title: Intraoperative stress in cardiac surgery: attendings versus residents.
abstract: BACKGROUND
  Performing cardiac surgery is associated with stress for surgeons. We investigated stress levels of experienced surgeons and trainees during coronary artery bypass graft teaching procedures.
  
  
  METHODS
  We assessed heart rate (HR) and sympathovagal balance (SVB) of experienced surgeons (attendings; n = 7) and residents enrolled in a training program (residents; n = 3) using a one-lead electrocardiogram during a total of 109 elective isolated coronary artery bypass graft procedures. We measured HR and SVB for baseline values at rest and at prespecified phases during the procedure in the role as primary surgeons (n = 10) and assistants (n = 9).
  
  
  RESULTS
  All participants were healthy men with a mean age of 41.4 ± 4.3 y. For patients operated on during this study, demographic and intraoperative data were homogeneous. Compared with rest, mean HR and SVB for the whole procedure were higher for surgeons and assistants, with significant differences for HR values (surgeons, 83.7 ± 8.8 beats/min [bpm]; assistants, 85.4 ± 12.7 bpm, P < 0.05 versus 62.3 ± 5.1 bpm). Courses of HR and SVB were comparable for attending and resident groups but values were higher throughout for attendings compared with residents in their role as surgeons during the total procedure, and as assistants during cardiopulmonary bypass. Mean HR and SVB values of attendings assisting the procedure were higher compared with those of residents performing the operation.
  
  
  CONCLUSIONS
  Surgical experience is not associated with reduced stress levels. Supervising a teaching case in cardiac surgery can be linked with more stress compared with the resident performing the procedure.
authors.affiliation: Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany.
authors.forename: Elmar W
authors.initials: EW
authors.lastname: Kuhn
authors.forename: Yeong-Hoon
authors.initials: YH
authors.lastname: Choi
authors.forename: Marc
authors.initials: M
authors.lastname: Schönherr
authors.forename: Oliver J
authors.initials: OJ
authors.lastname: Liakopoulos
authors.forename: Parwis B
authors.initials: PB
authors.lastname: Rahmanian
authors.forename: Claudia Yeong-Un
authors.initials: CY
authors.lastname: Choi
authors.forename: Thorsten
authors.initials: T
authors.lastname: Wittwer
authors.forename: Thorsten
authors.initials: T
authors.lastname: Wahlers
mesh_terms: D000328:Adult; D001026:Coronary Artery Bypass; D006339:Heart Rate; D006801:Humans; D007396:Internship and Residency; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D013315:Stress, Psychological / Q000209:etiology*; D013564:Sympathetic Nervous System / Q000502:physiology; D014630:Vagus Nerve / Q000502:physiology