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Measuring Mental Stress During Otologic Surgery Using Heart Rate Variability Analysis.

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Mental stress in surgeons during otologic procedures was measured using heart rate variability (HRV). HRV decreased significantly during actual surgeries, especially facial nerve dissection, indicating elevated stress levels.

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Area of Science:

  • Neurosurgery
  • Cardiology
  • Surgical Education

Background:

  • Heart rate variability (HRV) naturally fluctuates in healthy individuals.
  • Mental stress demonstrably reduces HRV.
  • Objective stress assessment is crucial in demanding surgical fields like otology.

Purpose of the Study:

  • To objectively quantify mental stress in otologic surgeons during procedures using HRV.
  • To compare stress levels during real surgeries versus simulated cadaveric dissections.

Main Methods:

  • A pilot study involving two neurotology fellows.
  • Continuous electrocardiogram (ECG) monitoring during mastoidectomy and facial nerve (FN) dissections in the operating room and cadaver lab.
  • Analysis of beat-to-beat intervals, including standard deviation of normal intervals (SDNN) and the low frequency to high frequency power ratio (LF/HF) to assess stress.

Main Results:

  • SDNN significantly decreased during intraoperative mastoidectomy and FN dissection compared to preoperative rest.
  • The LF/HF ratio, indicating sympathetic tone, significantly increased during intraoperative FN dissection.
  • Cadaveric dissections did not show significant changes in SDNN or LF/HF compared to rest, suggesting lower stress levels.

Conclusions:

  • Intraoperative facial nerve dissection in otologic surgery induces significant mental stress, evidenced by decreased HRV and increased sympathetic tone.
  • Cadaveric simulations do not replicate the mental stress experienced during live surgical procedures.
  • HRV serves as a valuable objective tool for assessing surgical stress.