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

• Published in: Eye (London) Vol. 37; no. 14; pp. 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: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.10.2023; Nature Publishing Group
• Subjects: 692/699/3161/3175; 692/700/565/545; Adrenergic beta-Antagonists - pharmacology; Adrenergic beta-Antagonists - therapeutic use; Beta blockers; Caffeine; Caffeine - pharmacology; Cross-Sectional Studies; Double-Blind Method; Humans; Laboratory Medicine; Male; Medicine; Medicine & Public Health; Ophthalmology; Pharmaceutical Sciences/Technology; Placebos; Propranolol; Propranolol - pharmacology; Propranolol - therapeutic use; Retina; Surgeons; Surgery; Surgical Oncology; Tremor; Tremor - drug therapy
• ISSN: 0950-222X; 1476-5454; 1476-5454
• DOI: 10.1038/s41433-023-02429-8

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.