1.

Review Article Hypnosis in the Perioperative Management of Breast Cancer Surgery:

Clinical Benefits and Potential Implications Arnaud Potié, Fabienne Roelants, Audrey
Pospiech, Mona Momeni, and Christine Watremez Cliniques Universitaires Saint-Luc,
Universite Catholique de Louvain, Service d’Anesth ´ esiologie, ´ 10 Avenue Hippocrate, 1200
Brussels, Belgium Correspondence should be addressed to Arnaud Potie;
arnaudpotie@hotmail.com ´ Received 5 April 2016; Revised 27 July 2016; Accepted 28 July
2016 Academic Editor: Michael Fras

However, the definition proposed by Montgomery characterizes hypnosis as “an agreement

between a person designated as the hypnotist (e.g., healthcare professional) and a person
designated as the client or the patient to participate in a psychotherapeutic technique based on
the hypnotist providing suggestions for changes in sensation, perception, cognition, affect,
mood, or behavior” [23]. This definition places emphasis on the relationship between hypnotist
and patient, a necessary condition for anyone practicing hypnosis. More recently, the American
Psychological Association (Division 30) proposed a definition of hypnosis as “a state of
consciousness involving focused attention and reduced peripheral awareness characterized by
an enhanced capacity for response to suggestion” [24].
From a clinical point of view, there are three basic phases during a hypnosis session, starting
with induction, followed by therapeutic suggestions and concluded by emergence from the
hypnotic state.

The main and crucial element that distinguishes hypnosis from meditation or a relaxation
session is use of suggestion [25]. When asked about their experience, patients describe
alterations in body image, time distortion, dissociation, feelings of relaxation and peace,
attentional focus, and increased positive affectivity, but diminished self-awareness and memory
[26]. From a neurocognitive and neuroscientific perspective, hypnosis was thought to be
mediated by the right cerebral hemisphere. This theory was supported by the discovery of
hemispheric specialization in the 1970s, and the brain was artificially divided into the creative
right and analytic left [27].

From a neuroanatomical point of view, studies using voxel-based morphometry are able to
assess hypnotic suggestibility-linked and hypnosis depth-related differences in local gray matter
volume, especially in parts of the frontal, temporal, and occipital cortex [30]. During hypnosis,
activation of regional cerebral blood flow distribution is different from activation triggered by
evoking episodic memory [31] and by the resting state [32]. Different parts of the brain are
involved, including occipital, parietal, precentral, premotor, and ventrolateral prefrontal areas,
the anterior cingulate cortex, the thalamus, and the pontomesencephalic brainstem. Compared to
“normal alertness” with mental imagery, a hypnotic state shows prominently decreased activity
in the medial parietal cortex, particularly in the precuneus [31–33].

Since 1992, hypnosis has been seen in operating rooms for procedures such as thyroidectomy,
parathyroidectomy, and plastic surgery [20]. It can currently be used instead of general
anesthesia for tumorectomies, quadrantectomies, and even mastectomies, in association with
local or regional anesthesia [21, 22].
Studies conducted by Faymonville et al. showed a significant reduction in pain scores, analgesic
consumption, and postoperative nausea when patients underwent surgery with local anesthesia
and hypnosis (hypnosedation) compared to general anesthesia [20, 40]. Similarly, in a
prospective randomized study, Defechereux et al. found lower pain levels, less fatigue,
improved recovery rates, and a decreased inflammatory response (IL-6) one day after surgery
with use of hypnoanalgesia compared to general anesthesia [41]. Hypnosis techniques enhance
intraoperative comfort and reduce anxiety, pain, and intraoperative requirements for anxiolytic
and analgesic drugs, while ensuring optimal surgical conditions and faster recovery rates [22,
42]. In a prospective randomized trial, Lang et al. showed hypnosis to be beneficial during
invasive medical procedures by decreasing pain and anxiety symptoms, improving
hemodynamic stability, and shortening operating times [43].

2. Clinical hypnosis enables oral surgery in a young brain tumour patient with high dental
anxiety Dirk Hermes, MD, DMD, PhD *; Jutta Stec, MD, DMD *; Ludger Bahlmann, MD,
PhD **; Stephan Klaus, MD, PhD *** *Oral and Maxillofacial Surgeon, University Hospital
Schleswig-Holstein / Campus Luebeck, Luebeck, Germany ** Anaesthetist, Head of
Department, Katholic Hospital Union, Hoexter, Germany *** Anaesthetist, Head of
Department, Herz-Jesu Hospital, Muenster, Germany

Our case report describes surgical treatment of a young female patient suffering from a pilocytic
astrocytoma. The patient herself refused to have dental treatment under general anaesthesia and
asked for hypnosis. As a result of high acceptance of hypnosis by our oral and maxillofacial
surgery patients Hermes et al (2002) established a hypnosis procedure that was incorporated in
the work of the department (Hermes et al 2004, Hermes et al 2005). So far 400 oral surgical,
traumatological, oncological and reconstructive procedures have been performed under
combined local anaesthesia and hypnosis.

3. Hypnosis for cataract surgery in an American Society of Anesthesiologists physical status IV

patient G. KISS*, J. BUTLER† Department of Anaesthesia and Surgical Intensive Care,
University Hospital of Brest, Brest, France

SUMMARY ​A 73-year-old morbidly obese female patient (weight 125 kg, height 156 cm) was
scheduled for cataract surgery of her right eye. Due to a number of severe co-morbidities
general anaesthesia was contraindicated​. However, the patient was very anxious and requested
sedation if the procedure was to be undertaken under local anaesthesia. H​ypnotic induction was
achieved with the heavy eyelid technique as described by the modified Elman technique14-16,
putting the patient into trance within 30 seconds. She later reported that she was not aware of
being in the operating room, but experienced profound relaxation during the procedure.
Perioperative hypnosis proved to be a satisfactory option for sedation in this high-risk patient
and should be actively considered for similar, easily suggestible patients who are undergoing
minor surgery.

4. Din carte

Hipnoza ca principal anestezic a fost folosita in urmatoarele proceduri medicale:

mentinerea unei grefe la picior cand era important ca pacientul sa fie”blocat” intr-o pozitie fixa
pentru o lunga perioada de timp (Kelsey si Borrow-1958);
cazuri specifice implicand laminectomia, tiroidectomia, legaturarea venelor, operarea fistulei
recto-vaginale, hemoroidectomia, histerectomia, pneumonectomia, comisurotomia mitrala si
pudrajul cardiac;
Unitatea Elvirei Lang (Lang, Joyce, Spiegel, Hamilton si Lee, 1996) de la Beth Israel
Deaconess Medical Center (Harvard) foloseste hipnoza ca anestezic standard pentru o serie
intreaga de proceduri complet invazive.

In tratarea pacientilor cu arsuri (Ewin, 1986 a, 1986 b) deseori apar doua probleme pentru care
hipnoza poate oferi o solutie: debridarea tesuturilor moarte si schimbarea pansamentelor.
Pacientii sunt invatati sa dezvolte o anestezie “in manusa” la nivelul unei maini si apoi sunt
instuiti sa o transfere in zona afectata apasand usor cu mana anesteziata partea acoperita de
tratament. Anestezia este transferata, iar pansamentul poate fi indepartat fara disconfort sau cu
unul minim (Gilboa, Borenstein, Seidman si Tsur, 1990; Patterson, Questad si Boltwood, 1987).

Procedura hipnotica este menita sa minimalizeze sangerarea stimuland atitudinile constructive,

speranta si vointa de a se recupera.

In randul celor mai utile sugestii care pot fi date pentru a imbunatati desfasurarea recuperarii
postoperatorii a unui pacient sunt: a) lipsa greturilor, b) capacitatea de a tusi fara durere,
c)aportul crescut de lichide si apetitul pentru mancare, d) nevoia unei cantitati mai mici de
narcotice si sedative, e) controlul reflexului de voma si sughitul. Ideal ar fi ca acestea sa fie date
inaintea interventiei cu ajutorul hipnozei, dar ele pot fi administrate sau intarite si in timp ce
pacientul se afla inca pe masa de operatie.

Marmer (1959) noteaza indicatiile clasice ale hipnozei in anesteziologie si sustine ca sunt utile
in: a) abilitatea de a depasi anxietatea si frica, b)asigurarea unei reactii mai confortabile in
timpul anesteziei si a recuperarii postoperatorii, c) cresterea rezitentei la durere si d) abilitatea
de a induce anestezia si analgezia.
Henry Bennett (1993) a realizat si a testat noi tehnici ale hipnozei in chirurgie, cum ar fi : a)
reducerea cantitatii de agenti chimici necesari pentru anestezie sau inlocuirea lor completa, b)
reducerea cantitatii de sange pierdut in timpul operatiei, c) repornirea circulatiei sangvine in
zona afectata de operatie pe durata procesului de vindecare, d) cresterea vitezei de vindecare si
recuperarea dupa operatie. Bennett considera ca hipnoza poate fi administrata si pacientilor cu
un nivel mediu de hipnotizabilitate. Cei de la Univerity of California (Davis) Medical Center au
avut 100 de pacienti care au suferit operatii la coloana si au fost supusi la procedura de hipnoza.
Conform rezultatelor cei care au folosit hipnoza au pierdut cu 400 ​cm cub ​mai putin, fata de cei
din grupul de control supusi doar procedurii medicale standard si grupul care a invatat tehnici
de relaxare profunda. Au aparut doua mari avantaje: pacientii au fost mai fericiti si furnizorii au
investit mai putin.

Gasim in literatura stiintifica o serie de efecte pozitive ale hinozei: un numar mai mic de
medicamente inaintea operatiei cresc porobabilitatea ca pacientul sa se recupereze mai repede
dupa operatie, eliminarea fricii initiale, a prostraumatizarii si scad sansele ca pacientul sa
dezvolte anxietate de lunga durata, nevroza sau fobie.

Hipnoza este tratamentul preferat cand pacientul are o fobie legata de anestezie, alergie la
sedative, exista riscuri chirurgicale datorate anesteziei prin agenti chimici, in cazul anesteziei
spinale sau epidurale inadecvate sau zona in care urmeaza sa fie efectuata operatia este prea
existinsa.

Schultz-Stubner (1996) au folosit in mod obisnuit hipnoza in locul sedativelor cerebrale, in

special in cazurile cu un grad de risc crescut , datorata sigurantei hipnozei.

5. Din carte

A meta-analysis of controlled trials of hypnotic analgesia indicates that hypnosis can provide
substantial relief for 75% of the population (Montgomery, Du Hamel and Redd, 2000) in a
comprehensive review of the clinical trial literature indicates that it is effective in the treatment
of both chronic and acute pain (Patterson and Jensen, 2003). Hypnotic suggestion has been
found to reduce acute pain associated with labor during childbirth (Harmon, Hynau and Tyre,
1990), burus (Patterson, Everett, Burus and Marvin, 1992, Patterson, Questad and DeLateur,
1989, Wakeman and Kaplan, 1978, Wright and Drummond, 2000) and various surgical and
radiological procedures (Faymonwille et. al, 1997, Kuttner, 1988...pg 176) in both medical and
dental settings (see Pinnele and Covino, 2000).
Among the chronic pain conditions that have been found amenable to hypnotic treatment are
cancer (D. Spiegel and Bloon, 1983), fibromyalgia (Haamen et. al, 1991) and headache
(Anderson, Basker and Dalton, 1975, Andreychuck and Skriver,....pg 176).

The recognition of the role of hypnosis in pain management by the National Institutes of Health
Consensus Tasck Force (Anonymous, 1996) accord with Montgomery et. al’s (2000)
observation that hypnotic pain reduction should now be regarded as a well-established,
empirically validated treatment.

The two sets of suggestions described a member of identificable components that are frequently
used in hypnotic pain management. That include dissociation (the sense that the mind has
become separated from the body), numbness, transformation, the specific qualities of the pain
sensation, relaxation, thermal imagery and distraction (by focusing on breathing or an specific
images and by allowing one’s mind to float to any topic or image it wishes).