Decreasing Sedative Requirements for Peripheral Vascular Interventions using Preoperative Guided Meditation

项目概要/摘要： 患者焦虑是普遍存在的，并且可能会对接受手术的患者造成影响 在程序性镇静和镇痛（PSA）下，与全身麻醉相反， 清醒并持续意识到围手术期活动。围手术期焦虑的治疗 传统上围绕着抗焦虑药和镇痛药的给药，最常见于 短效阿片类药物和苯二氮卓类药物。然而，这些药物不仅具有短 长期副作用包括呼吸抑制和可能的呼吸暂停，但在某些情况下也可能导致 成瘾和长期依赖。 我们提出了一种新的干预措施：围手术期，手术特定的指导冥想计划， 减少病人的焦虑。我们相信，这样的冥想计划是一种最佳的手段， 减少血管手术患者的焦虑，因为它是一种非药物干预， 经证明，可有效减少全身手术患者的围手术期疼痛和焦虑 心脏和脊柱外科的麻醉。此外，指导冥想技术 比如身体扫描技术和专注于呼吸的冥想， 要求在术中做，即保持他们的腿不动，间歇性地保持他们的腿不动。 呼吸从可行性的角度来看，我们也鼓励冥想以前是 在围手术期竞技场成功实施，尽管先前的冥想干预还没有 对于清醒镇静（而不是全身麻醉）的患者， 纳入了手术特定信息，因为他们使用了通用的现有技术。 为了以科学严谨的方式创建上述冥想计划，我们 将召集一个利益相关者小组，包括冥想专家、患者和血管外科医生。 通过德尔菲法，该小组将生成特定于患者的冥想程序的关键租户 接受外周动脉血管内介入治疗，根据冥想计划， 随后将创建。然后将进行试点可行性研究，并有一个招募期 持续一年，并将分析包括患者围手术期焦虑在内的结局。 完成后，本研究将提供关于手术可行性和影响的数据- 外周动脉血管内介入治疗患者的特定引导冥想程序 干预措施。我们还希望收集足够的初步数据，以便为随机对照提供动力 study.最后，我们设想我们的研究将引起人们对以病人为中心的重要性的关注。 研究和刺激进一步调查解决围手术期病人的焦虑。

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.