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Hypnosis: a new anesthetic technique!
M.M. LUCAS-POLOMENI MD
Service d’Anesthe´sie-Re´animation Chirurgicale 2, Hoˆpital Pontchaillou, Universite´ Rennes 1, Rennes, France
In parallel with its rapid development in psychotherapy, hypnosis also finds applications in anesthesia and surgery. The founding father of modern
hypnosis is Milton Erickson, who was born in 1901 and founded the American Society for Clinical Hypnosis. He defined hypnosis as a natural phenomenon
that anyone of us can reach. It is an altered state of consciousness based on the principle of dissociation, with a concentrated but focused attention
which is different from the state of sleep (1). In fact, hypnosis corresponds to a state of inner absorption and such a focused attention that the
individual becomes unconcerned about any other consideration (2). The analgesic effect of hypnosis in pain management has been extensively studied (3).
It is used both for acute and chronic pain management in adults (4–6). Indeed at Liege University, in Belgium, Faymonville’s team has been using hypnosedation
that is, use of hypnosis as an adjunct to conscious sedation for surgery performed under local anesthesia since 1992 (7). Hypnosis and hypnosedation
techniques can easily be adapted to children who have a natural power of playing, andfor whom an imaginary world is close and accessible. Anesthetists can have no problem inducing a
formal trance in children. Recall of pleasant life experiences has served as the hypnotic substratum. Preoperative anxiety most often reveals a fear of
separation from the parents and familiar environment, the loss of control and also the confrontation with an unknown place and people; this anxiety has
significant consequences, especially as it may contribute to the occurrence of postoperative behavioral disorders (8). The most common technique to reduce
preoperative anxiety is sedative premedication with midazolam (9). In our department, hypnosis is used as premedication instead of rectally administered
midazolam. This practice has reduced preoperativeanxiety and also the incidence of postoperative behavioral disorders (personal data).
We have also used hypnosedation with success (hypnosis in combination with conscious intravenous sedation mainly using low dose remifentanil)
and local anesthesia, for example ilio-inguinal/iliohypogastric block for hernia repair. This has proved to be a valuable alternative to traditional anesthesia
techniques with halogenated agents, as previously reported in adults (10). The child is asked to choose a pleasant life experience to think about during surgery;
the initiation of the relaxation technique itself is simple and usually provides the child with a sense of control. The technique primarily uses indirect
suggestions for developing and deepening a hypnotic state; the exact content of the specific suggestions used during the course of induction depends
on the patient’s behavior and on our judgment of what would most readily elicit a response from the patient. When the child is thought to be at an
adequate trance level, i.e. occurrence of muscle relaxation, decrease in heart rate and respiratory rate, local anesthesia is performed. Sometimes small
amounts of remifentanil are given throughout the surgical procedure to facilitate conduct of surgery. At the end of the procedure, the anesthetist can
wake up the child from the trance by changing the behavior and quality of the tone of voice. Our hypnotic technique uses indirect suggestion
and distraction to reduce the sensory and affective dimension of the pain experience (11). Suggestion of pleasant experiences seems more effective in producing
pain relief than suggestion of declining pain (12). The resulting hypnotic trance almost always involves essential dissociation. This unconscious
dissociative mechanism results in decreased pain. Correspondence to: d’Anesthe´sie-Re´animation Chirurgicale 2, Hoˆ pital Pontchaillou,
35033-Rennes cedex 9, France (email: marie-madeleine.lucas@ chu-rennes.fr). Dr Marie-Madeleine Lucas-Polomeni, Service
Pediatric Anesthesia 2004 14: 975–976
Indeed, providing well-being and a relaxed state, enables the children to actively participate in the anesthesia and is likely to leave them with a pleasant
memory. This anesthetic technique is based on close collaboration between the patient, the anesthetist
and the surgeon. Normal working conditions change dramatically: the operation theatre is calm, the child is conscious but distracted during surgery, although
surgical manipulation must be gentle and precise. The anesthetist closely follows the operation to anticipate the patient needs.
There is no question that the phenomenon of hypnotic analgesia is real. In order to better understand what happens during the hypnotic state
during surgery, the brain mechanisms underlying the hypnotic state have been studied in healthy volunteers by determining the distribution of regional
cerebral blood flow, taken as an index of local neuronal activity. Hypnosis is related to the activation of a widespread, mainly left-sided, set of cortical
areas involving occipital, parietal, precentral, premotor and ventrolateral prefrontal cortices and a few right sided regions (occipital and anterior cingulated
cortices). The pattern of activation during the hypnotic state differs from that induced in normal subjects by simple evocation of autobiographical
memories. These results suggest that, hypnosis is a particular cerebral waking state where the subject, although seemingly somnolent, experiences vivid
multimodal, coherent, memory-based mental imagery that invades and fills the consciousness (13,14). Practicing hypnosis does require some contribution
especially in terms of training and competence. It especially calls for information because hypnosis is first and foremost a state of mind; the will to
communicate differently and depends on the quality of the relationship between the child and the person performing the hypnosis. There are few contraindications,
the main restrictions being deafness and states of mental retardation. Nonetheless, hypnosis is a very effective technique for providing relief of
anxiety and pain in surgery under local anesthesia.
2004 Blackwell Publishing Ltd 975
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976 M.M. LUCAS-POLOMENI
2004 Blackwell Publishing Ltd, Pediatric Anesthesia, 14, 975–976
Disclaimer: The services we render are held out to the public as non-therapeutic hypnotism, defined as the use of hypnosis to inculcate positive thinking and the capacity for self-hypnosis. Results may vary from person to person. We do not represent our services as any form of medical, behavioral, or mental health care, and despite research to the contrary, by law we make no health claim to our services.