title: Increased cardiovascular and anxiety outcomes but not endocrine biomarkers of stress during performance of endoscopic sinus surgery: a pilot study among novice surgeons.
abstract: OBJECTIVE
  To compare psychophysiological responses among novice surgeons during performance of endoscopic sinus surgery (ESS).
  
  
  METHODS
  Randomized study.
  
  
  METHODS
  Academic institution.
  
  
  METHODS
  Fifteen novice surgeons.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Rhinology Unit and Smell Clinic, Department of Otorhinolaryngology, Universitat de Barcelona, Villarroel 170, Barcelona 08036, Spain. 32874iao@comb.cat
authors.forename: Isam
authors.initials: I
authors.lastname: Alobid
authors.forename: Juan
authors.initials: J
authors.lastname: de Pablo
authors.forename: Joaquim
authors.initials: J
authors.lastname: Mullol
authors.forename: Silvia
authors.initials: S
authors.lastname: Centellas
authors.forename: Gemma
authors.initials: G
authors.lastname: Parramon
authors.forename: Javier
authors.initials: J
authors.lastname: Carrasco
authors.forename: Antonio
authors.initials: A
authors.lastname: Armario
authors.forename: Manuel
authors.initials: M
authors.lastname: Bernal-Sprekelsen
mesh_terms: D000328:Adult; D001007:Anxiety / Q000523:psychology*; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure / Q000502:physiology; D004724:Endoscopy / Q000193:education / Q000523:psychology*; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D010254:Paranasal Sinus Diseases / Q000523:psychology / Q000601:surgery*; D010820:Physicians / Q000523:psychology*; D010865:Pilot Projects; D011388:Prolactin / Q000097:blood; D018709:Statistics, Nonparametric; D013315:Stress, Psychological / Q000523:psychology*; D025321:Surgery, Computer-Assisted; D013997:Time Factors
chemical_list: D015415:Biomarkers; D011388:Prolactin; D006854:Hydrocortisone