Heart rate and heart rate variability as indirect markers of surgeons’ intraoperative stress

Rieger, Anja; Stoll, Norbert; Kreuzfeld, Steffi; Behrens, Katharina; Weippert, Matthias

doi:10.1007/s00420-013-0847-z

Cited by 93 publications

(88 citation statements)

References 63 publications

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“…This could increase the psychological stress and anxiety, which could in turn result in altered HRV [23,24]. The only study measuring for at least 14 days postoperatively was the study by Kimura et al [19].…”

Section: Discussionmentioning

confidence: 98%

Lack of circadian variation and reduction of heart rate variability in women with breast cancer undergoing lumpectomy: a descriptive study

Hansen

Rosenberg

Gögenur

2013

Breast Cancer Res Treat

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Changes in the autonomic nervous system with increased sympathetic tone may be a cause of postoperative short-, and long-term cardiovascular complications. Heart rate variability (HRV) is assessed by Holter monitoring as a measure of autonomic tone and has not been investigated in patients with breast cancer undergoing surgery. We aimed to investigate evening- and night-time HRV after lumpectomy. Twelve patients were included in this descriptive study. HRV was measured the night before surgery (PREOP), the night after surgery (PO1) and 14 days after surgery (PO14) from 1900 to 0700 h. For calculation of HRV, time domain parameters (SDNN-standard deviation of all normal-to-normal (NN) intervals around the mean NN for the period of measurement, pNN50-percentage of beats where the change from one beat to the next is more than 50 ms, rMSSD-root mean square of successive differences) were used. We analyzed the variation of the overall time period and the circadian variation between evening and night (sympathetic vs. parasympathetic tonus). Mean heart rate increased from PREOP to PO1 (p < 0.001) and also increased between PREOP and PO14 (p < 0.05). SDNN (p < 0.001) and PNN50 (p < 0.001) decreased from PREOP to PO1. There was also a significant decrease between PREOP and PO14 for both parameters (p < 0.005 and p = 0.05 respectively). SDNN increased from PO1 to PO14 (p < 0.005). rMSSD decreased from PREOP to PO1 (p < 0.001). A circadian variation was found in the mean heart rate for all three monitoring periods (p < 0.005). Circadian variation was also present on PREOP for pNN50 (p ≤ 0.05) and rMSSD (p < 0.05). This variation was missing for both PO1 and PO14. Patients had a shift of autonomic tone with reduced parasympathetic activity and lack of circadian variation 14 days after lumpectomy.

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Section: Discussionmentioning

confidence: 98%

Lack of circadian variation and reduction of heart rate variability in women with breast cancer undergoing lumpectomy: a descriptive study

Hansen

Rosenberg

Gögenur

2013

Breast Cancer Res Treat

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“…Furthermore, in the same surgeon, the autonomic nervous status did not return to the baseline level for quite a while after surgery. A HRV analysis in a previous study showed that stressed surgeons during operation, in whom the magnitude of stress was measured using the State Trait Anxiety Inventory (STAI), demonstrated less relaxation during sleep compared with non-stressed surgeons (Rieger et al 2014). Out of the surgical setting, stressors were related to a higher heart rate and lower HRV during waking as well as the sleeping period (Brosschot et al 2007).…”

Section: Discussionmentioning

confidence: 99%

Increase in Operator’s Sympathetic Nerve Activity during Complicated Hepatobiliary Surgery: Evidence for Surgeons’ Mental Stress

Yamanouchi

Hayashida

Kuba

et al. 2015

Tohoku J. Exp. Med.

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Surgeons often experience stress during operations. The heart rate variability (HRV) is the variability in the beat-to-beat interval, which has been used as parameters of stress. The purpose of this study was to evaluate mental stress of surgeons before, during and after operations, especially during pancreaticoduodenectomy (PD) and living donor liver transplantation (LDLT). Additionally, the parameters were compared in various procedures during the operations. By frequency domain method using electrocardiograph, we measured the high frequency (HF) component, representing the parasympathetic activity, and the low frequency (LF)/HF ratio, representing the sympathetic activity. In all 5 cases of PD, the surgeon showed significantly lower HF component and higher LF/HF during operation, indicating predominance of sympathetic nervous system and increased stress, than those before the operation (p < 0.01) and these did not return to the baseline level one hour after the operation. Out of the 4 LDLT cases, the value of HF was decreased in two and the LF/HF increased in three cases (p < 0.01) during the operation compared to those before the operation. In all cases, the value of HF was decreased and/or the LF/HF increased significantly during the reconstruction of the vessels or bile ducts than during the removal of the liver. Thus, sympathetic nerve activity increased during hepatobiliary surgery compared with the level before the operation, and various procedures during the operations induced diverse changes in the autonomic nervous activities. The HRV analysis could assess the chronological changes of mental stress by measuring the autonomic nervous balances.

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“…Decreased HRV has been observed in individuals with increased psychological stress levels (Lee and Theus, 2012; Rieger et al, 2013; Suh et al, 2013) and has been proposed as a link between psychosocial risk and workplace stress in the development of metabolic and CVD (Thayer et al, 2010). Police officers may be at increased risk for decreased HRV due to their constant exposure to several occupational stressors (Covey et al, 2013; Fekedulegn et al, 2012; Miller, 2006; Violanti, 2011).…”

mentioning

confidence: 99%

Associations between insulin and heart rate variability in police officers

Charles

Andrew

Sarkisian

et al. 2013

American J Hum Biol

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Objective Low heart rate variability (HRV) has been linked to cardiovascular disease. Our objective was to examine the cross-sectional association between insulin and HRV. Methods Insulin levels were measured in 355 nondiabetic officers from the BCOPS study, following a 12 h fast. HRV was performed according to methods published by the task force of the European Society of Cardiology and the North American Society of Pacing Electrophysiology for measurement and analysis of HRV. Mean values of high (HF) and low frequency (LF) HRV were compared across tertiles of insulin using ANOVA and ANCOVA; p-values were obtained from linear regression models. Results Higher mean levels of insulin were significantly associated with lower (i.e., worse) mean levels of HRV before and after risk-factor adjustment. The results for HF HRV (ms2) were as follows: 1st insulin (µU/ml) tertile (156.3; 95% confidence interval (CI) = 128.6–189.9); 2nd tertile (154.3; 95% CI = 124.3–191.5); 3rd tertile (127.9; 95% CI = 105.0–155.8), p for trend = 0.017. Results with LF HRV were similar to HF HRV. Insulin was also inversely and significantly associated with HRV among officers with BMI ≥25 kg/m2, with ≥25.5% body fat, and among those who reported low (

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Heart rate and heart rate variability as indirect markers of surgeons’ intraoperative stress

Abstract: Our results reveal that higher perceived stress in the operating room is associated with increased intraoperative HR and decreased HRV at night. Non-stressed surgeons show greater relaxation during sleep compared to their stressed colleagues.

Cited by 93 publications

References 63 publications

Lack of circadian variation and reduction of heart rate variability in women with breast cancer undergoing lumpectomy: a descriptive study

Lack of circadian variation and reduction of heart rate variability in women with breast cancer undergoing lumpectomy: a descriptive study

Increase in Operator’s Sympathetic Nerve Activity during Complicated Hepatobiliary Surgery: Evidence for Surgeons’ Mental Stress

Associations between insulin and heart rate variability in police officers

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