Effects of a hot ambient operating theatre on manual dexterity, psychological and physiological parameters in staff during a simulated burn surgery


Autoři: Zehra Palejwala aff001;  Karen Wallman aff001;  MK Ward aff002;  Cheryl Yam aff002;  Tessa Maroni aff001;  Sharon Parker aff002;  Fiona Wood aff003
Působiště autorů: School of Human Sciences (Sports Science, Exercise and Health), The University of Western Australia, Perth, Western Australia, Australia aff001;  Centre for Transformative Work Design, Faculty of Business and Law, Curtin University, Western Australia, Australia aff002;  Fiona Stanley Hospital, Perth, Western Australia, Australia aff003
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0222923

Souhrn

Objectives

Hot environmental conditions can result in a high core-temperature and dehydration which can impair physical and cognitive performance. This study aimed to assess the effects of a hot operating theatre on various performance, physiological and psychological parameters in staff during a simulated burn surgery.

Methods

Due to varying activity levels, surgery staff were allocated to either an Active (n = 9) or Less-Active (n = 8) subgroup, with both subgroups performing two simulated burn surgery trials (CONTROL: ambient conditions; 23±0.2°C, 35.8±1.2% RH and HOT: 34±0°C, 28.3±1.9% RH; 150 min duration for each trial), using a crossover design with four weeks between trials. Manual dexterity, core-temperature, heart-rate, sweat-loss, thermal sensation and alertness were assessed at various time points during surgery.

Results

Pre-trials, 13/17 participants were mildly-significantly dehydrated (HOT) while 12/17 participants were mildly-significantly dehydrated (CONTROL). There were no significant differences in manual dexterity scores between trials, however there was a tendency for scores to be lower/impaired during HOT (both subgroups) compared to CONTROL, at various time-points (Cohen’s d = -0.74 to -0.50). Furthermore, alertness scores tended to be higher/better in HOT (Active subgroup only) for most time-points (p = 0.06) compared to CONTROL, while core-temperature and heart-rate were higher in HOT either overall (Active; p<0.05) or at numerous time points (Less-Active; p<0.05). Finally, sweat-loss and thermal sensation were greater/higher in HOT for both subgroups (p<0.05).

Conclusions

A hot operating theatre resulted in significantly higher core-temperature, heart-rate, thermal sensation and sweat-loss in staff. There was also a tendency for slight impairment in manual dexterity, while alertness improved. A longer, real-life surgery is likely to further increase physiological variables assessed here and in turn affect optimal performance/outcomes.

Klíčová slova:

Cognitive impairment – Exercise – Sensory perception – Surgeons – Surgical and invasive medical procedures – Sweat – Dehydration (medicine) – Menstrual cycle


Zdroje

1. Nowak T. Burn pathophysiology. Perioperative Nurs Clin. 2012; 7(1):9–17.

2. Rizzo JA, Rowan MP, Driscoll IR, Chan RK, Chung KK. Perioperative temperature management during burn care. J Burn Care Res. 2017; 38(1):e277–e283. doi: 10.1097/BCR.0000000000000371 27294857

3. John M, Crook D, Dasari K, Eljelani F, El-Haboby A, Harper C. Comparison of resistive heating and forced air warming to prevent inadvertent perioperative hypothermia. Brit J Anaesth. 2016; 116(2):249–254. doi: 10.1093/bja/aev412 26787794

4. Díaz M, Becker D. Thermoregulation: physiological and clinical considerations during sedation and general anesthesia. Anesth Progress. 2010; 57(1):25–33. doi: 10.2344/0003-3006-57.1.25 20331336

5. Sohn VY, Steele SR. Temperature control and the role of supplemental oxygen. Clin Colon Rect Surg. 2009; 22(1):021–027. doi: 10.1055/s-0029-1202882 20119552

6. Corallo JP, King B, Pizano LR, Namias N, Schulman CI. Core warming of a burn patient during excision to prevent hypothermia. Burns. 2008; 34(3):418–420. doi: 10.1016/j.burns.2007.08.012 18082961

7. Moran DS, Mendal L. Core temperature measurement: methods and current insights. Sports Med. 2002; 32(14):879–885. doi: 10.2165/00007256-200232140-00001 12427049

8. Yaicharoen P, Wallman K, Morton A, Bishop D. The effect of warm-up on intermittent sprint performance and selected thermoregulatory parameters. J Sci Med Sport. 2012; 15(5):451–456. doi: 10.1016/j.jsams.2012.02.003 22503126

9. Faulds M, Meekings T. Temperature management in critically ill patients. Continuing Education in Anaesthesia, Critical Care & Pain. 2013; 13(3):75–79.

10. Gregson W, Drust B, Batterham A, Cable N. The effects of pre-warming on the metabolic and thermoregulatory responses to prolonged submaximal exercise in moderate ambient temperatures. Eur J Appl Physiol. 2002; 86(6):526–533. doi: 10.1007/s00421-002-0580-x 11944101

11. Casa DJ. Exercise in the heat. I. Fundamentals of thermal physiology, performance implications, and dehydration. J Athl Training. 1999; 34(3):246–252.

12. Morrison S, Sleivert G, Cheung S. Passive hyperthermia reduces voluntary activation and isometric force production. Eur J Appl Physiol. 2004; 91(5):729–736.

13. Gonzalez-Alonso J, Teller C, Andersen S, Jensen F, Hyldig T, Nielsen B. Influence of body temperature on the development of fatigue during prolonged exercise in the heat. J Appl Physiol. 1999; 86(3):1032–1039. doi: 10.1152/jappl.1999.86.3.1032 10066720

14. Davis J, Bake L, Barnes K, Ungaro C, Stofan J. Thermoregulation, fluid balance, and sweat losses in American football players. Sports Med. 2016; 46(10):1391–1405. doi: 10.1007/s40279-016-0527-8 27071988

15. Barley OR, Iredale F, Chapman DW, Hopper A, Abbiss C. Repeat effort performance is reduced 24 hours after acute dehydration in mixed martial arts athletes. J Strength Cond Res. 2018; 32(9):2555–61. doi: 10.1519/JSC.0000000000002249 28930879

16. Gopinathan PM, Pichan G, Sharma VM. Role of dehydration in heat stress-induced variations in mental performance. Arch Environ Occup H. 1988; 43(1):15–17.

17. Sharma V, Sridharan K, Pichan G, Panwar M. Influence of heat stress induced dehydration on mental functions. Ergonomics. 1986; 29(6):791–799. doi: 10.1080/00140138608968315 3743537

18. McHugh SM, Hill ADK, Humphreys H. Laminar airflow and the prevention of surgical site infection. More harm than good? The Surgeon. 2015;13(1):52–58. doi: 10.1016/j.surge.2014.10.003 25453272

19. Cramer MN, Jay O. Biophysical aspects of human thermoregulation during heat stress. Auton Neurosci-Basic. 2016; 196:3–13.

20. Agha RA, Fowler AJ, Sevdalis N. The role of non-technical skills in surgery. Ann Med Surg. 2015; 4(4):422–427.

21. Wright K, Hull J, Czeisler C. Relationship between alertness, performance and body temperature in humans. Am J Physiol-Reg I. 2002;283(6):R1370–R1377.

22. Mackie RR, Wylie CD. Countermeasures to loss of alertness in motor vehicle drivers: A taxonomy and evaluation. Proc Hum Fact Soc An. 1991; 35(15):1149–1153.

23. Sharma VM, Pichan G, Panwar MR. Differential effects of hot-humid and hot-dry environments on mental functions. Int Arch Occ Env Hea. 1983; 52(4):315–327.

24. Hakim M, Walia H, Dellinger HL, Balaban O, Saadat H, Kirschner RE, et al. The effect of operating room temperature on the performance of clinical and cognitive tasks. Pediatric quality & safety. 2018; 3(2):e069.

25. Berg RJ, Inaba K, Sullivan M, Okoye O, Minneti M, Teixeira G,et al. The impact of heat stress on performance and cognitive function during simulated laparoscopic surgical tasks. J Am Coll Surgeons. 2012; 215(3):S118.

26. Lim J, Liew S, Chan H, Jackson T, Burrows S, Edgar DW, et al. Is the length of time in acute burn surgery associated with poorer outcomes? Burns. 2014; 40(2):235–240. doi: 10.1016/j.burns.2013.06.005 23876784

27. Mostardi R, Kubica R, Veicsteinas A, Margaria R. The effect of increased body temperature due to exercise on the heart rate and on the maximal aerobic power. Eur J Appl Physiol O. 1974; 33(3):237–245.

28. Australian Government Bureau of Meteorology. http://www.bom.gov.au/climate/current/annual/wa/perth.shtml

29. Nagashima K. Thermoregulation and menstrual cycle. Temperature. 2015; 2(3):320–321.

30. Kavouras SA. Assessing hydration status. Curr Opin Clin Nutr. 2002; 5 (5):519–524.

31. Tiffin J, Asher EJ. The purdue pegboard: norms and studies of reliability and validity. J Appl Psychol. 1948; 32 (3):234. doi: 10.1037/h0061266 18867059

32. Young AJ, Sawka MN, Epstein Y, Decristofano D, Pandolf KB. Cooling different body surfaces during upper and lower body exercise. J Appl Physiol. 1987; 63(3): 1218–1223. doi: 10.1152/jappl.1987.63.3.1218 3654466

33. Hoddes E, Zarcone V, Smythe H, Phillips R, Dement W. Quantification of sleepiness: A new approach. Psychophysiology. 1973; doi: 10.1111/j.1469-8986.1973.tb00801.x 4719486

34. Cohen J. Statistical power analysis for the behavioural sciences, 2nd ed.: Hillsdale NJ: Lawrence Erlbaum Associates Inc; 1988.

35. Faundes A, Segal SJ, Adejuwon CA, Brache V, Leon P, Alvarez-Sanchez F. The menstrual cycle in women using an intrauterine device. Fertil Steril. 1980; 34(5):427–430. doi: 10.1016/s0015-0282(16)45131-9 7439408

36. Bishop D. Warm up I—Potential mechanisms and the effects of passive warm up on exercise performance. Sports Med. 2003; 33(6):439–454. doi: 10.2165/00007256-200333060-00005 12744717

37. Asmussen E, Bøje O. Body temperature and capacity for work. Acta Physiol Scand. 1945; 10(1):1–22.

38. Barcroft J, King WOR.The effect of temperature on the dissociation curve of blood. J Physiol. 1909; 39(5):374–384. doi: 10.1113/jphysiol.1909.sp001345 16992990

39. Koga S, Shiojiri T, Kondo N, Barstow TJ. Effect of increased muscle temperature on oxygen uptake kinetics during exercise. J Appl Physiol. 1997; 83(4):1333–1338. doi: 10.1152/jappl.1997.83.4.1333 9338444

40. Karvonen J. Importance of warm-up and cool down on exercise performance. Med Sport Sci. 1992; 35(1):189–214.

41. Maroni T, Dawson B, Dennis M, Naylor L, Brade C, Wallman K. Effects of half-time cooling using a cooling glove and jacket on manual dexterity and repeated-sprint performance in heat. J Sport Sci Med. 2018; 17(3):485–491.

42. Noguchi T, Demura S, Nagasawa Y, Uchiyama M. An examination of practice and laterality effects on the purdue pegboard and moving beans with tweezers. Percept Motor Skill. 2006; 102(1):265–274.

43. Zwolińska M, Bogdan A. Thermal sensations of surgeons during work in surgical gowns. Int J Occup Saf Ergo. 2013; 19(3):443–453.

44. Below PR, Mora-Rodríguez R, González-Alonso J, Coyle EF. Fluid and carbohydrate ingestion independently improve performance during 1 h of intense exercise. Med Sci Sport Exer. 1995; 27(2):200–210.

45. Van Cutsem J, Marcora S, De Pauw K, Bailey S, Meeusen R, Roelands B. The effects of mental fatigue on physical performance: A systematic review. Sports Med. 2017; 47(8):1569–1588. doi: 10.1007/s40279-016-0672-0 28044281

46. Sadeghniiat-Haghighi K, Yazdi Z. Fatigue management in the workplace. Ind Psychiatry J. 2015; 24(1):12–17. doi: 10.4103/0972-6748.160915 26257477

47. Refinetti R, Menaker M. The circadian rhythm of body temperature. Physiol Behav. 1992; 51(3):613–637. doi: 10.1016/0031-9384(92)90188-8 1523238

48. Wright KP, Hull JT, Czeisler CA. Relationship between alertness, performance, and body temperature in humans. Am J Physiol-Reg I. 2002; 283(6):R1370–R1377.

49. González-Alonso J, Mora-Rodríguez R, Coyle EF. Stroke volume during exercise: Interaction of environment and hydration. Am J Physiol-Heart C. 2000; 278(2):H321–H330.


Článek vyšel v časopise

PLOS One


2019 Číslo 10