Hypnotic techniques
Anxiety, fear, tension and apprehension are common emotions in patients undergoing surgery. Clinicians are becoming increasingly aware of the importance of patients’ psychological reactions as well as their physical needs. For instance, surgeons now explain more to their patients than was formerly the case. The anaesthetist is therefore presented with an opportunity to use the pre-operative anaesthesia assessment as a means of fostering greater rapport and providing reassurance. There is, of course, still much reliance upon sedative and analgesic drugs to relieve anxiety and tension prior to major anaesthesia. However, sedatives are not the only answer. Sedation can be accomplished pharmacologically, but drugs cannot re-educate patients in a way that enables them to respond more positively to their medical or surgical treatment. The challenge for anaesthetists seeking to provide optimal anaesthetic care for their patients is not only to become more expert in the latest state-of-the-art technology, but rather to acquire the skills necessary to function effectively in the role of physician healer. Hypnosis is not a ‘therapy’, but a potentially valuable tool in the anaesthetist’s professional armamentarium, and deserves to receive equal consideration with other tools and skills which anaesthetists acquire. Hypnotic techniques can influence communication to such a degree that the patient’s entire medical experience is beneficially affected. Anaesthetists trained in the use of hypnosis can use this approach in ‘formal hypnosis’ or as ‘awake suggestions’. Hypnosis has had a cyclical history of acceptance and rejection. It has been practised in one form or another for thousands of years. However, it was not until 1828 that a scientific publication first reported its effectiveness as an anaesthetic for surgery. However, when volatile agents were introduced, the use of hypnosis as a sole anaesthesia technique died out. Because of its historical association with magic, hypnosis has had to struggle to become disentangled from faith-healing methods and the occult. In a number of hospitals around the world, hypnosis is used as an adjuvant to pharmacological anaesthesia, either before or after general anesthesia. At the same time, the fact that major surgery has been comfortably performed entirely under hypnosis overcomes some of the scepticism associated with its ancillary uses.