• Kyle M Fargen, Raymond D Turner, and Alejandro M Spiotta.
• Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA. Electronic address: fargen@musc.edu.
• World Neurosurg. 2016 Feb 1; 86: 384-9.

IntroductionAll individuals have a physiologic tremor that may become more pronounced in periods of stress, stimulant use, or caffeine. There are few publications measuring the effects of these factors on surgeons or trainees and no comprehensive reviews. We sought to review the representative literature.Materials And MethodsAn exhaustive literature search to identify journal articles evaluating factors that affect surgical tremor or dexterity was performed.ResultsOur search identified 34 studies. All included manuscripts are from small, single-center studies and the vast majority evaluated procedural skills on the basis of laparoscopic simulators. Only one study in which the authors evaluated microsurgical procedural performance was identified.ConclusionsThe literature evaluating tremor and its relationship to surgical performance is limited. Surgeons wishing to optimize surgical dexterity may benefit from avoiding caffeine use or fasting before operating and avoiding sleep deprivation or alcohol use the night before procedures. Those surgeons prone to anxiety or stress-related tremor may obtain a benefit from certain beta-blockers. Finally, the use of appropriate surgical ergonomics with hand or wrist steadying may improve surgical tremor and reduce fatigue.Copyright © 2016 Elsevier Inc. All rights reserved.

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