3 Undetectable Ways to Regulate in the OR | Wellness Wednesdays

***@ 14:42 my podcast software thinks "voo-ing is a "removable background noise" so this episode may be best experienced on YouTube

Have you ever searched for wellness resources that truly understand what it means to be a Certified Anesthesiologist Assistant? You're not alone. Wellness Wednesday are candid conversations about the unique challenges and opportunities facing CAAs in their pursuit of sustainable wellbeing.

In this episode I relate how OR life can jack your nervous system into overdrive... constant alarms, literal hammering, a sudden “patient’s moving", and yet our role as a Certified Anesthesiologist Assistant demands we have steady hands and a clear head. I unpack three discreet, science-backed techniques you can use behind the drape to quiet the buzz without calling attention to yourself. Think long, quiet exhales that nudge your vagus nerve, a quick dose of tension-then-release to steady your hands, and a soft “voo” on the breath that taps the laryngeal branches of the vagus for an extra parasympathetic boost.

Whether you're a practicing CAA, AA student, or prospective applicant, this episode marks the beginning of a community-centered approach to wellness that finally names and validates your experience. Welcome in. 

FYI "To "regulate" means to monitor and adjust one’s internal state—such as emotions, thoughts, or physiological responses—in order to maintain balance and support adaptive behavior." so says ChatGpt

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Chapters

• 0:00 Sponsor And Wellness Context
• 1:29 Setting The OR Scene
• 2:35 Why Deep Breathing Works
• 6:43 Silent Deep Exhale Technique
• 6:57 Progressive Muscle Relaxation Origin
• 8:11 How To Tense And Release Discreetly
• 12:27 Forehead, Jaw, And Tongue Release
• 12:59 Vooing: Breath With Vocalization
• 15:10 Applying Vooing During OR Stress
• 16:01 Wrap Up And Resources

Transcript

SPEAKER_00: 0:00

This Wellness Wednesday is brought to you by CAA Matters, the first comprehensive wellness and professionalism curriculum designed to truly support the AA student experience. We all know AA education is streamlined to produce competent providers in a fast-paced program. Meanwhile, wellness and professionalism often get overlooked, lumped in with medical students, or addressed too late to help. CAA Matters fills this gap, centering student anesthesiologist assistance and equipping them with the tools, resources, and mindset shifts to succeed in school and build long, fulfilling careers. It's a turnkey curriculum, fully prepared, facilitated, and supported from planning to delivery. Program leaders and AA educators can learn more, read reviews from early adopters, and explore piloting CAA Matters at awakenedanesthetist.com or by clicking the link in the show notes. It's hot. I just went for a walk and sat back down, and now I'm sweaty. Let me cool myself here. I realize I'm talking to no one because I'm just here by myself. Okay. Here we go. Welcome to Wellness Wednesday, CAA community. I am so grateful to be here. So this episode, I'll be sharing three methods to regulate yourself in the operating room undetected. So I'm sitting in a chair. It's my podcast chair, but imagine it's a roly black chair that we have from the operating room. Um, and you know, there's a drape in front of me. I'm in a mask and a hat and scrubs, and maybe they're completely by myself. Maybe there's a student sitting next to me, or my attendings coming in and out. These are all techniques that I have done in that environment. So truly in the operating room, as well as between cases, maybe as I'm walking to pre-op, as I'm walking into the operating room for the first time. Like, so these are so, so applicable to the CAA experience or the student experience or the pre-AA shadowing experience that I wanted to share. So we're gonna run through all three of them quite quickly. I'll probably demo a little bit, but this is more of an information sharing, and I hope you get a lot out of it. So the first technique to regulate undetected in the OR, and it's where I started, was simply deep breathing. So if you've been to any level of a yoga class or a, you know, mindful moment in some like community setting, like maybe before your church, or um sometimes in operating rooms, they've started to incorporate this, which I'm all for, is just like a slow down, mindful moment. Almost always, what's cute is to slow down your breathing and take a big deep breath. And while love it, awesome, it's what I'm teaching you here. It didn't resonate with me until I really understood what that is doing, like what is the physiology behind that? I needed that level of evidence-based buy-in in order to, I don't know, release a little bit of shame or like that, like woo-woo, that's not for me. Like seeing myself as someone who would regulate in the operating room has been a journey. I did not just come into this level of like acceptance and okayness, kind of talking about some of these softer parts of me. Deep breathing is a critical important skill to regulate because it's always available to you. So if you're breathing, you're alive. So I know that if I tell you to take a big deep breath, that it is likely possible. Um, you know, of course, if you have asthma or there's some sort of like trauma that you have with deep breathing, which I know sometimes people have, um, then this technique's not for you. But a deep breath activates your vagus nerve. And it does that by um the way our diaphragm pulls down and releases during breathing. So when you are deeply exhaling, our diaphragm is actually pushing up, and that changes our cardiac output, changes the amount of blood going to the heart. And we know from physiology then that that triggers our vagus nerve to be stimulated and tell the heart to slow down. And that heart rate drop, again, is one of the um symptoms of a parasympathetic, an active parasympathetic system. It's just a sign that your vagus nerve has been triggered, that your parasympathetic system has been triggered. And so deep consecutive breaths can just trigger the parasympathetic system over your sympathetic system. So that system starts to quiet, your parasympathetic system starts to upregulate, and you are actively managing that by doing some deep breathing. So you very likely have heard of like box breathing or maybe four, seven, eight breathing, which is a four-second inhale, a seven-second hold, and an eight-second exhale. And I love structure, and those are important and also great tools, but the bigger picture is just a deep exhale. Generally, longer than your inhale is a good measure to know if it was deep enough. So a nice big inhale, but a longer, deeper exhale is going to activate that um parasympathetic trigger, that vagus nerve trigger from the changes in your cardiac output, which is caused by the changes in your diaphragmatic movement. So it can look like this: an inhale and a deep exhale. Notice you don't have to make noise, you don't have to like anything. Of course, you can, but sometimes when you have a student sitting right next to you or your attending's like rounding the corner, coming back behind the drape, you maybe want to regulate yourself, but you don't want everyone to know. And so you can just keep it quiet. You have a mask on, of course, which is a nice little um safety as well. So a nice big inhale. Our diaphragm pulls down, and a deep exhale. Our diaphragm pushes up, changes our cardiac output, triggers that vagus nerve, drops our heart rate, and all these little pieces I hope are falling into place about how to regulate your system or how to control your parasympathetic system, but it's absolutely just about activating your vagus nerve. Okay, so the number one way to regulate in the operating room undetected is deep breathing, a deep exhale. Number two way that I love was uh a shout out actually to Mr. Dave Zagorski, who is a CAA from Case Cleveland. I recently ran into him at the Quad A, I think it was this year, 2025, and was able to tell him that I've remembered this tip since he told me when I was in school in 2006, on through now. And I've been telling AA students about it. And it was sort of during my own journey of um understanding what I needed to like get out of the like buzzy, stressful high of fight or flight that I'd been in for decades, that I kind of came back to this technique and was like, huh, that worked. Why does that work? So, what Mr. Dave Zagorski told me years and years ago is that before starting an IV, so he was kind of helping us learn how to control nerves before an IV, you should duck behind some like private corner and make fists with your hands, bulb them up, hold them as tight as you can till it gets uncomfortable, and then let them go. And it allows your hands to not be super shaky. And it worked. And I did it all the time. And then I started teaching other AA students how to start IVs, and so I passed along this little tip. And then as I got into, again, my own journey into mindfulness and self-regulation and all of the process that I've been in, I was presented with something called paired or progressive muscle relaxation. You'll hear it termed both ways. And I remembered that Dave Zagorski told me about this years and years ago. So progressive muscle relaxation is just the progression of tightening your muscles manually and then purposefully releasing them. And you generally kind of do it over a wave of your body. So you start, you know, head or toe, either way, and you kind of do it with your feet, your legs, your abdomen, your shoulders, your jaw, your forehead. And, you know, there's a whole method, and like you can get really into the weeds. But Dave was right that just doing this is enough. And so oftentimes, for years and years, in fact, I have found a little hidey hole corner. Maybe, you know, in pre-op, if I'm about to start an A-line on an awake patient and I feel like nerves in my body. Um, I currently work PRN, and so there are times when I don't feel 100% comfortable. I've not done something like let's say a spinal for six months and I'm about to do one, and I'll find myself feeling that upregulated, that buzzy, like nervous, anxious, sympathetic system response. And I will just quick do um like a tight muscle grip on my hands. What has also developed is that I've noticed I carry a ton of tension and stress in my forehead. So if I can manage it undetected, maybe I'll turn around and like face like I'm drawing up drugs or something, facing away from people if if anyone's in there. And I will tighten my forehead, tighten my jaw, and then do a purposeful release of both my forehead, my eyebrows, and my jaw. And it just tells my body, like when you're doing this, your sympathetic system turns on and you're like, oh God, this is you can almost even feel sort of like tingly sometimes if you've ever felt that. It's like almost uncomfortable when you're like um making a muscle or like cringing your face. And then you're overriding that sensation with a purposeful release. There's that paired muscle relaxation part of it. And that tells your body, oh, and your brain, oh, we must be out of that, like need to keep our muscles on tight. We are out of that sympathetic response. And you're kind of again manually overriding into your parasympathetic response by manually releasing and relaxing and telling your brain and mind I'm safe, it's okay to relax. I can have the and both. I can be kind of having a stress response that helps me kind of keep my brain and mind sharp in order to be able to put in this IV or put in this A-line or spinal, but I also can um have the and both of being regulated while I'm doing this task. So paired muscle relaxation in the operating room can look just like this. Just your fists. I, you know, often I'm holding them up because I want you guys to see, but oftentimes, like sometimes I'll even just do this and like do my fists this way so really no one can see, or down by my sides, or I'll find a little cubby hidey hole and pre-op to do it. Um, and I hold it usually until it's uncomfortable, like kind of you get like itchy and you want to release it. I'll keep it for another one or two seconds after that, and then a big release, sometimes a shakeout. And I'll do it two, three, four times until I can really feel my body responding. Um, and if I'm doing my forehead or jaw especially feels good, and I have a mask on, I'll just tighten my jaw or like squint my eyebrows, you know, hold it for a few seconds and then release it, kind of soften my eyebrows, part my back molar, so like separate my back teeth. And then something that feels super damn good is take your tongue off the roof of your mouth. So like drop your tongue inside your mouth. I, you know, you can have your mouth open, you have your mask on, but generally I keep my mouth shut and just kind of like let my tongue fall, and you just feel this release of tension. And I'll do it again if I want to, or if it feels good. Again, this is all for me, all for you. And um, it just feels good to have something to go to when you are in those high stress moments or after those high stress moments, and you want to bring yourself back down. Okay, so deep breathing. We've heard a deep exhale, paired or progressive muscle relaxation. And the third one is something I've been teaching to CAA Matters students and to pre-AA matters students, and it's called vooing. I've just started calling it that. It was introduced to me um through actually a neuroscience-minded manifestation company called To Be Magnetic that I've been doing for years and years. Um, very much about parenting and reparenting your inner child and like um making tactical approaches to your dream life. If you at all um have heard me talk about process episodes or expanders or taking aligned action, like those are all things that they talk about in Tubo Magnetic. But, anyways, they teach this breathing that involves vocalization. So, this is very much if you've ever um, you know, like been nervous and like started humming, or if you are hurting, um, I know I did this when I was having my kids, like during childbirth, I was like, uh, or like you're sick or you don't feel good. Oftentimes you find yourself reflexively kind of um making some of these vocalizations. And it is because our bodies are trying to calm us down, are trying to regulate and soothe us. Uh news flash, your vagus nerve innervates your larynx. So surprise to know CAA or SAA who is learning this anatomy, but the vagus nerve innervates your larynx. In particular, there are two branches of your vagus nerve that go directly to your larynx, your superior laryngeal nerve and your recurrent laryngeal nerve. And those control your voice, your vocal cords. And so when you phonate, when you make noise, it's activating those nerves. Of course, they're branches of the vagus nerve. Vagus nerve controls our parasympathetic system, and lo and behold, you are regulating yourself. You are pulling down your sympathetic system, you're turning up your parasympathetic system. That's what regulation is. And so what I love to teach in CAA Matters and Pre-AA matters is a combined deep exhale with a vo. So it looks like an inhale, just like we were practicing before. Nice big inhale. And then a longer, deeper exhale where you're phonating the sound voo. So I take the voo as long as I can, as long as I can exhale, and I just can feel my body regulating, especially when I'm not doing it on camera and not doing it to like show people, but I'm truly doing it to regulate myself. I do this all the dang time. I do this walking into the operating room, walking into the hospital. I do this during ortho cases, like with all the hammering and noise. You can be vooing there behind the drape and no one knows what's going on. Um, of course, maybe I'm not choosing this as my go-to if there's a bunch of like people in the room or if it's really quiet, but you can do it kind of quietly as well. Like, I now have no shame. I know this makes me feel good. I know this helps me get out of fight or flight to regulate after some big event in the operating room, or maybe the patient's moving. Like, you know, when the surgeon leans over or is like, hey, patient's moving, and you get that like like surge of like fight or flight, sympathetic response, and you do whatever needs to get done, and then you sit back down, but you're like buzzy. I will do this deep breathing with a voo or one of the other methods to help myself regulate. Okay, I'm gonna put some links in the show notes, some graphics that will hopefully help you. Um, but yeah, three ways to regulate in the operating room totally undetected. Deep breathing with a deep exhale, paired muscle relaxation, and voo breathing. So I hope this helps, and I will see you next wellness Wednesday, everyone. Bye. Thanks for listening to Awakened Anesthetist. If this episode resonated with you, share it with a CAA friend, an AA student in your life, or a perspective, and let them know why you loved it. It's the most important thing you can do to support this podcast and its mission. You can always find more ways to connect with me and this CAA community at awakenedanesthetist.com, including an invitation to join season five Mindful Connections. These are free virtual gatherings open to anyone in our Awakened Anesthetist community. And while you're scrolling the website, check out my trusted CAA partners who make this podcast possible with a special thank you to my season five sponsor, Harmony Anesthesia Staffing. Talk soon.