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Quantitative Measurement of the Effects of Caffeine and Propranolol on Surgeon Hand Tremor

Quantitative Measurement of the Effects of Caffeine and Propranolol on Surgeon Hand Tremor Abstract Objective: To quantitatively measure the effects of caffeine and propranolol, a nonselective β-blocking agent, on surgeon hand tremor during simulated vitreoretinal microsurgery. Methods: Seventeen ophthalmic surgeons were tested on 3 separate days. On each day, subjects ingested 200 mg of caffeine, 10 mg of propranolol hydrochloride, or gelatin placebo. The drugs were administered as part of a double-masked, placebo-controlled trial. Hand tremor was measured using the Microsurgery Advanced Design Laboratory Stability, Activation, and Maneuverability tester (MADSAM), a high-resolution, noncontact position tracking system. Results: The average percent magnitude changes from baseline tremor measurements were +15%, +31%, and −22% for placebo, caffeine, and propranolol groups, respectively. Analysis of variance techniques accounting for effects of individuals, drugs, and day order demonstrated that only drug effects on percent magnitude change of tremor were statistically significant (P=.01, F test). Detailed comparisons of the 2 drug groups with the placebo group revealed that, after adjusting for individual and order effects, only the mean decrease in tremor due to ingestion of propranolol was a statistically significant trend (P=.03, F test). Although caffeine caused a larger mean increase in percent magnitude change in tremor than placebo, this trend was not statistically significant (P=.34, F test). The evaluation of systemic physiologic measurements showed that there were statistically significant drug effects on percent change in systolic (P <.001, F test) and diastolic (P=.002, F test) blood pressure and pulse rate (P=.002, F test). Individual and day order effects were not significant. No adverse side effects were observed or reported in our test subjects. Conclusion: Physiologic surgeon hand tremor can be decreased by the oral intake of a low dose of propranolol. References 1. Evans DR. Evans arm and hand rest of microsurgery . Ophthalmology . 1978;85:878-880.Crossref 2. Jacobson BH, Winter-Roberts K, Gemmell HA. Influence of caffeine on selected manual manipulation skills . Percept Mot Skills . 1991;72:1175-1181.Crossref 3. Jacobson BH, Thurma-Lacey SR. Caffeine effect on motor performance by caffeine-naive and familiar subject . Percept Mot Skills . 1992;74:151-157.Crossref 4. Gillespie MM. Tremor . J Neurosurg Nurs . 1991;23( (3) ):170-174.Crossref 5. Abila B, Wilson JF, Marshall RW. Exercise-induced hand tremor: a possible test for β2-adrenoceptor selectivity in man? Br J Clin Pharmacol . 1986;22:104-107. 6. Wade P, Gresty MA, Findley LJ. A normative study of postural tremor of the hand . Arch Neurol . 1982;39:358-362.Crossref 7. Calzetti S, Findley LJ, Gresty MA, et al. Effect of a single dose of propranolol on essential tremor: a double-blind controlled study . Ann Neurol . 1983;13:165-171.Crossref 8. Kruse P, Ladefoged J, Nielson U, et al. β-blockade used in precision sports: effect on pistol shooting performance . J Appl Physiol . 1986;61( (2) ):417-420. 9. Humayun MU, Rader RS, Walsh AC, et al. The objective analysis of vitreoretinal surgical instruments . Invest Ophthalmol Vis Sci . 1994;35( (suppl 4) ):1261. 10. Schiffman SM, Gritz ER, Maltese J, et al. Effects of cigarette smoking and oral nicotine on hand tremor . Clin Pharmacol Ther . 1983;33:800-805.Crossref 11. Findley LJ, Cleeves L, Calzetti S. Primodone in essential tremor of the hands and head: a double blind controlled clinical study . J Neurol Neurosurg Psychiatry . 1985;48:911-915.Crossref 12. Arnold RW, Springer DT, Engel WK, et al. The effect of wrist rest, caffeine, and oral timolol on the hand steadiness of ophthalmologists . Ann Ophthalmol . 1993;25:250-253. 13. Holmes JM, Toleikis SC, Jay WM. The effect of arm exercise and ocular massage on postural hand tremor . Ann Ophthalmol . 1992;24:156-158. 14. Kirby TJ. Dexterity and residents' surgical performance . Trans Am Ophthalmol Soc . 1979;77:294-307. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Ophthalmology American Medical Association

Quantitative Measurement of the Effects of Caffeine and Propranolol on Surgeon Hand Tremor

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Publisher
American Medical Association
Copyright
Copyright © 1997 American Medical Association. All Rights Reserved.
ISSN
0003-9950
eISSN
1538-3687
DOI
10.1001/archopht.1997.01100150373010
Publisher site
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Abstract

Abstract Objective: To quantitatively measure the effects of caffeine and propranolol, a nonselective β-blocking agent, on surgeon hand tremor during simulated vitreoretinal microsurgery. Methods: Seventeen ophthalmic surgeons were tested on 3 separate days. On each day, subjects ingested 200 mg of caffeine, 10 mg of propranolol hydrochloride, or gelatin placebo. The drugs were administered as part of a double-masked, placebo-controlled trial. Hand tremor was measured using the Microsurgery Advanced Design Laboratory Stability, Activation, and Maneuverability tester (MADSAM), a high-resolution, noncontact position tracking system. Results: The average percent magnitude changes from baseline tremor measurements were +15%, +31%, and −22% for placebo, caffeine, and propranolol groups, respectively. Analysis of variance techniques accounting for effects of individuals, drugs, and day order demonstrated that only drug effects on percent magnitude change of tremor were statistically significant (P=.01, F test). Detailed comparisons of the 2 drug groups with the placebo group revealed that, after adjusting for individual and order effects, only the mean decrease in tremor due to ingestion of propranolol was a statistically significant trend (P=.03, F test). Although caffeine caused a larger mean increase in percent magnitude change in tremor than placebo, this trend was not statistically significant (P=.34, F test). The evaluation of systemic physiologic measurements showed that there were statistically significant drug effects on percent change in systolic (P <.001, F test) and diastolic (P=.002, F test) blood pressure and pulse rate (P=.002, F test). Individual and day order effects were not significant. No adverse side effects were observed or reported in our test subjects. Conclusion: Physiologic surgeon hand tremor can be decreased by the oral intake of a low dose of propranolol. References 1. Evans DR. Evans arm and hand rest of microsurgery . Ophthalmology . 1978;85:878-880.Crossref 2. Jacobson BH, Winter-Roberts K, Gemmell HA. Influence of caffeine on selected manual manipulation skills . Percept Mot Skills . 1991;72:1175-1181.Crossref 3. Jacobson BH, Thurma-Lacey SR. Caffeine effect on motor performance by caffeine-naive and familiar subject . Percept Mot Skills . 1992;74:151-157.Crossref 4. Gillespie MM. Tremor . J Neurosurg Nurs . 1991;23( (3) ):170-174.Crossref 5. Abila B, Wilson JF, Marshall RW. Exercise-induced hand tremor: a possible test for β2-adrenoceptor selectivity in man? Br J Clin Pharmacol . 1986;22:104-107. 6. Wade P, Gresty MA, Findley LJ. A normative study of postural tremor of the hand . Arch Neurol . 1982;39:358-362.Crossref 7. Calzetti S, Findley LJ, Gresty MA, et al. Effect of a single dose of propranolol on essential tremor: a double-blind controlled study . Ann Neurol . 1983;13:165-171.Crossref 8. Kruse P, Ladefoged J, Nielson U, et al. β-blockade used in precision sports: effect on pistol shooting performance . J Appl Physiol . 1986;61( (2) ):417-420. 9. Humayun MU, Rader RS, Walsh AC, et al. The objective analysis of vitreoretinal surgical instruments . Invest Ophthalmol Vis Sci . 1994;35( (suppl 4) ):1261. 10. Schiffman SM, Gritz ER, Maltese J, et al. Effects of cigarette smoking and oral nicotine on hand tremor . Clin Pharmacol Ther . 1983;33:800-805.Crossref 11. Findley LJ, Cleeves L, Calzetti S. Primodone in essential tremor of the hands and head: a double blind controlled clinical study . J Neurol Neurosurg Psychiatry . 1985;48:911-915.Crossref 12. Arnold RW, Springer DT, Engel WK, et al. The effect of wrist rest, caffeine, and oral timolol on the hand steadiness of ophthalmologists . Ann Ophthalmol . 1993;25:250-253. 13. Holmes JM, Toleikis SC, Jay WM. The effect of arm exercise and ocular massage on postural hand tremor . Ann Ophthalmol . 1992;24:156-158. 14. Kirby TJ. Dexterity and residents' surgical performance . Trans Am Ophthalmol Soc . 1979;77:294-307.

Journal

Archives of OphthalmologyAmerican Medical Association

Published: Mar 1, 1997

References