Effects of the Brief Simha Kriya Breathing Practice for Health Care Workers During the COVID-19 Pandemic.

Introduction: During the COVID-19 pandemic, health care workers (HCWs) experienced increased anxiety, depression, loneliness, and other mental health issues. HCWs need additional resources to cope with the mental health impact of their work. Yoga techniques could be helpful strategies to manage different stressors during times of uncertainty. Methods: This prospective, single-arm, trial examined the effects of a brief pranayama yoga practice on the wellbeing of HCWs during the height of COVID-19. HCWs were recruited through announcements and institutional websites at a large major cancer center in the southern United States. A short, prerecorded, 5-min breathwork video intervention called "Simha Kriya" was provided to participants, and they were encouraged to practice one to two times daily for 4 weeks. Participants completed self-report instruments at baseline and weeks 1 and 4, including: (1) Perceived Stress Scale (PSS); (2) Brief Resilient Coping Scale (BRCS); and (3) a questionnaire assessing the experience of COVID-19 among HCWs that had five subscales. HCWs also conducted a measure of breath holding time. Paired sample t-tests and mixed-effects analysis of variance models examined changes over time. Results: One hundred participants consented to the study, with 88 female, 60 white, 39 worked remotely, and 27 were clinical staff. Sixty-nine participants provided data at week 1 and 56 at week 4. Participants' adherence to the breathing exercises between weeks 1 and 4 was similar, with a mean of six times per week. At week 4, there were significant decreases in the COVID-19 Distress score (p < 0.0001) and COVID-19 Disruption (p = 0.013), yet no changes in the PSS. There were also significant increases in COVID-19 Stress Management (p = 0.0001) and BRCS scores (p = 0.012), but no changes in Perceived Benefits of COVID-19 and no changes in breath holding time. Discussion: Brief yoga-based breathing practices helped reduce pandemic-specific stress, improved resilience, and stress management skills in HCWs. Trial Registration Number: NCT04482647.

Yoga-Based Breathing Techniques for Health Care Workers During COVID-19 Pandemic: Interests, Feasibility, and Acceptance.

Objectives: The authors explored the feasibility of virtual yoga-based breathwork and meditation among health care workers (HCW) during the COVID-19 pandemic. Methods: Consented employees of a large cancer center accessed a video of breathwork called "Simha Kriya" to be practiced for 4 weeks. Results: Of 217 participants who expressed interest within 2 weeks, 90 were recruited to the study in 1 month and 100 in 2 months. Of 69 participants who provided data between weeks 1 and 4, 77% perceived the intervention as useful. Conclusions: Yoga-based breathing practices were feasible and acceptable among HCW in the setting of a pandemic. ClinicalTrials.gov ID: NCT04482647.

Innovations in treating aortic diseases: the abdominal aorta.

Patients with an abdominal aortic aneurysm (AAA) could benefit from earlier diagnosis to improve long-term outcomes. Candidate serum biomarkers for earlier AAA diagnosis include D-dimer, fibrinogen, low-density lipoprotein, high-density lipoprotein, lipoprotein(a), and the proteolytic enzymes known as matrix metalloproteinases. Furthermore, biomarkers such as brain natriuretic peptide significantly stratify perioperative risk in AAA repair. Statins significantly improve outcomes after AAA repair. They may also significantly slow AAA growth to allow pharmacologic arrest of AAA development. Recent trials have focused attention on fluid management for AAA repair. Although restrictive fluid management may significantly improve clinical outcomes, current evidence does not clearly support crystalloid or colloid for AAA repair. There may be an increased risk of renal dysfunction associated with hetastarch therapy. Endovascular repair has revolutionized the clinical management of AAAs. Recent trials have shown its significant outcome advantages. Furthermore, it is also applicable in high-risk operative cohorts and, in the future, may be suited for earlier AAA repair. This technology continues to advance with the development of branched and fenestrated grafts as well as total percutaneous endovascular AAA repair. Regardless of these advances, the clinical management of endoleaks will remain a major clinical focus. Taken together, these advances in the management of AAAs likely will significantly influence future clinical approaches to this challenging patient cohort.

The year in cardiothoracic and vascular anesthesia: selected highlights from 2010.

The aortic valve treatment revolution continues with the maturation of aortic valve repair and the dissemination of transcatheter aortic valve implantation. The recent publication of comprehensive multidisciplinary guidelines for diseases of the thoracic aorta has assigned important roles for the cardiovascular anesthesiologist and perioperative echocardiographer. Although intense angiotensin blockade improves outcomes in heart failure, it might further complicate the maintenance of perioperative systemic vascular tone. Ultrafiltration as well as intensive medical management guided by the biomarker brain natriuretic peptide improves outcomes in heart failure. Continuous-flow left ventricular assist devices have further improved outcomes in the surgical management of heart failure. Major risk factors for bleeding in the setting of these devices include advanced liver disease and acquired von Willebrand syndrome. The metabolic modulator perhexiline improves myocardial diastolic energetics to achieve significant symptomatic improvement in hypertrophic cardiomyopathy. A landmark report was also published recently that outlines the major areas for future research and clinical innovation in this disease. Landmark trials have documented the outcome importance of perioperative cerebral oxygen saturation monitoring as well as the outcome advantages of the Sano shunt over the modified Blalock-Taussig shunt in the Norwood procedure. Furthermore, the development and evaluation of pediatric-specific ventricular assist devices likely will revolutionize the mechanical management of pediatric heart failure. A multidisciplinary review has highlighted the priorities for future perioperative trials in congenital heart disease. These pervasive developments likely will influence the future training models in pediatric cardiac anesthesia.

Challenges in intraoperative monitoring.

Predicting major adverse events following surgery remains a significant problem. Currently, the perioperative period is too often considered a black box, with risk assessment and prediction largely based on static pre-surgical parameters. Here, we review the problem of intraoperative hypotension and outline some of the opportunities for improved monitoring during surgery.

Myocardial performance index is a predictor of outcome after abdominal aortic aneurysm repair.

OBJECTIVE: Perioperative measurement of the myocardial performance index (MPI) with transesophageal echocardiography in patients undergoing elective abdominal aortic aneurysm repair and its association with outcome. DESIGN: A prospective observational study. SETTING: A tertiary care university hospital. PARTICIPANTS: Patients undergoing elective abdominal aortic aneurysm repair. INTERVENTION: Perioperative transesophageal echocardiography. MEASUREMENTS: Fifty-one consecutive patients undergoing elective abdominal aortic aneurysm repair were enrolled in the study. The MPI was calculated by using pulse-wave Doppler from the midesophageal window and the deep transgastric position of the probe. In addition, diastolic function was measured as the slope of the transmitral flow propagation velocity, and ejection fraction was calculated as a measure of ventricular systolic function. Comparisons between subjects with uncomplicated versus adverse outcomes were made by using a Mann-Whitney U test. Comparison of the incidence of adverse outcome among subjects with normal and elevated MPIs was made by using a Fisher exact test. Statistical significance was set at p < 0.05. RESULTS: It was possible to calculate MPI in all patients with transesophageal echocardiography perioperatively. Patients with adverse postoperative outcomes had an elevated MPI as compared with those without any adverse outcome (0.50 v 0.30, p < 0.001). Also, an MPI of > or = 0.36 was associated with a statistically significant higher incidence of complications (congestive heart failure/prolonged intubation) (p < 0.001). CONCLUSIONS: The MPI is an easily obtained echocardiographic measure of global ventricular performance, which can be measured perioperatively and may be useful as a prospective risk stratification index for patients undergoing elective abdominal aortic aneurysm surgery.

Transmitral flow propagation velocity and assessment of diastolic function during abdominal aortic aneurysm repair.

INTRODUCTION: In the perioperative arena, pronounced changes in cardiac loading conditions can make assessment of diastolic parameters difficult. A number of Doppler techniques have been introduced to assess perioperative diastolic function. OBJECTIVES: To compare transmitral flow propagation velocity (Vp) with other pulse-wave Doppler echocardiographic assessments of diastolic function in patients undergoing elective abdominal aortic aneurysm (AAA) resection. DESIGN: A prospective observational study. STUDY SUBJECTS: Forty-five consecutive patients undergoing elective AAA repair under general anesthesia. METHODS: Transesophageal echocardiographic examination was performed before, during, and after removal of the aortic cross-clamp (AXC). Diastolic function was categorized on the basis of the ratio of transmitral pulse-wave Doppler (PWD) into early (E) and late (A) waves and their ratio (E/A), deceleration time, and use of pulmonary venous inflow patterns to identify pseudonormal pattern. Subjects were then assessed by using the Canadian Consensus Guidelines (CCG) and on the basis of transmitral flow Vp. The correlation among methods for diagnosis of diastolic dysfunction and pseudonormal pattern was examined. Diastolic function over each of the 3 periods to assess changes during AXC was examined. RESULTS: Data analysis was completed in 35 patients. The authors found excellent correlation between E/A ratio and Vp for diagnosis of diastolic dysfunction (24/25 cases) and a pseudonormal pattern (18/20 cases). The CCG methodology identified fewer cases of diastolic dysfunction than Vp (p = 0.003). The evaluation using CCG methodology could not be categorized in 15% of cases. The incidence of diastolic dysfunction increased during placement of AXC with both Vp and CCG (p < 0.05) but not by E/A ratio, and returned to baseline after removal of the AXC. Good correlation was found among all 3 methods (p < 0.05 and r > 0.5 for all). CONCLUSION: Vp assessment identified the majority (93%) of cases of diastolic dysfunction identified by traditional methods. Furthermore, the incidence of diastolic dysfunction increased with application of the AXC but returned to baseline after removal.