Hypnopraxia, a new hypnotic technique for hypnoanesthesia.

Various hypnotic techniques are used in anesthesia, either on their own or as adjuncts. A new hypnotic technique, hypnopraxia, was tested in 5 patients undergoing various procedures (4 colonoscopies, 1 inguinal hernia repair, and 1 transobturator tape procedure). The patients were accompanied throughout the procedure by an anesthetist trained in hypnoanesthesia and hypnopraxia. Initially developed for use in hypnotherapy, the accompaniment with hypnopraxia relied on the closeness of the link between the anesthetist and the patient. This was constantly built in the present moment, here and now, by giving back to the patient what the anesthetist observed of the manifestations of the patient's unconscious mind (the patient's speech and choice of words, facial microexpressions, involuntary bodily movements, and emotions). The anesthetist's verbal accompaniment was therefore determined by the patient. No other anesthetic technique was needed during the colonoscopies. For the 2 surgical procedures, some sufentanil was given and local anesthetic was applied by the surgeon. All 5 patients were well satisfied after the procedure. They were especially pleased at having been able to go through their procedure without needing any drug anesthesia, and at being in charge throughout. This preliminary experience with hypnopraxia would tend to show that this technique could be useful in the anesthetic setting. More experience is obviously required with hypnopraxia in anesthesia so as to improve the technique further, and to determine its implications, if any, for the patients and for the procedures. Furthermore, it will be of the greatest interest to determine, before carrying out any procedure with hypnoanesthesia, which patient will benefit most from which hypnotic technique.

Heart rate variability during total intravenous anesthesia: effects of nociception and analgesia.

BACKGROUND: Changes in heart rate variability (HRV) during anesthesia likely result from the interaction of hypnosis, surgical stimulation, analgesia and direct cardiovascular effects of drugs, but the interaction between these variables is unclear. This study was designed to characterize the impact of both surgical nociception and analgesia on HRV in propofol-anesthetized patients. METHODS: HRV was analyzed using wavelet transform in 49 patients (ASA status 1-2) before induction of anesthesia and then throughout stable anesthesia with propofol, in the absence of nociceptive stimulation, and then during surgery, in the presence of deep (adequate) or light (inadequate) analgesia provided by various opioids (sufentanil [n=19], alfentanil [n=18], or remifentanil [n=12]. RESULTS: Anesthesia reduced total power as well as high frequency (HF) and low frequency (LF) powers (all: P<0.01), with an increase (P=0.002) in the proportional part of HF power (HFnu). During nociception, HFnu decreased in a sensitive and reproducible way (P<0.01) in case of light analgesia, whereas HRV did not change when patient received adequate analgesia. CONCLUSIONS: The nociception-analgesia balance is a direct determinant of HRV during surgical anesthesia. HFnu may behave like an early indicator of inadequate analgesia. These results have potential implication for monitoring adequacy of analgesia in healthy patients undergoing intravenous anesthesia. Additional work is needed for application across patient populations.

Estudio comparativo del índice biespectral y la entropía espectral en cirugía ginecológica / Comparison of the bispectral index and spectral entropy in gynecological surgery

OBJETIVOS: La entropía espectral (EE) cuantifica los cambios de la actividad eléctrica cortical (EEG) y la electromiografía frontal (fEMG). El objetivo de este estudio fue comparar los valores del índice biespectral (BIS) con los de la EE en sus dos componentes, entropía de estado (ES) y entropía de respuesta (ER), durante la anestesia general. MATERIAL Y MÉTODOS: Se incluyeron 16 mujeres, ASA I-II, que se sometieron a intervenciones ginecológicas. Se mantuvieron valores de BIS entre 40-50. Se colocaron ambos sensores para monitorizar el BIS y la EE en cada paciente. Se registraron valores de forma simultánea en determinados momentos: entrada de quirófano, inducción, relajación, intubación, apertura vaporizador, inicio cirugía, tracción de mesos y funcionamiento del electrobisturí, cierre vaporizador, fin de cirugía, al toser, extubación y apertura de ojos. Los datos fueron analizados mediante un ANOVA y el coeficiente de correlación intraclase (CCI) para el análisis de concordancia. RESULTADOS: Se observaron diferencias entre los valores medios de BIS y ES y ER en los momentos: entrada a quirófano, intubacion e inducción. Durante el despertar de la anestesia sólo entre BIS y ER con ES. En los momentos entrada a quirófano, electrobisturí, y despertar de la anestesia no hubo concordancia (CCI<0,7). CONCLUSIÓN: BIS, ES y ER presentan buena concordancia durante los efectos de la anestesia. Las diferencias observadas en el momento basal y en el despertar podrían atribuirse a la actividad electromiográfica frontal. La separación de las señales del EEG y fEMG podría dar una información adicional en estas situaciones

OBJECTIVES: Spectral entropy quantifies variations in cortical electrical activity measured by electroencephalography and frontal activity measured by electromyography. The aim of this study, in the context of general anesthesia, was to compare bispectral index values with the two components of spectral entropy: state entropy and response entropy. MATERIAL AND METHODS: Sixteen women (ASA I-II) undergoing gynecological surgery were enrolled. The bispectral index was maintained between 40 and 50 for all patients. Both sensors, for monitoring the bispectral index and spectral entropy, were placed on each patient. Simultaneous readings were recorded at the following moments: operating room arrival, induction, relaxation, intubation, switching on the vaporizer, start of surgery, traction of the intestinal mesenteries and maneuvering of the electric scalpel, switching off the vaporizer, end of surgery, during cough, extubation, and eye opening. The data sets were subjected to analysis of variance, and the intraclass correlation coefficient (ICC) was used to analyze agreement. RESULTS: Differences between mean values of the bispectral index, state entropy and response entropy were observed at operating room arrival, intubation, and induction. Differences when the patient awakened from anesthesia were observed only between the bispectral index and response entropy, on the one hand, and state entropy on the other. There was no agreement (ICC<0.7) upon operating room arrival, maneuvering the electric scalpel, or awakening from anesthesia. CONCLUSION: The bispectral index, state entropy, and response entropy show good agreement during recordings that reflect the effects of anesthesia. The differences observed at baseline and upon awakening can be attributed to frontal electromyographic activity. Distinguishing cortical electrical activity from frontal electromyographic activity may provide additional information in these situations

Hypnosis with conscious sedation instead of general anaesthesia? Applications in cervical endocrine surgery.

Between April 1994 and June 1997, 197 thyroidectomies and 21 cervical explorations for hyperparathyroidism were performed under hypnosedation (HYP) and compared to the operative data and postoperative courses of a closely-matched population (n = 121) of patients operated on under general anaesthesia (GA). Conversion from hypnosis to GA was needed in two cases (1%). All surgeons reported better operating conditions for cervicotomy using HYP. All patients having HYP reported a very pleasant experience and had significantly less postoperative pain while analgesic use was significantly reduced in this group. Hospital stay was also significantly shorter, providing a substantial reduction of the medical care costs. The postoperative convalescence was significantly improved after HYP and full return to social or professional activity was significantly shortened. We conclude that HYP is a very efficient technique providing physiological, psychological and economic benefits to the patient.

[Thyroid and parathyroid surgery under hypnosis: from fiction to clinical application]. / Chirurgie thyroïdienne et parathyroïdienne sous hypnose: de la fiction à l'application clinique.

Since 1992, we have used hypnosis routinely in more than 1400 procedures in plastic surgery. Our clinical success and experience with this technique led us to test wether hypnosis using active patient collaboration, could be used as an effective adjunct to conscious intravenous sedation ("hypnosedation", (HS)) for endocrine surgery, as an alternative to general anaesthesia. On a total of 1905 cervical endocrine surgical procedures performed between 1995 and 1998, 296 thyroidectomies and 33 cervical explorations for hyperparathyroidism were conducted under HS. Conversion to GA was needed in three cases (0.9%). All patients having HS reported a very pleasant experience and had significantly less postoperative pain while analgesic use was significantly reduced in this group. Hospital stay was also significantly shorter, providing a substantial reduction of the costs of medical care. The postoperative convalescence was significantly improved after HS and full return to social or professional activity was significantly shortened. We conclude that HS is a very efficient technique that provide physiological, psychological and economic benefits to the patient.

Hypnosis in surgery--why and when.

Hypnosis offers an excellent alternative to conventional anesthesia in certain selected or complicated cases. Ten different patients were selected from a group of 38 and were studied thoroughly. Good surgery and a smooth recovery were possible through hypnosis, alone or with conventional anesthesia.