title: Practicality of using galvanic skin response to measure intraoperative physiologic autonomic activation in operating room team members.
abstract: BACKGROUND
  Physiologic and psychological stress are commonly experienced by operating room (OR) personnel, yet there is little research about the stress levels in OR teams and their impact on performance. Previously published procedures to measure physiologic activation are invasive and impractical for the OR. The purpose of this study was to determine the practicality of a new watch-sized device to measure galvanic skin response (GSR) in OR team members during high-fidelity surgical simulations.
  
  
  METHODS
  Interprofessional OR teams wore sensors on the wrist (all) and ankle (surgeons and scrub nurses/technicians) during the orientation, case, and debriefing phases for 17 simulations of a surgical airway case. Data were compared across all simulation phases, collectively and for each professional group.
  
  
  RESULTS
  Forty anesthesiology residents, 35 surgery residents, 27 OR nurses, 12 surgical technicians, and 7 CRNAs participated. Collectively, mean wrist GSR levels significantly increased from orientation phase to the case (0.40-0.62 μS; P < .001) and remained elevated even after the simulation was over (0.40-0.67 μS; P < .001). Surgery residents were the only group that demonstrated continued increases in wrist GSR levels throughout the entire simulation (change in GSR = 0.21 to 0.32 to 0.11 μS; P < .01). Large intraindividual differences (≤ 200 times) were found in both wrist and ankle GSR. There was no correlation between wrist and ankle data.
  
  
  CONCLUSIONS
  Continuous GSR monitoring of all professionals during OR simulations is feasible, but would be difficult to implement in an actual OR environment. Large variation in individual levels of physiologic activation suggests complementary qualitative research is needed to better understand how people respond to stressful OR situations.
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Massachusetts General Hospital Learning Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Electronic address: rphitayakorn@mgh.harvard.edu.
authors.forename: Roy
authors.initials: R
authors.lastname: Phitayakorn
authors.affiliation: Massachusetts General Hospital Learning Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Anesthesiology, Critical Care & Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: R D
authors.initials: RD
authors.lastname: Minehart
authors.affiliation: Massachusetts General Hospital Learning Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Anesthesiology, Critical Care & Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: M C M
authors.initials: MC
authors.lastname: Pian-Smith
authors.affiliation: Massachusetts General Hospital Learning Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Perioperative Services, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: M W
authors.initials: MW
authors.lastname: Hemingway
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Massachusetts General Hospital Learning Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: E R
authors.initials: ER
authors.lastname: Petrusa
mesh_terms: D000328:Adult; D004506:Education, Nursing; D005240:Feasibility Studies; D005260:Female; D005712:Galvanic Skin Response / Q000502:physiology*; D006801:Humans; D007396:Internship and Residency; D008297:Male; D018670:Monitoring, Ambulatory / Q000295:instrumentation*; D010348:Patient Care Team; D000066908:Simulation Training; D013315:Stress, Psychological / Q000503:physiopathology*; D013964:Thyroid Neoplasms / Q000601:surgery; D013965:Thyroidectomy / Q000193:education*