Hypnosis: a new anesthetic technique!

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, and for 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 preoperative anxiety 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: Dr Marie-Madeleine Lucas-Polomeni, Service d’Anesthésie-Réanimation Chirurgicale 2, Hôpital Pontchaillou, 35033-Rennes cedex 9, France (email: marie-madeleine.lucas@ chu-rennes.fr). Pediatric Anesthesia 2004 14: 975–976