title: Anaesthetists stress is induced by patient ASA grade and may impair non-technical skills during intubation.
abstract: The aims of this study were to determine if patient ASA grade was associated with increased stress in anaesthetists with a subsequent effect on non-technical skills.
  
  
  
  Stress was measured using a validated objective (heart rate variability or heart rate) and subjective tool. We studied eight consultant anaesthetists at baseline (rest) and during 16 episodes of intubation with an ASA 1 or 2 patient vs. an ASA 3 or 4 patient. The primary outcome for the study was objective and subjective stress between both patient groups. Secondary outcomes were non-technical skill ratings and the association between stress measurements.
  
  
  
  ASA 3 or 4 patients were associated with increases in objective stress when compared to baseline (mean 4.6 vs. 6.7; P = 0.004). However, ASA 1 or 2 patients were not associated with increases in stress when compared to baseline (mean 4.6 vs. 4.7; P = 1). There was no significant difference in subjective stress between the groups (P = 0.18). Objective stress negatively affected situational awareness (P = 0.03) and decision-making (P = 0.03); however, these did not decline to a clinically significant threshold. Heart rate variability (r = 0.60; P = 0.002) better correlated with subjective stress when compared to heart rate (r = 0.30; P = 0.15). Agreement between raters for Anaesthetic Non-Technical Skills (ANTS) scores was acceptable (ICC = 0.51; P = 0.003).
  
  
  
  This study suggests that higher patient ASA grade can increase stress in anaesthetists, which may impair non-technical skills.
authors.affiliation: Division of Medical Sciences and Graduate Entry Medicine, Royal Derby Hospital, University of Nottingham, Derby, UK.
authors.forename: B
authors.initials: B
authors.lastname: Doleman
authors.affiliation: Division of Medical Sciences and Graduate Entry Medicine, Royal Derby Hospital, University of Nottingham, Derby, UK.
authors.forename: J
authors.initials: J
authors.lastname: Blackwell
authors.affiliation: Division of Medical Sciences and Graduate Entry Medicine, Royal Derby Hospital, University of Nottingham, Derby, UK.
authors.forename: A
authors.initials: A
authors.lastname: Karangizi
authors.affiliation: Division of Medical Sciences and Graduate Entry Medicine, Royal Derby Hospital, University of Nottingham, Derby, UK.
authors.forename: W
authors.initials: W
authors.lastname: Butt
authors.affiliation: Division of Medical Sciences and Graduate Entry Medicine, Royal Derby Hospital, University of Nottingham, Derby, UK.
authors.forename: A
authors.initials: A
authors.lastname: Bhalla
authors.affiliation: Division of Medical Sciences and Graduate Entry Medicine, Royal Derby Hospital, University of Nottingham, Derby, UK.
authors.forename: J N
authors.initials: JN
authors.lastname: Lund
authors.affiliation: Division of Medical Sciences and Graduate Entry Medicine, Royal Derby Hospital, University of Nottingham, Derby, UK.
authors.forename: J P
authors.initials: JP
authors.lastname: Williams
mesh_terms: D000328:Adult; D000368:Aged; D000072077:Anesthetists / Q000523:psychology* / Q000706:statistics & numerical data*; D002983:Clinical Competence / Q000706:statistics & numerical data*; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007442:Intubation, Intratracheal / Q000592:standards*; D008297:Male; D008875:Middle Aged; D012306:Risk; D012720:Severity of Illness Index; D013312:Stress, Physiological / Q000502:physiology*; D013315:Stress, Psychological / Q000503:physiopathology / Q000523:psychology*