Hypnosis-Assisted Awake Craniotomy for Eloquent Brain Tumors: Advantages and Pitfalls.

BACKGROUND: Awake craniotomy (AC) is recommended for the resection of tumors in eloquent areas. It is traditionally performed under monitored anesthesia care (MAC), which relies on hypnotics and opioids. Hypnosis-assisted AC (HAAC) is an emerging technique that aims to provide psychological support while reducing the need for pharmacological sedation and analgesia. We aimed to compare the characteristics and outcomes of patients who underwent AC under HAAC or MAC. METHODS: We retrospectively analyzed the clinical, anesthetic, surgical, and neuropsychological data of patients who underwent awake surgical resection of eloquent brain tumors under HAAC or MAC. We used Mann-Whitney U tests, Wilcoxon signed-rank tests, and repeated-measures analyses of variance to identify statistically significant differences at the 0.05 level. RESULTS: A total of 22 patients were analyzed, 14 in the HAAC group and 8 in the MAC group. Demographic, radiological, and surgical characteristics as well as postoperative outcomes were similar. Patients in the HAAC group received less remifentanil (p = 0.047) and propofol (p = 0.002), but more dexmedetomidine (p = 0.025). None of them received ketamine as a rescue analgesic. Although patients in the HAAC group experienced higher levels of perioperative pain (p < 0.05), they reported decreasing stress levels (p = 0.04) and greater levels of satisfaction (p = 0.02). CONCLUSION: HAAC is a safe alternative to MAC as it reduces perioperative stress and increases overall satisfaction. Further research is necessary to assess whether hypnosis is clinically beneficial.

Hypnosis in the operating room: are anesthesiology teams interested and well-informed?

BACKGROUND: Hypnosis can be a beneficial complementary anesthesia technique for a variety of surgical procedures. Despite favorable scientific evidence, hypnosis is still rarely used in the operating room. Obstacles to implementation could be a lack of interest or training, misconceptions, as well as limited knowledge amongst anesthesiology teams. Hence, this study aimed to assess the interest, training, beliefs, and knowledge about hypnosis in the operating room staff. DESIGN: A questionnaire with 21-items, based on a prior survey, was set up on an online platform. The medical and nursing anesthesiology staff of four Swiss academic and large regional hospitals (N = 754) were invited to participate anonymously through e-mails sent by their hierarchy. Results were analyzed quantitatively. RESULTS: Between June, 2020 and August, 2021 353 answers were collected (47% response rate). Most (92%) were aware that hypnosis needs specific training, with 14% trained. A large majority of the untrained staff wished to enroll for conversational hypnosis training. There was a strong agreement for hypnosis playing a role in anesthesia. Nevertheless, many of these professionals believed that hypnosis has a limited field of action (53%) or that it would be too time consuming (33%). The reduction of misconceptions was based more on exposure to hypnosis than on training. CONCLUSION: Overall, anesthesia providers' attitude was in favor of using hypnosis in the operating room. Misconceptions such as a prolongation of the procedure, alteration of consent, lack of acceptability for patients, and limited indications were identified as potential barriers. These deserve to be challenged through proper dissemination of the recent scientific literature and exposure to practice.

[Perioperative hypnosis: What analgesic impact†?] / Hypnose périopératoire†: quel impact antalgique†?

Perioperative pain is a burden that often is insufficiently addressed. Considering the limitations of pharmacological approaches in this context, hypnosis is a promising technique as part of a multimodal management plan for acute surgical pain. There is a growing interest for hypnosis from patients and the medical community. It can be practiced in the pre- or post-operative setting for acute symptom management (pain and anxiety), as well as per-operatively as a substitute to anesthetic care, or as a complement (hypnosedation). This article aims to clarify these different uses of hypnosis for perioperative analgesia, as well as the benefits that can be expected.

Les douleurs périopératoires restent problématiques et souvent insuffisamment traitées. Au vu des limitations des approches médicamenteuses, l'hypnose est prometteuse comme adjonction à une prise en charge multimodale de la douleur aiguë chirurgicale. En effet, l'hypnose bénéficie d'un intérêt croissant tant des patients que de la communauté médicale. Elle peut se pratiquer en phase pré- ou postopératoire, pour aider à la gestion de symptômes momentanés (douleur et anxiété), mais aussi en peropératoire, soit en remplacement d'une technique anesthésique ou en complément de celle-ci (hypnosédation). Cet article vise à clarifier les différentes utilisations possibles de l'hypnose antalgique en périopératoire, ainsi que les bénéfices qui peuv ent en être attendus.