Hypnosis As An Alternative To Drug-Induced Sedation

Sebastian Schulz-Stubner, M.D., Ph.D., UI assistant professor of anesthesia, investigated whether clinical hypnosis could be used in place of sedating drugs to relax patients undergoing surgery with local or regional anesthesia. A local anesthetic numbs the body part undergoing surgery but, unlike a general anesthetic, the patient remains conscious.

"One of the problems with local anesthesia is that the patient may be anxious or may not want to be aware of the procedure as it is happening. They often don't want to see or hear anything," Schulz-Stubner explained. "Rather than giving these patients sedating drugs to calm them or make them more relaxed, we used clinical hypnosis."

In Schulz-Stubner's study, 48 patients undergoing surgery that required local anesthesia received clinical hypnosis in place of sedating drugs. The study was performed in Aachen University in Germany, where Schulz-Stubner was a physician prior to his move to the UI.

The technique proved to be very successful under certain circumstances. In particular, all the patients undergoing elective surgery were successfully hypnotized and did not require sedating drugs. Prior to the surgery, these patients met with the anesthesiologist who explained the technique and familiarized the patient with the procedure.

In contrast to these well-prepared and receptive patients, only two of 12 emergency cases who also were part of the study were successfully hypnotized. The instances where hypnotism was successful in emergency cases involved patients who were already familiar with similar relaxation methods such as yoga or auto-suggestive training.

"If you carefully select patients who are suitable and you have some time to inform them about the method and maybe even perform a test hypnosis, it works with a high success rate," Schulz-Stubner said. "On the other hand, if someone is completely unfamiliar with the concept and is also under stress as in an emergency case, the hypnosis does not work."

In addition to the importance of the patient being comfortable with and prepared for the hypnosis, a second important study finding was that a hypnosis-induced trance was only reliably sustained for about one hour. After that time the trance was easily disrupted.

The induction technique used by Schulz-Stubner involves the patient first focusing on an object such as a pen or a finger. The patient is then told to concentrate on their own body sensations of warmth and heaviness of their limbs. As the patient relaxes, the physician uses suggestion to create a scenario that is appealing for the patient.

"During the preparation session we ask the patient what they like and don't like to find out what kind of image would be suitable for them," Schulz-Stubner said. "You don't want to ask someone with hay-fever to imagine lying in a meadow."

The physician continues to create and build on the scenario until the patient's reactions, such as breathing rate, indicate that an adequate state of hypnosis has been achieved. These same reactions allow the physician to monitor the hypnosis state and if there are changes, the physician can use more suggestion to reinforce the scenario and deepen the relaxation.

"The term hypnosis often has negative associations," Schulz-Stubner said. "Many people associate hypnosis with being controlled by someone else and that is not what it is. In fact, the patient is actually doing the work; the anesthetist is just providing the suggestions on how to do it."

One limitation of the technique is that the scenario has to be somewhat consistent with the physical realities of the operating room (OR). Too many noises or disturbances from activity in the OR will distract the patient.

"It means that the OR team needs to be somewhat familiar with the technique and be willing and able to accommodate it," Schulz-Stubner said.

Hypnosis itself is very safe and none of the patients who were hypnotized in the study experienced any side effects. However, hypnosis can trigger adverse effects in patients with certain psychoses, schizophrenia, and some substance abuse. People with these conditions were excluded from the study.

Most patients who were hypnotized (80 percent) remembered nothing about the procedure. Ten percent remembered sensations of warmth or heaviness, the remaining 10 percent remembered images.

In a large hospital like the UI Hospitals and Clinics, patients who might be good candidates to receive clinical hypnosis instead of sedating drugs during short elective surgeries fall somewhere in between the two patient groups in Schulz-Stubner's study. They would not be emergency cases, but because of the nature of outpatient practices, they would have to learn about and prepare for clinical hypnosis on the day of surgery.

"There are some limitations here," Schulz-Stubner said. "In Germany, where the study was done, patients often stay in the hospital the evening before the procedure so they could be seen by the anesthesiologist at that time. It would be interesting to find out how the outpatient population that is more typical here would do with this technique with only a short interval to introduce them to the method prior to the surgery."

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