Hypnosis: why doctors recommend using it to reduce the use of intraoperative anesthesia | Health | magazine

“Find a nice, quiet, safe place, and make yourself comfortable,” says a soft female voice with a calming tone.

“Now, breathe in very slowly and let it out very slowly, gently,” he continues, giving instructions with the same serenity as in the beginning.

The audio is part of a series of audio recordings posted on the website of the UK’s Royal College of Anaesthesiologists (RCoA), which recently called for more use of these recordings on the eve of surgery.

The idea is to take the patient, through Self-hypnosis. To a state of relaxation for Reduce your anxiety level before entering the operating room.

The aim of making these recordings is also to have “a resource for patients to offer (developed, tested and modified with their returns in mind), rather than recommending that they look for this information on the Internet”, as Dr Samantha Black, a pediatrician and anesthesiologist who contributed to the BBC World Service, told BBC News. Developed by RCoA Audio.

According to the evidence, Black adds, this psychological advance (plus eating nutritious foods and physical exercise) improves surgery outcomes.

Other European countries, as well as the United States, have made a step forward: in some hospitals, this technology is used not only by, but also by during the operation.

Numerous studies and randomized clinical trials – some conducted in the United States, Belgium and France – show that the use of hypnosis (also known as hypnosis or hypnotherapy) helps reduce the dose of anesthesia during surgery, as well as reduce the time and need for painkillers in the recovery period.

Like immersing yourself in a movie

Hypnosis is the state in which it is Attention is highly focused, with limited awareness of what is happening in the periphery.

This is generally achieved with the help of another person guiding us with their words until they cause a trance, although it is also possible to practice self-hypnosis. In this state, the person is neither asleep nor unconscious, but relaxed.

“You detach, separate what is happening on the periphery of your consciousness and enter a state Cognitive flexibilityYou are more open to trying new ideas and experiences, ignoring your usual way of doing things,” David Spiegel, professor in the Department of Psychiatry and Behavioral Sciences at Stanford University, USA, explains to BBC Mundo. USA

In the context of surgery, where the patient is directed to a place other than his own body, this technique is used “for Restructuring the surgical experience“, Add.

Simply put, you are instructing your mind to “filter out the pain, literally ignore the sensation and focus on being somewhere else.”

A pioneer in hypnosis research compares this condition to Watch a movie that completely fascinates and absorbs usso much so that we sometimes forget that we are part of the audience because of how involved we are in the drama unfolding on screen.

Or like when you get in the car and drive somewhere, Elizabeth Rebelo, professor in the department of anesthesiology and surgical medicine at MD Anderson Cancer Center in Texas, USA, tells BBC Mundo.

“While driving, you think about what you have to do during the day, or about something related to your family and oh! Suddenly you realize that you have already arrived. This is what hypnosis does, ”reflects the expert.

The effect on the brain

Technically, hypnosis is born Three effects on the brainSpiegel, who has observed these changes in functional magnetic resonance imaging (fMRI) studies, explains as part of his research:

• 1 There is decreased activity in the dorsal region of the anterior cingulate cortex, an area of ​​the brain that helps you become aware of your surroundings.
• 2 increases connectivity between two regions of the brain (dorsolateral prefrontal cortex and insula). This “brain-body” connection helps the brain process and control what is happening in the body.
• 3 Communications between the dorsolateral prefrontal cortex and the default neural network are reduced, possibly representing a disconnect between a person’s actions and awareness of their actions (such as when we do something without really thinking about what we are doing). This dissociation allows the person to respond to instructions during hypnotherapy without devoting mental resources to being aware of it.

compliment

The goal of those who advocate the use of hypnosis in the operating room is not to replace general anesthesia with hypnosis in very complex surgeries, but to use it as a method Complement in simpler interventions And a shorter duration in addition to local anesthesia.

That’s exactly what a team of doctors and researchers has been doing for several years at the University of Texas MD Anderson Cancer Center.

Rebelo and his team use hypnosis on some patients who are undergoing a lumpectomy (surgery to remove a cancerous or abnormal lump from the breast), a procedure that It is usually performed under general anesthesia.

Patients are open to the idea and, in addition to receiving intraoperative hypnosis, have prior sessions with the same professional.

Once in the operating room, a multidisciplinary team in constant contact monitors the patient’s comfort levels and increases medication or local anesthesia based on their needs.

“It’s a very safe environment, because we’re in an operating room. And if you need general anesthesia, you have everything to do,” explains Rebelo, who maintains that it’s only a viable option. in certain procedures and in a particular group of patients.

benefits

The benefits are multiple, highlighting the doctors consulted by BBC Mundo.

In addition to reducing anxiety before and during the procedure, it allows Reduce the dose of anesthetics and sedatives, and thus nausea, vomiting and other discomfort that many patients suffer later as a result.

Patients also don’t feel groggy or groggy, as they do after general anesthesia, and are almost ready to go home when the procedure is complete.

Rebello also points out that its use has the potential to reduce opioid consumption, as they are needed in lower doses during and after surgery.

Another benefit of avoiding general anesthesia when possible is that “it can cause both short-term and long-term cognitive deficits,” says Lorenzo Cohen, MD, director of the Integrative Medicine Program at the University of Texas MD Anderson Cancer Center.

“Moreover, there is evidence that it causes immunosuppression, which is something we don’t want to happen when we’re trying to control cancer growth,” the doctor explains regarding a lumpectomy performed at his institution.

cons

Given the benefits of hypnosis, it is interesting to ask why this continues to be a secondary clinical practice, even though it has gained ground in recent years.

One of the obstacles is that Not everyone can be hypnotized.

“It’s a stable trait, like IQ. And to some extent most are prone to hypnosis. But there are 25 percent of adults who aren’t,” says Spiegel, who estimates that this variability probably responds to genetic causes.

On the other hand, it requires spending more time training the patient to prepare for surgery, as well as more careful monitoring during surgery.

Other critical voices point to this It is not used in major surgerieswhich involve internal organs, and are long-lasting, because in those cases the pain is intolerable.

And we should not forget that although there are many studies published in the most prestigious scientific media that support its effectiveness in certain contexts, hypnosis still has a long way to go. A halo of pseudoscience More akin to the world of Victorian entertainment than to medicine.

“That stigma attaching hypnosis to television shows is still in the past rather than in the medical world,” says Black, though he believes that view is slowly changing with the increase in access and hypnosis training courses for people, doctors and anesthesiologists.

However, Spiegel believes that hypnosis is not widely used in the medical setting because that is behind this methodology There are no big pharmaceutical companies Earn money with it.

“Part of the problem is that we don’t have a good economic model for spreading the practice,” the expert concludes.