title: Factors That Affect Physiologic Tremor and Dexterity During Surgery: A Primer for Neurosurgeons.
abstract: BACKGROUND
  All individuals have a physiologic tremor that may become more pronounced in periods of stress, stimulant use, or caffeine. There are few publications measuring the effects of these factors on surgeons or trainees and no comprehensive reviews. We sought to review the representative literature.
  
  
  METHODS
  An exhaustive literature search to identify journal articles evaluating factors that affect surgical tremor or dexterity was performed.
  
  
  RESULTS
  Our search identified 34 studies. All included manuscripts are from small, single-center studies and the vast majority evaluated procedural skills on the basis of laparoscopic simulators. Only one study in which the authors evaluated microsurgical procedural performance was identified.
  
  
  CONCLUSIONS
  The literature evaluating tremor and its relationship to surgical performance is limited. Surgeons wishing to optimize surgical dexterity may benefit from avoiding caffeine use or fasting before operating and avoiding sleep deprivation or alcohol use the night before procedures. Those surgeons prone to anxiety or stress-related tremor may obtain a benefit from certain beta-blockers. Finally, the use of appropriate surgical ergonomics with hand or wrist steadying may improve surgical tremor and reduce fatigue.
authors.affiliation: Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA. Electronic address: fargen@musc.edu.
authors.forename: Kyle M
authors.initials: KM
authors.lastname: Fargen
authors.affiliation: Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Raymond D
authors.initials: RD
authors.lastname: Turner
authors.affiliation: Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Alejandro M
authors.initials: AM
authors.lastname: Spiotta
mesh_terms: D007839:Functional Laterality / Q000502:physiology*; D006801:Humans; D008866:Microsurgery; D009048:Motor Skills / Q000502:physiology; D019635:Neurosurgical Procedures; D014202:Tremor / Q000503:physiopathology*
keywords: Caffeine; Dexterity; Fatigue; Neurosurgery; Propranolol; Surgery; Tremor