Weight-adjusted caffeine and β-blocker use in novice versus senior retina surgeons: a self-controlled study of simulated performance.

Autor: Roizenblatt M; Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil. maroizenb@gmail.com.; Vision Institute, IPEPO, Universidade Federal de São Paulo, São Paulo, Brazil. maroizenb@gmail.com.; The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA. maroizenb@gmail.com., Gehlbach PL; The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA., da Silveira Saraiva V; Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil.; Vision Institute, IPEPO, Universidade Federal de São Paulo, São Paulo, Brazil., Nakanami MH; Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil., da Cruz Noia L; Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil., Watanabe SES; Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil., Yasaki ES; Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil., Passos RM; Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil.; Vision Institute, IPEPO, Universidade Federal de São Paulo, São Paulo, Brazil., Magalhães Junior O; Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil., Fernandes RAB; Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil., Stefanini FR; Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil., Caiado R; Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil., Jiramongkolchai K; Kaiser Permanente Medical Group, McLean, VA, USA., Wolf M; Department of Ophthalmology and Visual Science, University of Wisconsin School of Medicine, Madison, WI, USA., Eid Farah M; Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil.; Vision Institute, IPEPO, Universidade Federal de São Paulo, São Paulo, Brazil., Belfort Junior R; Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil.; Vision Institute, IPEPO, Universidade Federal de São Paulo, São Paulo, Brazil., Maia M; Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil.; Vision Institute, IPEPO, Universidade Federal de São Paulo, São Paulo, Brazil.
Jazyk: angličtina
Zdroj: Eye (London, England) [Eye (Lond)] 2023 Oct; Vol. 37 (14), pp. 2909-2914. Date of Electronic Publication: 2023 Feb 13.
DOI: 10.1038/s41433-023-02429-8
Abstrakt: Background/objectives: Tremor and expertise are potentially influenced variables in vitreoretinal surgery. We investigated whether surgeon experience impacts the association of microsurgical performance with caffeine and β-blockers weight-adjusted intake.
Subjects/methods: Novice and senior surgeons (<2 and >10 practice years, respectively) were recruited in this self-controlled, cross-sectional study. A simulator's task sequence was repeated over 2 days, 30 min after the following exposures: day 1, placebo, 2.5 mg/kg caffeine, 5.0 mg/kg caffeine, and 0.6 mg/kg propranolol; and day 2, placebo, 0.2 mg/kg propranolol, 0.6 mg/kg propranolol, and 5.0 mg/kg caffeine. Outcomes were total score (0-700, worst-best), simulation time (minutes), intraocular trajectory (centimeters), and tremor-specific score (0-100, worst-best).
Results: We recruited 15 novices (9 men [60%], 1.33 ± 0.49 practice years) and 11 seniors (8 men [72.7%], 16.00 ± 4.24 practice years). Novices performed worse after 2.5 mg/kg caffeine and improved following 0.2 mg/kg propranolol in total score (557 vs. 617, p = 0.009), trajectory (229.86 vs. 208.07, p = 0.048), time (14.9 vs. 12.7, p = 0.048), and tremor-score (55 vs. 75, p = 0.009). Surgical performance improved with propranolol post-caffeine but remained worse than 0.2 mg/kg propranolol in total score (570 vs. 617, p = 0.014), trajectory (226.59 vs. 208.07, p = 0.033), and tremor-score (50 vs. 75, p = 0.029). Seniors' tremor-score was lower after 2.5 mg/kg caffeine compared to 0.2 mg/kg propranolol (8 vs. 37, p = 0.015). Tremor-score following propranolol post-caffeine remained inferior to 0.6 mg/kg propranolol alone (17 vs. 38, p = 0.012).
Conclusion: While caffeine and propranolol were associated with performance changes among novices, only tremor was affected in seniors, without dexterity changes. The pharmacologic exposure impact on surgical dexterity seems to be offset by increased experience.
(© 2023. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.)
Databáze: MEDLINE
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