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Claudia CASTILLO AYOMETZI, Alfonso Garcia Lopez, Alejandro Babayan Sosa, Alfredo R. Castillejos; Quantitative Evaluation Of The Effect Of Oral Propranolol And Sublingual Timolol On Hand Tremor And Its Effect On Surgical Performance. Using The EYESi Surgical Simulator. Invest. Ophthalmol. Vis. Sci. 2012;53(14):6632.
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To quantitatively evaluate and compare the effect of oral propanolol 10mg and sublingual timolol maleate 0.5% on hand tremor and its effect on surgical performance assessed while performing the anti-tremor level 3 training module of the EYESi surgical simulator (Mannheim,Germany,VRmagic)
A randomized, single masked study was performed at Hospital Nuestra Senora de la Luz, Mexico. 19 ophthalmology residents (PGY2 to 4) volunteered for the study. Residents were tested on 4 separate days. On each day subjects injested 10 mg of propranolol, 1 sublingual drop of timolol maleate 0.5%, placebo or 1 sublingual drop of sodium hyaluronate 30 minutes prior to performing the anti-tremor level 3 training modules. Scores were recorded with the standarized software of the simulator. Two variables were evaluate: avarage tremor and out of tolerance percentage.The means of both variables were calculated for the two groups. A T-test was used to compare each group against placebo.
There was a significant effect of propranolol in reducing surgical tremor (p=0.02). Statistically significant difference was not observed with timolol (p=0.9). Comparing the two beta-adrenergic receptor blocking agents, propranolol achieved significantly better tremor scores (p=0.004). The out of tolerance percentage was also lower with propranolol however the difference was not statistically significant (p=0.35)
Oral propanolol taken 30 min before surgery may reduce hand tremor of the surgeon. Further investigation of this possible beneficial effect on surgical performance is warranted.
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