TY - JOUR
T1 - Weight-adjusted caffeine and β-blocker use in novice versus senior retina surgeons
T2 - a self-controlled study of simulated performance
AU - Roizenblatt, Marina
AU - Gehlbach, Peter Louis
AU - da Silveira Saraiva, Vinicius
AU - Nakanami, Mauricio Hiroshi
AU - da Cruz Noia, Luciana
AU - Watanabe, Sung Eun Song
AU - Yasaki, Erika Sayuri
AU - Passos, Renato Magalhães
AU - Magalhães Junior, Octaviano
AU - Fernandes, Rodrigo Antonio Brant
AU - Stefanini, Francisco Rosa
AU - Caiado, Rafael
AU - Jiramongkolchai, Kim
AU - Wolf, Mitchell
AU - Eid Farah, Michel
AU - Belfort Junior, Rubens
AU - Maia, Mauricio
N1 - Funding Information:
MR reported receiving research funding from Lemann Foundation, Instituto da Visão, Latinofarma, and Coordination for the Improvement of Higher Education Personnel. PLG reported receiving research funding from Research to Prevent Blindness and gifts from the J. Willard and Alice S Marriott Foundation, the Gale Trust, Herb Ehlers, Bill Wilbur and Rajandre Shaw, Helen Nassif, Mary Ellen Keck, Don and Maggie Feiner, and Ronald Stiff. MM and RB Jr reported receiving research funding from National Council for Scientific and Technological Development. The abovementioned institutions had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, or review of the manuscript.
Publisher Copyright:
© 2023, The Author(s), under exclusive licence to The Royal College of Ophthalmologists.
PY - 2023/10
Y1 - 2023/10
N2 - Background/Objectives: Tremor and expertise are potentially influenced variables in vitreoretinal surgery. We investigated whether surgeon experience impacts the association of microsurgical performance with caffeine and β-blockers weight-adjusted intake. Subjects/Methods: Novice and senior surgeons (<2 and >10 practice years, respectively) were recruited in this self-controlled, cross-sectional study. A simulator’s task sequence was repeated over 2 days, 30 min after the following exposures: day 1, placebo, 2.5 mg/kg caffeine, 5.0 mg/kg caffeine, and 0.6 mg/kg propranolol; and day 2, placebo, 0.2 mg/kg propranolol, 0.6 mg/kg propranolol, and 5.0 mg/kg caffeine. Outcomes were total score (0–700, worst-best), simulation time (minutes), intraocular trajectory (centimeters), and tremor-specific score (0–100, worst-best). Results: We recruited 15 novices (9 men [60%], 1.33 ± 0.49 practice years) and 11 seniors (8 men [72.7%], 16.00 ± 4.24 practice years). Novices performed worse after 2.5 mg/kg caffeine and improved following 0.2 mg/kg propranolol in total score (557 vs. 617, p = 0.009), trajectory (229.86 vs. 208.07, p = 0.048), time (14.9 vs. 12.7, p = 0.048), and tremor-score (55 vs. 75, p = 0.009). Surgical performance improved with propranolol post-caffeine but remained worse than 0.2 mg/kg propranolol in total score (570 vs. 617, p = 0.014), trajectory (226.59 vs. 208.07, p = 0.033), and tremor-score (50 vs. 75, p = 0.029). Seniors’ tremor-score was lower after 2.5 mg/kg caffeine compared to 0.2 mg/kg propranolol (8 vs. 37, p = 0.015). Tremor-score following propranolol post-caffeine remained inferior to 0.6 mg/kg propranolol alone (17 vs. 38, p = 0.012). Conclusion: While caffeine and propranolol were associated with performance changes among novices, only tremor was affected in seniors, without dexterity changes. The pharmacologic exposure impact on surgical dexterity seems to be offset by increased experience.
AB - Background/Objectives: Tremor and expertise are potentially influenced variables in vitreoretinal surgery. We investigated whether surgeon experience impacts the association of microsurgical performance with caffeine and β-blockers weight-adjusted intake. Subjects/Methods: Novice and senior surgeons (<2 and >10 practice years, respectively) were recruited in this self-controlled, cross-sectional study. A simulator’s task sequence was repeated over 2 days, 30 min after the following exposures: day 1, placebo, 2.5 mg/kg caffeine, 5.0 mg/kg caffeine, and 0.6 mg/kg propranolol; and day 2, placebo, 0.2 mg/kg propranolol, 0.6 mg/kg propranolol, and 5.0 mg/kg caffeine. Outcomes were total score (0–700, worst-best), simulation time (minutes), intraocular trajectory (centimeters), and tremor-specific score (0–100, worst-best). Results: We recruited 15 novices (9 men [60%], 1.33 ± 0.49 practice years) and 11 seniors (8 men [72.7%], 16.00 ± 4.24 practice years). Novices performed worse after 2.5 mg/kg caffeine and improved following 0.2 mg/kg propranolol in total score (557 vs. 617, p = 0.009), trajectory (229.86 vs. 208.07, p = 0.048), time (14.9 vs. 12.7, p = 0.048), and tremor-score (55 vs. 75, p = 0.009). Surgical performance improved with propranolol post-caffeine but remained worse than 0.2 mg/kg propranolol in total score (570 vs. 617, p = 0.014), trajectory (226.59 vs. 208.07, p = 0.033), and tremor-score (50 vs. 75, p = 0.029). Seniors’ tremor-score was lower after 2.5 mg/kg caffeine compared to 0.2 mg/kg propranolol (8 vs. 37, p = 0.015). Tremor-score following propranolol post-caffeine remained inferior to 0.6 mg/kg propranolol alone (17 vs. 38, p = 0.012). Conclusion: While caffeine and propranolol were associated with performance changes among novices, only tremor was affected in seniors, without dexterity changes. The pharmacologic exposure impact on surgical dexterity seems to be offset by increased experience.
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U2 - 10.1038/s41433-023-02429-8
DO - 10.1038/s41433-023-02429-8
M3 - Article
C2 - 36782058
AN - SCOPUS:85147969650
SN - 0950-222X
VL - 37
SP - 2909
EP - 2914
JO - Eye (Basingstoke)
JF - Eye (Basingstoke)
IS - 14
ER -