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Archive January 2020 XXI, No. 1

Anesthesia Alert: Believe in the Power of Hypnosis

Sedating patients with guided imagery and local anesthetics

Elizabeth Rebello

Elizabeth Rebello, MD, FASA

BIO

NO SHORTCUTS
MD Anderson Cancer Center
SOOTHING VOICE Hypnotherapists help patients recall the details of comforting memories as they guide them through surgery.

I know what you're thinking, and no, hypnosedation doesn't involve swinging a pocket watch while telling patients you're getting sleepy very, very sleepy before surgery. Hypnosedation combines hypnosis with the incremental doses of local anesthetics to keep patients calm and comfortable during surgery without the use of inhalational gases or short-acting sedatives.

The concept is neither new (Scottish neurosurgeon James Braid coined the term "hypnosis" in the 1840s to describe the state of deep relaxation he put his patients in) nor experimental (the National Comprehensive Cancer Network lists hypnosis in its pain management guidelines). It's also not yet mainstream, however, so let's explore the anesthesia alternative that's no cheap parlor trick.

A team of collaborators from the breast surgery, integrative medicine and anesthesia departments here at MD Anderson Cancer Center implemented a hypnosedation program for patients undergoing segmental mastectomies with sentinel node biopsy and intraoperative lymph node mapping.

Candidates for hypnosedation are assessed on a case-by-case basis, but patients who respond positively to the idea and are open to trying it generally have the right temperament and attitude to be successfully hypnotized. Patients who agree to be hypnotized meet with a hypnotherapist before scheduled procedures to practice entering a hypnotic state and learn about what to expect during the process.

How does it work?

On the day of surgery, after the patient is positioned on the OR table, the surgical team works quietly and often with the lights dimmed to create a relaxed environment. The hypnotherapist sits close to the patient's ear and uses a soothing voice to lead them through guided imagery hypnosis. Patients are asked to recall places where they felt at ease (the beach or a relative's house) and to focus on specific details (the scratch of sand on their feet or the smell of grandmom's cookies baking in the oven). They breathe deeply, feeling each breath at it enters and leaves their body. It generally takes only a few minutes for the hypnotherapist to hypnotize the patient.

The feedback from patients who have been hypnotized during surgery has been overwhelmingly positive.

During surgery, the hypnotherapist maintains the patient in a conscious, but disassociated state. You likely experience this sensation during your morning commute. Thoughts enter and leave your consciousness as you drive the familiar route and when you arrive at work, you likely don't remember maneuvering the car during every second of the trip. You were conscious, but not fully aware of what was going on around you.

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