As a trained provider that administers anesthesia to hundreds of patients every year, I have learned my job well, and developed the subtle art of determining which patients may present me with challenges under anesthesia. Most anesthesia professionals would agree that the vast majority of patients do just fine, but there is a small percentage of outliers that will throw you a curveball, and when this happens, it is not pretty. We are the gate keepers for the surgical team’s calm and focus during surgery. When we become frustrated and unable to handle problems with composure, a sense of panic is transmitted to the surgeon and chaos quickly spreads through the surgical suite. The way I prevent this is by training myself everyday to remain in a state of rest and digest (scientifically known as parasympathetic dominant state), relaxed state no matter what is going on around me. Unless I am being chased by a bear, which thankfully doesn’t happen often! I have achieved this through a daily practice of deep breathing, similar to sumo breathing that I will describe later. I personally didn’t realized how improved my state of relaxation was until a few weeks ago when I was faced with an emergency situation with one of my patients. He had a fairly simple procedure but was very sick and frail, and as we wheeled him into the recovery suite, I realized that he wasn’t breathing and had started to turn purple. We checked for his pulse and could not find one. This is a ‘code blue’ emergency situation (the highest level of urgency in our hospital). We immediately started the life-saving protocol and called for help. As the person who gave the anesthesia and the absence of a Medical doctor that usually leads the code team (doctors, nurses and technicians that are assigned to respond to all blue codes within the hospital), I had to lead the resuscitation efforts and directed the nurses and technicians present around me. I stood at the head of the bed, “breathing for the patient” using a breathing bag, and assigned specific tasks to each person. We successfully restored the patient’s pulse, before the arrival of the code team! I then established an airway by placing a breathing tube in the patient and surrendered care to the code team. As I stood by the door reflecting on what had just occurred, it dawned on me that I remained unusually composed throughout the critical event. I started to walk down the hall, lost in my thoughts. One of the nurses who was an active participant during the emergency approached me and mentioned what a great job I did by remaining calm and giving clear, concise directions that resulted in saving the life of the patient.
I then realized that my breathing exercises and intentional daily practice of living in a state of balance was working.
Step-by-step breathing exercise I use to activate the parasympathetic activity in my body:
1) Find a quiet space and sit in a relaxed position on a chair, or on a mat in a crosslegged position.
2) Straighten your back and torso to allow for a full extension of your lungs, but don’t strain.
3) Close your eyes and clear your thoughts.
4) Slowly breath in, filling your lungs and abdomen completely.
5) When you think you have reached the peak of inhalation, start to stack up short little breaths without releasing the air already inside your lungs. This is to allow more oxygen to reach the bottom of your lungs which is usually deprived of oxygen, because we naturally take shallow breaths without conscious effort. (It is interesting to note that stress can cause such shallow breathing that this alone increases feelings of anxiety and pressure.)
6) When you feel you can’t take in any more air, hold it for a couple of seconds. At this point, you should be feeling goosebumps and chills throughout your body. You have just touched or awakened a deeper aspect of yourself.
7) Release your breath slowly. (Be aware that you may feel a little dizzy, so give yourself a minute or so before walking.)
8) Repeat 4-5 times.
With continued practice, you could drive your respiratory rate down to 2-3 breaths per minute by taking in enough oxygen with slower, deeper breaths. Studies* have shown that deep breathing exercises stimulate the “rest and digest” response and inhibit the flight or fight response; keeping your conscious mind in charge of your thoughts and actions.This happens by decreasing your heart rate and oxygen consumption, lowering blood pressure, and increasing theta waves in the brain. It puts the whole body into a relaxed state. Like any new habit, it needs to be practiced regularly in order to reap its benefits for the long term.