Weight-adjusted caffeine and β-blocker use in novice versus senior retina surgeons: a self-controlled study of simulated performance

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. Novice and senior surgeons (10 practice years, respectively) were r...

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Published in:Eye (London) 2023-10, Vol.37 (14), p.2909-2914
Main Authors: Roizenblatt, Marina, Gehlbach, Peter Louis, da Silveira Saraiva, Vinicius, Nakanami, Mauricio Hiroshi, da Cruz Noia, Luciana, Watanabe, Sung Eun Song, Yasaki, Erika Sayuri, Passos, Renato Magalhães, Magalhães Junior, Octaviano, Fernandes, Rodrigo Antonio Brant, Stefanini, Francisco Rosa, Caiado, Rafael, Jiramongkolchai, Kim, Wolf, Mitchell, Eid Farah, Michel, Belfort Junior, Rubens, Maia, Mauricio
Format: Article
Language:English
Subjects:
Beta blockers
Caffeine
Placebos
Propranolol
Surgeons
Tremor
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Summary: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. Novice and senior surgeons (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). 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). 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.
ISSN:0950-222X
1476-5454
DOI:10.1038/s41433-023-02429-8