Intraoperative Cognitive Load in Anesthesia Nurses Across Anesthetic Phases: An Observational Study Using NASA-TLX.

NCT07568158 | Not Yet Recruiting

• 1 other identifier: ENCOPER-HCB-2026-001
• Study Type: observational
• Target: 50
• Locations: 1 country
• Sites: 1

Brief Summary

The goal of this observational study is to measure the cognitive load (mental effort) of anesthesia nurses during real surgical procedures at Hospital Clínic de Barcelona, Spain. The main questions it aims to answer are:

• Does cognitive load vary across the three phases of anesthetic care (induction, maintenance, and emergence/recovery)?
• Is cognitive load higher during general anesthesia than during spinal anesthesia with sedation?
• How do surgical specialty and patient complexity relate to cognitive load?
• How does monitor alarm perception relate to cognitive load during surgery? Participants (anesthesia nurses) will complete the NASA Task Load Index (NASA-TLX) questionnaire - a validated 6-item tool measuring mental effort - three times per surgical case: after induction or spinal block, during maintenance, and after patient awakening or sedation reversal. They will also answer 4 brief questions about alarm management at the end of each case. No changes are made to clinical care. Participation adds approximately 11 minutes per surgical case.

Conditions

Cognitive Load, Performance; Alarm Fatigue; Perioperative; Patient Safety

Keywords

NASA-TLX; Anesthesia Nursing; Perioperative Nursing; Mental Workload; Intraoperative; Patient Safety; Monitor Alarms; Operating Room

Outcome Measures

Primary Outcomes (1)

• Global Raw NASA-TLX Score

  Subjective cognitive load measured using the Raw NASA Task Load Index (NASA-TLX), calculated as the arithmetic mean of six subscales (mental demand, physical demand, temporal demand, performance, effort, and frustration), each rated on a 0-100 scale. Administered three times per surgical case: after induction or spinal block (T1), during maintenance (T2), and after extubation or end of sedation (T3). Study duration: approximately 8 months.

  At three time points per surgical case: T1 (5 minutes post-induction/spinal block), T2 (during maintenance, before surgical closure), and T3 (5 minutes after extubation/end of sedation ).

Secondary Outcomes (2)

• NASA-TLX Subscale Scores

  At T1, T2, and T3 per surgical case over approximately 8 months.

• Monitor Alarm Perception Visual Analog Scale (VAS)

  Once per surgical case, after T3, over approximately 8 months.

Other Outcomes (1)

• Alarm Management Behavior and Attention Interference During Intraoperative Care.

  Once per surgical case, after T3, over approximately 8 months.

Study Arms (2)

General Anesthesia (GA)

Anesthesia nurses managing surgical cases under general anesthesia (endotracheal intubation or laryngeal mask airway). Cognitive load measured at three phases: post-induction (T1), maintenance (T2), and post-extubation (T3).

Other: NASA Task Load Index (NASA-TLX)

Spinal Anesthesia with Sedation

Anesthesia nurses managing surgical cases under spinal anesthesia combined with intravenous sedation. Cognitive load measured at three phases: post-spinal block and sedation initiation (T1), maintenance (T2), and end of sedation (T3).

Other: NASA Task Load Index (NASA-TLX)

Interventions

NASA Task Load Index (NASA-TLX) OTHER

The Raw NASA Task Load Index (NASA-TLX) is a validated self-report questionnaire measuring subjective cognitive load across six dimensions: mental demand, physical demand, temporal demand, performance, effort, and frustration (scale 0-100). Administered three times per surgical case (T1, T2, T3) by the participating anesthesia nurse. Additionally, four questions about monitor alarm perception and management are completed after T3.

General Anesthesia (GA); Spinal Anesthesia with Sedation

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Registered nurse anesthetists actively working at Hospital Clínic de Barcelona, a university tertiary care hospital, assigned to the following operating rooms: main surgical block, ambulatory surgery unit (CMA), interventional radiology suite (RIO), DIVAS intraoperative radiotherapy unit, and transplant operating room.

You may qualify if:

• Registered nurse anesthetist actively working at Hospital Clínic de Barcelona.
• Minimum 3 months in the current anesthesia nursing position.
• Voluntary participation with signed informed consent.
• Scheduled surgery (including deferred urgent surgery) or solid organ transplantation.
• General anesthesia (endotracheal intubation or laryngeal mask airway) or spinal anesthesia with sedation.
• Minimum duration of 30 minutes.

You may not qualify if:

• Relief or rotating nurses without specific anesthesia training.
• Nurses in initial training period (less than 3 months in position).
• Refusal to participate or withdrawal of informed consent.
• Spinal anesthesia without sedation.
• Exclusive regional anesthesia without sedation.
• Sedation alone without regional technique.
• Duration less than 30 minutes.

Sponsors & Collaborators

• Hospital Clinic of Barcelona: lead

Study Sites (1)

Hospital Clínic de Barcelona

Barcelona, Catalonia, 08036, Spain

Location

Related Publications (13)

• The Joint Commission; Medical device alarm safety in hospitals; Sentinel Event Alert; 2013; (50)

  BACKGROUND

• ECRI Institute; Top 10 Health Technology Hazards for 2022; ECRI Institute; 2021

  BACKGROUND

• Hart SG, Staveland LE; Development of NASA-TLX (Task Load Index): results of empirical and theoretical research; Advances in Psychology; 1988; 52; 139-183

  BACKGROUND

• Wickens CD; Multiple resources and mental workload; Hum Factors; 2008; 50(3); 449-455

  BACKGROUND

• Sweller J; Cognitive load during problem solving: effects on learning; Cognitive Science; 1988; 12(2); 257-285

  BACKGROUND

• Carayon P, Gurses AP; A human factors engineering conceptual framework of nursing workload and patient safety in intensive care units; Intensive Crit Care Nurs; 2005; 21(5); 284-301

  BACKGROUND

• Reason J; Human error: models and management; BMJ; 2000; 320(7237); 768-770

  BACKGROUND

• Wunderlich CA, Barnsteiner JH, Minnick A; Development of the Clinical Alarm Fatigue Questionnaire (CAFQa); J Nurs Scholarsh; 2021; 53(6); 681-690

  BACKGROUND

• Cvach M; Monitor alarm fatigue: an integrative review; Biomed Instrum Technol; 2012; 46(4); 268-277

  BACKGROUND

• Kennedy-Metz LR, Lehane CM, Yule S, Dias RD, Zenati MA; Measuring cognitive load in the cardiac operating room; J Thorac Cardiovasc Surg; 2020; 160(6); 1621-1630

  BACKGROUND

• Piquilloud L, Tassaux D, Bialais E, Lambermont B, Roeseler J, Sottiaux T, Demoule A, Jolliet P; The work of breathing influences the cognitive load of nurses and physiotherapists during non-invasive ventilation assistance of patients with acute respiratory failure; Intensive Care Med; 2020; 46(5); 983-991

  BACKGROUND

• Olin K, Göras C, Nilsson U, Unbeck M, Ehrenberg A, Pukk-Härenstam K, Florin J; Mapping registered nurse anaesthetists' intraoperative work: tasks, multitasking, interruptions and their causes, and interactions: a prospective observational study; BMJ Open; 2022; 12(1); e052283

  BACKGROUND

• Göras C, Olin K, Unbeck M, Ehrenberg A, Pukk-Härenstam K, Nilsson U; Tasks, multitasking and interruptions among the surgical team in an operating room: a prospective observational study; BMJ Open; 2019; 9(5); e024763

  BACKGROUND

Related Links

• NASA Task Load Index (NASA-TLX) official resource

MeSH Terms

Conditions

Alert Fatigue, Health Personnel

Condition Hierarchy (Ancestors)

Mental Fatigue; Fatigue; Signs and Symptoms; Pathological Conditions, Signs and Symptoms; Behavioral Symptoms; Behavior

Study Officials

• Victor Caro-Frechilla, RN, MSc

  Hospital Clinic of Barcelona

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Victor Caro-Frechilla, RN, MSc

CONTACT

+34 633809919; vcaro@clinic.cat

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Target Duration: 8 Months
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Registered Nurse Anesthetist

Study Record Dates

• First Submitted: April 28, 2026
• First Posted: May 5, 2026
• Study Start (Estimated): June 1, 2026
• Primary Completion (Estimated): December 31, 2026
• Study Completion (Estimated): January 1, 2027
• Last Updated: May 5, 2026

Record last verified: 2026-04

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP, ICF
• Time Frame: IPD and supporting documents will be available starting 6 months after publication of the primary results article (estimated 2027-2028) and will remain available for 5 years.
• Access Criteria: IPD will be available upon reasonable request to the principal investigator (vcaro@clinic.cat). Requestors must provide: (1) a brief description of the proposed use, (2) institutional affiliation, and (3) agreement to data use conditions. Data will be shared as anonymized datasets in CSV format. No individual participant can be identified from the shared data.

Locations

ES (1)