Decreasing Sedative Requirements for Peripheral Vascular Interventions using Preoperative Guided Meditation

项目摘要/摘要： 患者焦虑普遍存在，对于正在接受手术的患者来说，焦虑可能会加剧。 在程序性镇静和止痛(PSA)下，与全身麻醉相比，它们仍然 清醒并持续意识到围手术期的活动。围手术期焦虑症的治疗 传统上围绕着焦虑和止痛药的管理，最常见的是 短效阿片类药物和苯二氮卓类药物。然而，这些药物不仅有短暂的 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 上瘾和长期依赖。 我们提出了一种新的干预方法：一种围手术期的指导性冥想计划，以 减少患者的焦虑。我们相信，这样的冥想计划是一种最佳的方式 减少血管手术患者的焦虑，因为这是一种非药物干预，具有 证实能有效地减轻全身手术患者的围手术期疼痛和焦虑 心脏和脊柱外科专科的麻醉学。此外，指导冥想的技巧 例如身体扫描技术和集中呼吸的冥想是与患者的 要求在术中做，即保持双腿不动并间歇性地握住 呼吸。从可行性的角度来看，我们还感到鼓舞的是，冥想以前 在围手术期成功实施，尽管之前的冥想干预没有 适用于清醒镇静状态下的患者(与全身麻醉相反)，也不适用 他们使用了通用的预先存在的技术，因此纳入了手术特有的信息。 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Delphi方法，该小组将生成特定于患者的冥想计划的关键租户 接受外周动脉血管内介入，根据这个冥想计划 将在随后创建。随后将进行试验性可行性研究，并设定招聘期。 持续一年，包括患者围手术期焦虑在内的结果将被分析。 完成后，这项研究将提供关于手术的可行性和影响的数据- 外周动脉血管内成形术患者的特定指导冥想方案 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 学习。最后，我们预计我们的研究将引起人们对以患者为中心的重要性的关注 研究并促进进一步的研究，以解决围手术期患者的焦虑问题。

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.