It is known that excessive levels of occupational stress affect professionals' technical and non-technical skills and surgeons are no exception. However, very few studies address this problem in neurosurgeons. A system for monitoring cardiovascular strain and autonomic imbalance during intracranial aneurysm procedures is proposed in order to obtain overall cardiac measures from those procedures. Additionally, this study also allows to detect stressful events and compare their impact with the surgeon's own appraisal. Linear and nonlinear heart rate variability (HRV) features were extracted from surgeon's electrocardiogram (ECG) signal using wearable ECG monitors and mobile technology during 10 intracranial aneurysm surgeries with two surgeons. Stress appraisal and cognitive workload were assessed using self-report measures. Findings suggest that the surgeon associated to the main role during the clipping can be exposed to high levels of stress, especially if a rupture occurs (pNN20 = 0%), while the assistant surgeon tends to experience mental fatigue. Cognitive workload scores of one of the surgeons were negatively correlated with AVNN, SDNN, pNN20, pNN50, 1 V, 2 L V, SD2 and CVI measures. Cognitive workload was positively related with stress appraisal, suggesting that more mentally demanding procedures are also assessed as more stressful. Finally, pNN20 seems to better mirror behavior during stress moments than pNN50. Additionally, a sympathovagal excitation occurs in one of the professionals after changing to main role. The present methodology shows potential for the identification of harmful events. This work may be of importance for the design of effective interventions in order to reduce surgeons stress levels. Furthermore, this approach can be applied to other professions.

中文翻译：

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一种可穿戴的方法，用于对多个合作医生进行术中生理压力监测。

众所周知，过度的职业压力会影响专业人员的技术和非技术技能，外科医生也不例外。但是，很少有研究解决神经外科医师中的这个问题。提出了一种在颅内动脉瘤手术过程中监测心血管劳损和自主神经失调的系统，以便从这些手术中获得总体心脏测量结果。此外，这项研究还可以检测压力事件，并将其影响与外科医生自己的评估相比较。在有两名外科医生的10次颅内动脉瘤手术中，使用可穿戴式心电图监护仪和移动技术从外科医生的心电图（ECG）信号中提取了线性和非线性心率变异性（HRV）特征。压力评估和认知工作量使用自我报告的方法进行评估。研究结果表明，与修剪过程中的主要角色相关的外科医生可能会承受较高的压力，特别是如果发生破裂（pNN20 = 0％），而助理外科医生则容易出现精神疲劳。一名外科医生的认知工作量得分与AVNN，SDNN，pNN20，pNN50、1 V，2 L V，SD2和CVI度量呈负相关。认知工作量与压力评估呈正相关，表明对心理要求更高的程序也被认为具有更大的压力。最后，pNN20似乎比pNN50更好地反映了压力时刻的行为。此外，在换了主要角色后，一名专业人士发生交感迷走神经兴奋。本方法学表明了识别有害事件的潜力。这项工作对于设计有效的干预措施以降低外科医生的压力水平可能具有重要意义。此外，该方法可以应用于其他专业。