Hypnosis and anesthesia: back to the future.

Hypnosis is a physiological mind activity characterized by focused attention, absorption, dissociation and plastic imagination. In the early 19th century, several hundred surgical interventions were described with hypnosis as the sole anesthetic, in an epoch when no anesthetic drugs were available; then hypnosis was prejudicially abandoned and forgotten after its introduction. In the past two decades, an increasing number of studies on hypnosis has shown its capacity to modify the activity of the prefrontal cortex, default mode network and pain neuromatrix (including the anterior cingulate cortex, amygdala, thalamus, insula and somatosensory cortex) and increase pain threshold up to the level of surgical anesthesia. Hypnotic analgesia also prevents pain-related cardiovascular response: therefore, it may stand comparison with pharmacological anesthesia, yielding true protection from stress for the patient. The wealth of data available in the literature provides clear evidence of its meaningful effects on perioperative emotional distress, pain, medication consumption, physiological parameters, duration of surgery and outcome. Hypnosis may be used as follows: 1) as sole anesthetic, in minor surgery and invasive maneuvers and/or selected patients; 2) as adjuvant of pharmacological anesthesia (local anesthesia and/or sedation); 3) as an adjuvant technique in both pre- and postoperative phases in patients submitted to general anesthesia. Hypnosis, unlike any other therapeutic tools, does not call for drugs or equipment and is an attractive technique: it is free of charge, not burdened with proved adverse events and promises to help improving cost/benefits ratio.

Manejo hemodinámico intraoperatorio con esmolol durante la extirpación de un feocromocitoma bilateral en una paciente de 10 años / Esmolol to control hemodynamic response during removal of a bilateral pheochromocytoma from a 10-year-old girl

Los feocromocitomas son tumores derivados de lascélulas cromafines, que pueden secretar grandes cantidadesde catecolaminas. Su incidencia es baja, 2-8 casospor millón de habitantes, solamente un 10% de éstos sedan en edad infantil. Para el tratamiento perioperatoriocorrecto se requiere un conocimiento profundo desu fisiopatología, y de la farmacología implicada. Haygran cantidad de información publicada sobre fármacosque pueden utilizarse pero no tan extensa en niños.En los últimos años se han ido desarrollando nuevosfármacos entre los que se encuentran el esmolol, unbeta bloqueante de acción corta. Presentamos un casode tratamiento intraoperatorio con esmolol en unapaciente de 10 años programada para la extirpación deun feocromocitoma bilateral(AU)

Pheochromocytomas, which derive from chromaffincells, can secrete catecholamines in large amounts. Theincidence of these tumors is low at 2 to 8 cases permillion population and only 10% of cases occur inchildren. A thorough understanding of thepathophysiology of these tumors and the consequenteffect of drugs will be necessary for treating thesepatients during the perioperative period. A great dealhas been published on drugs that can be used in thissetting, but only a small portion of the information isrelevant to children. Esmolol, a short-action -blocker,figures among the drugs that have been developed inrecent years. We report a case in which esmolol was usedduring surgery in a 10-year-old girl undergoingscheduled removal of a bilateral pheochromocytoma(AU)

Hypnosis and surgery: past, present, and future.

Hypnosis has been defined as the induction of a subjective state in which alterations of perception or memory can be elicited by suggestion. Ever since the first public demonstrations of "animal magnetism" by Mesmer in the 18th century, the use of this psychological tool has fascinated the medical community and public alike. The application of hypnosis to alter pain perception and memory dates back centuries. Yet little progress has been made to fully comprehend or appreciate its potential compared to the pharmacologic advances in anesthesiology. Recently, hypnosis has aroused interest, as hypnosis seems to complement and possibly enhance conscious sedation. Contemporary clinical investigators claim that the combination of analgesia and hypnosis is superior to conventional pharmacologic anesthesia for minor surgical cases, with patients and surgeons responding favorably. Simultaneously, basic research of pain pathways involving the nociceptive flexion reflex and positron emission tomography has yielded objective data regarding the physiologic correlates of hypnosis. In this article I review the history, basic scientific and clinical studies, and modern practical considerations of one of the oldest therapeutical tools: the power of suggestion.

Teoría de hypnosis / No disponible

Durante aproximadamente los últimos 50 años, el estudio y la práctica de la hipnosis se han enmarcado dentro del campo de la Psicología. Este artículo revisa las conclusiones que constituyen un acuerdo emergente entre los científicos sobre los fenómenos fundamentales de la hipnosis, y describe la influencia de las teorías de hipnosis que han tenido una repercusión determinante en el campo, y que no descansan en la idea de que la hipnosis se puede explicar por un "estado de trance" específico de la hipnosis. Estas teorías incluyen la teoría socio-psicológica del rol (ejemplo: Sarbin, Coe), la teoría cognitivo-comportamental (ejemplo: Barber), la teoría neodisociativa (ejemplo: Hilgard), la teoría socio-psicológica de Spanos, la teoría de la expectativa de respuesta (ejemplo: Kirsch), el modelo integrador de Lynn, y la teoría del set de respuesta (ejemplo: Kirsch, Lynn) (AU)

In the past 50 years or so, the study and practice of hypnosis has moved into the mainstream of psychology. This article reviews findings that constitute an emerging consensus among scientists about the basic phenomena of hypnosis and describes influential theories of hypnosis have had a shaping influence on the field and do not rely on the idea that hypnosis can be explained by a "trance state" specific to hypnosis. These theories include social psychological role theory (e.g., Sarbin, Coe), cognitive behavioral theory (e.g., Barber), neodissociation theory (e.g., Hilgard), Spanos’s social psychological theory, response expectancy theory (e.g., Kirsch), Lynn’s integrative model, and response set theory (e.g., Kirsch, Lynn) (AU)

Hypnosis in the 1990s--and beyond.

For this Presidential Address, I accepted the challenge to discuss my perception of the future directions of hypnotherapy. I believe that the next decade will bring increased attention to the mind/body relationship and how hypnosis can be most effectively employed in this area. As an oncologist, one of the most exciting areas of current research is in psychoneuroimmunology. The role of communication in the practice of the health sciences is receiving more emphasis. Training in hypnosis is helpful in recognizing spontaneous trance states which may modify the effects of "nocebos." The use of hypnoanesthesia for surgery would be ideal in third world and developing countries. I believe there will be increased interest in the use of hypnosis in self-care, in the forensic area, and in the use of self-hypnosis by the general population. Finally, I expect that in the next decade the ASCH and SCEH will cooperate more closely in many areas of significance to hypnosis.

Resumiendo hipnosis y cirugía

A case where a patient had her baby through a Cesarean Section under hypnoanesthesea is presented. Also, a review of the use of hypnoanesthesea is presented. ALso, a review of the use of hypnosis in surgery is described. Hypnosis is a very important tool that we can use on the patients and on ourselves to enchance the results of surgery