Techniques developed over the last 30 years for preparing patients for surgical procedures include supplying information, cognitive coping strategies, relaxation and hypnosis, reassurance and support, and rehearsal. Intending to provide a practical guide for health-care practitioners, the author reviews research on the efficacy of these methods and on comparisons between methods and makes recommendations for further studies.
Zhurnal Nevropatologii I Psikhiatrii Imeni S.S. Korsakova (Moscow, Russia: 1952)
Observed were 117 patients with different neuroses (neurasthenia, hysteria, obsessive) involving intense vasoautonomic paroxysms of sympathetic-adrenal, vagoinsular and combined nature. Unfavorable course of such neuroses was noted. Combined one-session acupuncture and hypnosis treatment is put forth and the increased hypnogenicity phenomenon was demonstrated under acupuncture therapy. Both techniques benefited from their combination.
Although hypnotherapy has been applied to alcoholism for over a century and is accepted by the AMA as a medically valid technique, the effectiveness of hypnosis in treating alcoholics remains controversial. Systematic evaluation has been hampered by the unique role of hypnosis as a cultural artifact, by problems in defining and verifying hypnotic intervention, by individual and situational variation in hypnotizability, and by difficulty in separating hypnosis from the therapies to which it is applied.
33 patients with refractory irritable bowel syndrome were treated with four 40-minute sessions of hypnotherapy over 7 weeks. 20 improved, 11 of whom lost almost all their symptoms. Short-term improvement was maintained for 3 months without further formal treatment. Hypnotherapy in groups of up to 8 patients was as effective as individual therapy.
Hypnosis has been described anecdotally to be effective in the treatment of sleepwalking and sleep terror, potentially dangerous parasomnias. The authors report the use of hypnosis in the treatment of 27 adult patients with these disorders. A total of 74% of these individuals reported much or very much improvement when followed over substantial periods after instruction in self-hypnotic exercises that were practiced in the home. Hypnosis, often preferred over pharmacotherapy by patients, required one to six office visits (mean = 1.6).
Assessment of the physiological effects of physical and emotional stress has been hampered by a lack of suitable laboratory techniques. Since hypnosis can be used safely to induce specific emotional states of considerable intensity, we studied the effect on distal colonic motility of three hypnotically induced emotions (excitement, anger, and happiness) in 18 patients aged 20-48 years with irritable bowel syndrome.
Inhaled anaesthetic agents (gases and vapours) may be detrimental to the health of patients and cause a chronic operating room air pollution. Therefore, the authors expound the results obtained using a total intravenous anesthesia technique including propofol to induce and maintain hypnosis integrated with pancuronium bromide, droperidol and fentanyl. Patients have been ventilated with mixture of air and oxygen 30%.
The effects of a pure benzodiazepine antagonist (Flumazenil) on the responses R1 and R2 of the blink reflex, psychomotor tests, and Event Related Potentials (ERP), in six healthy volunteers sedated with Midazolam have been compared. Measurements were made during each of four successive phases. Phase 0 corresponded to control recordings. Midazolam was administered rapidly during phase 1 and slowly during phase 2. Phase 3 corresponded to spontaneous waking once the administration of Midazolam had been stopped. Flumazenil was administered during phase 2.
The intravenous anesthetics which are commonly used for electroconvulsive therapy (ECT) possess dose-dependent anticonvulsant properties. Since the clinical efficacy of ECT depends on the induction of a seizure of adequate duration, it is important to determine the optimal dose of the hypnotic for use during ECT. We compared the duration of seizure activity and cognitive recovery profiles after different doses of methohexital, propofol, and etomidate administered to induce hypnosis prior to ECT.