title: Hemodynamic response during aneurysm clipping surgery among experienced neurosurgeons.
abstract: BACKGROUND
  Neurosurgery is a challenging field associated with high levels of mental stress. The goal of this study was to investigate the hemodynamic response of experienced neurosurgeons during aneurysm clipping surgery and to evaluate whether neurosurgeons' hemodynamic responses are associated with patients' clinical statuses.
  
  
  METHODS
  Four vascular neurosurgeons (all male; mean age 51 ± 10 years; post-residency experience ≥7 years) were studied during 42 aneurysm clipping procedures. Blood pressure (BP) and heart rate (HR) were assessed at rest and during seven phases of surgery: before the skin incision, after craniotomy, after dural opening, after aneurysm neck dissection, after aneurysm clipping, after dural closure and after skin closure.
  
  
  RESULTS
  HR and BP were significantly greater during surgery relative to the rest situation (p ≤ 0.03). There was a statistically significant increase in neurosurgeons' HR (F [6, 41] = 10.88, p < 0.001), systolic BP (F [6, 41] = 2.97, p = 0.01), diastolic BP (F [6, 41] = 2.49, p = 0.02) and mean BP (F [6, 41] = 3.36, p = 0.003) during surgery. The greatest mean HR was after aneurysm clipping, and the greatest BP was after aneurysm neck dissection. Systolic, diastolic and mean BPs were significantly greater during surgical clipping for unruptured aneurysms compared to ruptured aneurysms across all stages of surgery (p ≤ 0.002); however, after adjusting for neurosurgeon experience, the difference in BP as a function of aneurysm rupture was not significant (p > 0.08). Aneurysm location, intraoperative aneurysm rupture, admission WFNS score, admission Glasgow Coma Scale scores and Fisher grade were not associated with neurosurgeons' intraoperative HR and BP (all p > 0.07).
  
  
  CONCLUSIONS
  Aneurysm clipping surgery is associated with significant hemodynamic system activation among experienced neurosurgeons. The greatest HR and BP were after aneurysm neck dissection and clipping. Aneurysm location and patient clinical status were not associated with intraoperative changes of neurosurgeons' HR and BP.
authors.affiliation: Department of Neurosurgery, Hospital of the Lithuanian University of Health Sciences, Eiveniu str. 2, LT-50009, Kaunas, Lithuania. a.bunevicius@yahoo.com.|Neuroscience Institute, Lithuanian University of Health Sciences, Eiveniu str. 4, Kaunas, Lithuania. a.bunevicius@yahoo.com.
authors.forename: Adomas
authors.initials: A
authors.lastname: Bunevicius
authors.affiliation: Department of Anesthesiology, Lithuanian University of Health Sciences, Eiveniu str. 2, Kaunas, Lithuania.
authors.forename: Diana
authors.initials: D
authors.lastname: Bilskiene
authors.affiliation: Department of Anesthesiology, Lithuanian University of Health Sciences, Eiveniu str. 2, Kaunas, Lithuania.
authors.forename: Andrius
authors.initials: A
authors.lastname: Macas
authors.affiliation: Department of Neurosurgery, Hospital of the Lithuanian University of Health Sciences, Eiveniu str. 2, LT-50009, Kaunas, Lithuania.|Neuroscience Institute, Lithuanian University of Health Sciences, Eiveniu str. 4, Kaunas, Lithuania.
authors.forename: Arimantas
authors.initials: A
authors.lastname: Tamasauskas
mesh_terms: D000328:Adult; D017542:Aneurysm, Ruptured / Q000601:surgery; D003399:Craniotomy; D004388:Dura Mater / Q000601:surgery; D005260:Female; D015600:Glasgow Coma Scale; D006339:Heart Rate; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D000069471:Neurosurgeons; D019635:Neurosurgical Procedures; D011446:Prospective Studies; D013315:Stress, Psychological / Q000503:physiopathology / Q000523:psychology; D058106:Wound Closure Techniques
keywords: Aneurysm; Blood pressure; Clipping; Heart rate; Neurosurgery