men [60%], 1.33±0.49 practice years) and 11 seniors (8 men [72.7%], 16.00±4.24 practice years). Novices had worse dexterity after 2.5-mg/kg caffeine, and improved following 0.2-mg/kg propranolol in total score (557[503–626] vs. 617[565–638], P=0.009), trajectory (229.86[203.34-2552.5] vs. 208.07[189.57-236.08], P=0.048), time (14.9[12.5-16.28] vs. 12.7[10.6-14.6], P=0.048), and tremor-specific score (55[32-75] vs. 75[47-88], P=0.009). Performance improved with propranolol post-caffeine but remained worse than 0.2-mg/kg propranolol alone in total score (570[535-591] vs. 617[565-638], P=0.014), trajectory (226.59[204.14-265.71] vs. 208.07[189.57-236.08], P=0.033), and tremor-specific score (50[37-62] vs. 75[47-88], P=0.029). Among seniors, tremor-specific score was lower after 2.5-mg/kg caffeine compared to 0.2-mg/kg propranolol (8[3-25] vs. 37[25-53], P=0.015). Tremor-specific score following propranolol post-caffeine remained inferior to 0.6-mg/kg propranolol alone (17[13-33] vs. 38[32-72], P=0.012).

Discussão e Conclusões / Conclusion

While caffeine and propranolol were associated with performance changes among novices, only tremor was affected in seniors, without dexterity changes. The pharmacologic exposure impact on surgical dexterity seems to be offset by increased experience.

Palavras Chave

β-blockers
Caffeine
Eyesi Simulator
Surgical Experience
Vitreoretinal Surgery

Area

SURGICAL RETINA