Fainting during surgery – a problem more common than we anticipate!

So you’re standing in theatre, four hours into open surgery. The place is becoming evermore like a sauna and the gown isn’t helping. The smell is exacerbating your senses.  And then, your vision begins to cloud in. Before you know it, you find yourself neatly placed in the seated position leaning against the wall. A damp cloth has been placed on your forehead and you sit there in an enigmatic trance, trying to piece together as to what just happened.

Surprisingly most theatre staff will say the same thing. ‘It’s happened to us before’ and that this is a ‘rite of passage’ for many. Therefore, ‘there is nothing to be ashamed off.’  This is actually true and nearly 1 in 10 medical students almost completely pass out in the operating theatre. A study carried out by the University of Nottingham showed that 12% of all medical students who attended theatre, almost or completely experienced syncope. Still, if such an event can be avoided through taking even the mildest precautions, then it would be wise to do so. After all, only you are going to miss out on the rest of the operation and your education.  It has been shown that observing and assisting in surgical procedures can substantially improve student’s knowledge of anatomy and surgical pathology.

Also, such an event will mean you are at risk of harming the patient and yourself. So, needless to say education to prevent syncope would be an ideal health hazard. Some students have even stated that fainting in surgery often makes medical students feel stigmatised, as it delays the operation and consequently reduces their confidence in pursuing a career in this discipline. If these opinions are as true as they have been suggested, then surely attendees should be educated on the methods to prevent such an outcome.

Syncope occurs when there is a sudden drop in blood pressure. The body physiologically responds to this by causing the person to collapse to increase blood perfusion to the brain.  Studies have shown the main causes of syncope in theatre are the hot temperature, prolonged standing, wearing a surgical mask and the smell of diathermy. Anxiety has also been found to play a small role too.  Interestingly, the type of operation has little effect on the number of syncope cases, although fainting is much more common in gynaecological operations. It is also significantly more common in women than men and a plausible explanation for this could be that women tend to have smaller hearts and lower vascular resistance.

Despite this, cautious measures can be taken by everyone to prevent such events. Having food prior to the operation, being well hydrated and getting a good night’s sleep have been found to reduce the incidence of syncope.  Also, physical manoeuvres such as leg crossing, muscle tensing, squatting and wearing compressive stockings are effective at maintaining blood pressure during the operation. For those of you that aren’t scrubbed in, taking regular breaks and sitting down every so often will be greatly beneficial too.

So, medical students and theatre staff should actively follow this simple advice, educate and encourage others to do so and most importantly, take care!

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