Pre-surgical hypnosis and suggestions in anesthesia

Abstract: Enqvist B (1996). Pre-surgical hypnosis and suggestions in anesthesia. Thesis, Karolinska Institutet. In a medical setting patients are often dependent, vulnerable and easily influenced by information, which may be interpreted in a way that creates anxiety and expectations of pain and complications. Information is often forgotten. Time can be experienced as very short or long, and there may be a feeling of unreality. Regression, time distortion, dissociation, suggestibility and amnesia are other expressions for these pheno- mena which can also be recognized as characteristics of hypnosis. Thus hypnosis and altered states of consciousness may be part of the daily clinical routines. This increased suggestibility is seldom systematically utilized for a beneficial influence. In the present thesis presurgical hypnosis and suggestions in anesthesia by means of audio tape were used with the following aims: - To give the patients better control of anxiety, pain and rehabilitation. - To influence the patients in a beneficial way regarding bleeding, oedema and rehabilitation. - To use therapeutic suggestions during anesthesia alone or in combination with preoperative hypnosis to improve peri- and post-operative behavior. The audio tapes started with a hypnotic induction-relaxation. The suggestions given were adapted to resolve problems associated with the various surgical procedures. The audio tapes lasted for 20 minutes and daily listening was recommended during the week before surgery. Therapeutic suggestions during anesthesia by means of audio tape were also used to improve peri- and postoperative behavior. Hypnosis by means of listening to a "hypnosis tape" preoperatively alone or in combination with suggestions during anesthesia produced the following (significant) results compared to the control groups. Studyl/ Hypnosis before maxillo-facial surgery performed in general anesthesia reduced peri-operative blood loss. The addition of suggestions during anesthesia did not increase the effects. Suggestions during anesthesia only lowered blood pressure and reduced the duration of hospital stay. Study 2/ The combination of preoperative hypnosis and suggestions during anesthesia reduced postsurgical oedema and fever. Less anxiolytic medication was needed. Study 3/ Hypnosis before surgical removal of wisdom teeth produced more calmness in the hypnosis group and reduced the postoperative analgesic requirements. Study 4/ Hypnosis before breast reduction surgery reduced postoperative nausea, vomiting and consumption of analgesics. Study 5/ The same suggestions as in the previous study given during anesthesia only, did not influence postoperative nausea and vomiting in breast surgery. Relaxation-hypnosis and instructions in stress reduction can influence factors like perioperative bleeding and postoperative swelling, nausea and vomiting. Pain medication can be reduced. The effects of suggestions given during anesthesia seem to be marginal. If the effects are due to increased calmness, improved expectations, posthypnotic suggestions, increased levels of plasma cortisol, or a combination of the above mentioned factors is not known. Several of the effects shown in study 1-4 have been possible to achieve with eg procedural information, increased care, behavior modification and/or cognitive therapy. Hypnotherapy has much in common with other sorts of therapy, and indications for the different preparatory methods are desirable, as well as a simple diagnostic tool to select the right patient to the right method. Key-words: Hypnosis; anesthesia; preoperative; relaxation; stress reduction; maxillofacial surgery; breast surgery; wisdom teeth; blood loss; nausea; vomiting; pain; analgesics. ISBN 91-628-2199-7

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