CC BY 4.0 · Surg J (N Y) 2016; 02(04): e126-e130
DOI: 10.1055/s-0036-1594246
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Muscle-Cooling Intervention to Reduce Fatigue and Fatigue-Induced Tremor in Novice and Experienced Surgeons: A Preliminary Investigation

Lauren Jensen
1   Doctoral candidate in Aging Studies, Tulane University, New Orleans, Louisiana
,
Michael Dancisak
2   Department of Biomedical Engineering, Tulane University, New Orleans, Louisiana
,
James Korndorffer
3   Center for Advanced Medical Simulation and Team Training, Tulane University, New Orleans, Louisiana
› Author Affiliations
Further Information

Publication History

31 May 2016

14 October 2016

Publication Date:
14 November 2016 (online)

Abstract

A localized, intermittent muscle-cooling protocol was implemented to determine cooling garment efficacy in reducing upper extremity muscular fatigue and tremor in novice (n = 10) and experienced surgeons (n = 9). Subjects wore a muscle-cooling garment while performing multiple trials of a forearm exercise and paired suturing task to induce muscular fatigue and exercise-induced tremor. A reduction in tremor amplitude and an extension in time to fatigue were expected with muscle cooling as compared with control trials. Each subject completed an intervention session (5°C cooling condition) and a control session (32°C or thermal neutral condition). A paired samples t test indicated that tremor amplitude was significantly reduced (t [8] = 1.89458; p < 0.05) in experienced surgeons in two dimensions (up and down, and back and forth). Tremor amplitude was reduced in novice surgeons but the effect was not significant. Time to fatigue and suture time improved in both cohorts with muscle cooling, but the effect did not reach significance. Results from the pilot work suggest muscle cooling as an intervention for reduction of fatigue and tremor is very promising, warranting further investigation. Surgical specialties that require prolonged procedures might benefit more from this intervention.

 
  • References

  • 1 Duffield R. Cooling interventions for the protection and recovery of exercise performance from exercise-induced heat stress. Med Sport Sci 2008; 53: 89-103
  • 2 Lakie M, Walsh EG, Arblaster LA, Villagra F, Roberts RC. Limb temperature and human tremors. J Neurol Neurosurg Psychiatry 1994; 57 (01) 35-42
  • 3 Schenarts PJ, Cemaj S. The aging surgeon: implications for the workforce, the surgeon, and the patient. Surg Clin North Am 2016; 96 (01) 129-138
  • 4 Katlic MR, Coleman J. The aging surgeon. Ann Surg 2014; 260 (02) 199-201
  • 5 Morrison S, Kavanagh J, Obst SJ, Irwin J, Haseler LJ. The effects of unilateral muscle fatigue on bilateral physiological tremor. Exp Brain Res 2005; 167 (04) 609-621
  • 6 Aoyagi Y, Shephard RJ. Aging and muscle function. Sports Med 1992; 14 (06) 376-396
  • 7 Zampieri S, Pietrangelo L, Loefler S. , et al. Lifelong physical exercise delays age-associated skeletal muscle decline. J Gerontol A Biol Sci Med Sci 2015; 70 (02) 163-173
  • 8 Marino FE. Methods, advantages, and limitations of body cooling for exercise performance. Br J Sports Med 2002; 36 (02) 89-94
  • 9 Patapoutian A. TRP channels and thermosensation. Chem Senses 2005; 30 (Suppl. 01) i193-i194
  • 10 Cuschieri A. Whither minimal access surgery: tribulations and expectations. Am J Surg 1995; 169 (01) 9-19
  • 11 Reyes DAG, Tang B, Cuschieri A. Minimal access surgery (MAS)-related surgeon morbidity syndromes. Surg Endosc 2006; 20 (01) 1-13
  • 12 Maclaren DP, Gibson H, Parry-Billings M, Edwards RH. A review of metabolic and physiological factors in fatigue. Exerc Sport Sci Rev 1989; 17 (01) 29-66
  • 13 Luttmann A, Sökeland J, Laurig W. Electromyographical study on surgeons in urology. I. Influence of the operating technique on muscular strain. Ergonomics 1996; 39 (02) 285-297
  • 14 Slack PS, Coulson CJ, Ma X, Webster K, Proops DW. The effect of operating time on surgeons' muscular fatigue. Ann R Coll Surg Engl 2008; 90 (08) 651-657
  • 15 Harwell RC, Ferguson RL. Physiologic tremor and microsurgery. Microsurgery 1983; 4 (03) 187-192
  • 16 Humayun MU, Rader RS, Pieramici DJ, Awh CC, de Juan Jr E. Quantitative measurement of the effects of caffeine and propranolol on surgeon hand tremor. Arch Ophthalmol 1997; 115 (03) 371-374
  • 17 Elman MJ, Sugar J, Fiscella R. , et al. The effect of propranolol versus placebo on resident surgical performance. Trans Am Ophthalmol Soc 1998; 96: 283-291 , discussion 291–294
  • 18 Hsu PA, Cooley BC. Effect of exercise on microsurgical hand tremor. Microsurgery 2003; 23 (04) 323-327