ABSTRACT
BACKGROUND: Minimally invasive surgery requires surgeons to allocate more attention and efforts than open surgery. A surgeon's pool of resource is affected by the multiple occurrences of interruptions and distractions in the operating room. Surgical flow disruption has been addressed from a quantitative perspective. However, little is known on its impact on the surgeons' physiological resources. METHODS: Three physiological markers, heat flux (HF), energy expenditure in metabolic equivalent of tasks and galvanic skin response were recorded using body sensor monitoring during the 21 surgical operations. The three markers, respectively, represent: stress, energy mobilization and task engagement. A total of 8 surgeons with different levels of expertise (expert vs. novice) were observed performing 21 surgical procedures categorized as short versus long. Factors of distractions were time-stamped, and triangulated with physiological markers. Two cases illustrate the impact of surgical flow disruptions on the surgeons. RESULTS: The results indicate that expert surgeons' mental schemata are better organized than novices. Additionally, the physiological markers indicate that novice surgeons display a higher HF at the start (tendency p = .059) and at the end of procedures (p = .001) when compared to experts. However, during longer procedures, expert surgeons have higher HF at the start (p = .041) and at the end (p = .026), than at the start and end of a short procedure. CONCLUSION: Data collected during this pilot study showed that interruptions and disruptions affect novice and expert surgeons differently. Surgical flow disruption appears to be taxing on the surgeons' mental, emotional and physiological resources; as a function of the length and nature of the disruptions. Several training curricula have incorporated the use of virtual reality programs to train surgeons to cope with the new technology and equipment. We recommend integrating interruptions and distractions in virtual reality training programs as these impact the surgeons' pool of resources.
Subject(s)
Surgeons , Clinical Competence , Energy Metabolism , Female , Galvanic Skin Response , Humans , Male , Metabolic Equivalent , Minimally Invasive Surgical Procedures , Operating Rooms , Pilot ProjectsABSTRACT
Prolonged use of the nondepolarizing neuromuscular blocking agents in the critical care setting has greatly increased in the recent past. Accompanying the increased use of these agents are numerous accounts of long-lasting adverse outcomes such as muscular atrophy and neuropathy that can be attributed to pharmacologic paralysis. There has been a financial impact on hospitals as well. Responding to these facts, the medical staff at the Medical College of Georgia Hospital and Clinics recently approved guidelines for the use of nondepolarizing neuromuscular blocking agents in the intensive care setting. These guidelines recommend clinical indications for these agents and dosing ranges reflecting current medical opinion.
Subject(s)
Atracurium/administration & dosage , Pancuronium/administration & dosage , Respiration, Artificial , Vecuronium Bromide/administration & dosage , Atracurium/adverse effects , Atracurium/pharmacokinetics , Atracurium/pharmacology , Critical Care , Georgia , Humans , Pancuronium/adverse effects , Pancuronium/pharmacokinetics , Pancuronium/pharmacology , Practice Guidelines as Topic , Schools, Medical , Vecuronium Bromide/adverse effects , Vecuronium Bromide/pharmacokinetics , Vecuronium Bromide/pharmacologyABSTRACT
The affinities of IgG antibodies to Haemophilus influenzae b capsular polysaccharide (polyribosyl ribitol phosphate [PRP]) elicited 1 month after immunization of 47 infants 2-greater than 18 months of age with a PRP-outer membrane protein conjugate (PRP-OMP) were measured by ELISA. Thirty-four sera had affinities distributed normally about a logarithmic mean of 3.2 x 10(5) l/mol, but 13 samples had undetectable affinities (less than 10(4) l/mol). Median affinities of sera from children 2-6 (1.5 x 10(5) l/mol) and 7-11 months of age (1.6 x 10(5) l/mol) were significantly greater than the median affinities of sera from infants 12-18 (1.8 x 10(4) l/mol) or greater than 18 months of age (4.2 x 10(4) l/mol). Sera from children greater than 18 months of age vaccinated with PRP conjugated to diphtheria toxoid had a median affinity of 6.1 x 10(4) l/mol, equivalent to that of the same age group vaccinated with PRP-OMP. Children vaccinated with PRP conjugate vaccines may produce antibodies of very low affinity, a finding that may have significance for protection from invasive disease.
