Abstract

Purpose
▪         To identify the stress‑related physiological parameters of ophthalmic surgeons during complicated cataract surgeries and compare the same factors with uncomplicated routine cataract surgery and study the variations between the two groups.
Method: Patients attending the Karnataka Institute of Medical Sciences ophthalmology OPD were considered for the study. The patients included in this study ranged between 45 and 80 years of age, they were grouped into two groups of 50 patients each and divided into complicated and uncomplicated cases. Group 1 included patients having cataracts corresponding to nuclear sclerosis ≤ Grade 4, posterior subcapsular cataract, and cataract with good pupillary dilatation (>7 mm) and no other ocular comorbidities. Group 2 included patients with mature, hypermature cataract, posterior polar cataract, traumatic cataract, cataract with poor pupillary dilatation (<5 mm), one‑eyed patients, pseudo‑exfoliative syndrome, patients with chronic or recurrent uveitis, floppy iris syndrome, and systemic comorbidities (cognitive disorder, Parkinson’s disease, Alzheimer’s disease, patients on tamsulosin). All patients underwent manual small incision cataract surgery with intraocular lens implantation. The outcomes measured were systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), and saturation of peripheral oxygen (SpO2). The surgeons were required to answer a set of questions to assess any external factors adding to stress during surgeries.
Results: In this study, we noted that the mean systolic blood pressure (SBP) pre-surgery and post-surgery was 135.8 ±5.38mm Hg and 131.8 ± 4.85 mm Hg respectively in uncomplicated cases. The mean SBP pre-surgery and post-surgery in complicated cases was 141.64 ± 6.4 mm Hg and 138.12 ± 8.21mm Hg respectively in uncomplicated cases. These were statistically significant (p = <0.005). Mean Arterial Pressure (MAP) showed significant changes. It ranged between 100.63 ± 3.83mm Hg pre-surgery and 99.27 ± 2.84mm Hg post-surgery in the uncomplicated group. While it ranged between 104.71 ± 4.27mm Hg and 101.29 ± 4.52mm Hg pre and post-surgery in the complicated surgery. The heart rate (HR) showed significant variation post-surgery in both groups between 87 ±1.01 and 86.16 ± 0.55  in group 1 and 2 respectively. The oxygen saturation (SPO₂) varied between 97.98 ± 0.14% pre and post-surgery in group 1. In group 2 it varied between 97.5 ± 0.51% post-surgery which was significant (<0.005). There was a significant change in post op DBP, MAP and heart rate in complicated groups compared to uncomplicated groups. In uncomplicated cases a decrease in the heart rate was noted but the same was significant after a complicated case. In order to identify other factors that lead to a decrease in heart rate a linear regression study was done by comparing it with PSAQ scores. Even in this measurement there was a significant reduction of heart rate in complicated cases and in those case with a PSAQ score of 3.
Conclusion: A surgeon being the most important factor for a successful surgery bears the pressures of imparting his best in each case. Physiological parameters such as heart rate, systolic and diastolic blood pressures, mean arterial pressures fluctuate with different levels of stress. This study helps to identify these variations while performing a complicated case compared to that of a routine case. As the differences in these vary significantly controlling these might help in the betterment of a surgeons’ mental health which is directly proportional to a better visual outcomes in the patients. This study also enables a surgeon to undertake steps to overcome a chronic burnout in the form of meticulous planning of the cases, exercise and relaxation techniques.