Png Chien Yi Maximilian, Mehta Darshan H, Dua Anahita, Stephen Antonia E, Bruce Alex M, Forsythe Aynsley, Chitilian Hovig V, Bringle Erik J, Simpson James C, Parady Katherine M, McNeil Lisa A, Baim Margaret A, Eagleton Matthew J, Chang David C, Yeh Gloria Y
Division of Vascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Boston, MA, USA.
Glob Adv Integr Med Health. 2024 Sep 16;13:27536130241285129. doi: 10.1177/27536130241285129. eCollection 2024 Jan-Dec.
Peripheral vascular interventions (PVIs) performed under procedural sedation and analgesia (PSA) can be associated with anxiety and poor compliance with patient instructions during surgery. Mind-body interventions (MBIs) such as meditation have demonstrated the potential to decrease perioperative anxiety, though this area is understudied, and no tailored interventions have been developed for the vascular surgical patient population.
We aimed to design a perioperative MBI that specifically targeted vascular surgical patients undergoing PVIs under PSA. We sought to perform this in a scientifically rigorous, multi-disciplinary collaborative manner.
Following the Obesity-Related Behavioral Intervention Trials (ORBIT) model, we designed (Phase 1a) and then refined (Phase 1b) a MBI for patients undergoing PVIs under PSA to decrease perioperative anxiety and sedation and facilitate patient intraoperative compliance. Phase 1a involved a literature review, informal information gathering and synthesis, and drafting a preliminary protocol for a perioperative MBI. Phase 1b involved assembling a multi-disciplinary expert panel of perioperative and mind-body clinicians and researchers to improve the MBI using an iterative, modified Delphi approach.
The modified Delphi process was completed, and a consensus was reached after three iterations. The resulting MBI consisted of two seven-minute preoperative guided meditations on the day of surgery, including diaphragmatic breathing, body scans, and guided imagery emphasizing awareness of the ipsilateral leg where the vascular surgery was performed. A document delineating the integration of the MBI into the operating room workflow was produced, including details regarding the intervention's timing, duration, and modality.
Using a multi-specialty expert panel, we designed a novel MBI in the form of a guided meditation with elements of mindfulness and guided imagery to decrease anxiety and increase intraoperative compliance for patients undergoing PVIs under PSA. A prospective pilot study is being planned to test the program's feasibility.
在程序镇静和镇痛（PSA）下进行的外周血管介入治疗（PVI）可能与焦虑以及手术期间患者对医嘱的依从性差有关。冥想等身心干预（MBI）已显示出降低围手术期焦虑的潜力，尽管该领域研究不足，且尚未针对血管外科患者群体开发出量身定制的干预措施。
我们旨在设计一种围手术期MBI，专门针对在PSA下接受PVI的血管外科患者。我们力求以科学严谨、多学科协作的方式开展此项工作。
遵循肥胖相关行为干预试验（ORBIT）模型，我们为在PSA下接受PVI的患者设计（1a期）并随后完善（1b期）了一种MBI，以降低围手术期焦虑和镇静程度，并促进患者术中的依从性。1a期包括文献综述、非正式信息收集与综合，以及起草围手术期MBI的初步方案。1b期包括组建一个由围手术期及身心临床医生和研究人员组成的多学科专家小组，采用迭代、改良的德尔菲法改进MBI。
完成了改良的德尔菲法流程，经过三轮迭代达成了共识。最终的MBI包括手术当天两次七分钟的术前引导冥想，内容包括膈式呼吸、全身扫描，以及强调对进行血管手术的同侧腿部的感知的引导式意象。编制了一份将MBI整合到手术室工作流程中的文件，包括有关干预措施的时间安排、持续时间和方式的详细信息。
我们利用一个多专业专家小组，设计了一种以引导冥想形式呈现的新型MBI，融合了正念和引导式意象元素，以降低在PSA下接受PVI的患者的焦虑并提高术中依从性。目前正在计划开展一项前瞻性试点研究，以测试该方案的可行性。
