Decreasing Sedative Requirements for Peripheral Vascular Interventions using Preoperative Guided Meditation

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Project Summary/Abstract: Patient anxiety is widely prevalent and can be compounded for patients undergoing procedures under procedural sedation and analgesia (PSA), in contrast to general anesthesia, as they remain awake and continuously aware of perioperative activity. The treatment of perioperative anxiety has traditionally revolved around the administration of anxiolytics and analgesics, most commonly in the form of short-acting opioids and benzodiazepines. However, these medications not only have short term side effects including respiratory depression and possible apnea but can also in some cases result in addiction and long-term dependence. We propose a novel intervention: a perioperative, surgery-specific guided meditation program to decrease patient anxiety. We believe that such a meditation program is an optimal means of decreasing anxiety in vascular surgery patients as it is a non-pharmacologic intervention that has proven to be effective in decreasing perioperative pain and anxiety for patients undergoing general anesthesia in the specialties of cardiac and spine surgery. Additionally, guided meditation techniques such as the body-scan technique and breath-focused meditation are synergistic with what patients are requested to do intraoperatively, namely keeping their legs immobile and intermittently holding their breath. From a feasibility standpoint, we are also encouraged that meditation has previously been successfully implemented in the perioperative arena, though prior meditation interventions have not been for patients under conscious sedation (as opposed to general anesthesia) nor have they incorporated surgery-specific information as they had used generic pre-existing techniques. In order to create the aforementioned meditation program in a scientifically rigorous manner, we will assemble a panel of stakeholders to include meditation experts, patients and vascular surgeons. Via the Delphi method, this panel will generate key tenants of a meditation program specific to patients undergoing peripheral arterial endovascular interventions, according to which the meditation program will subsequently be created. A pilot feasibility study will then be performed, with a recruitment period to last a year, and outcomes including patient perioperative anxiety will be analyzed. When completed, this study will provide data regarding the feasibility and impact of a surgery- specific guided meditation program on patients undergoing peripheral arterial endovascular interventions. We also expect to collect adequate preliminary data so as to power a randomized control study. Finally, we envision that our study will draw attention to the importance of patient-centered research and stimulate further investigations into addressing perioperative patient anxiety.