Elsevier

Journal of Clinical Anesthesia

Volume 37, February 2017, Pages 14-16
Journal of Clinical Anesthesia

Case Report
Hypnopraxia, a new hypnotic technique for hypnoanesthesia

https://doi.org/10.1016/j.jclinane.2016.10.039Get rights and content

Highlights

  • Hypnoanesthesia is an old technique which has been rediscovered.

  • Hypnopraxia is a new hypnotic technique which was developed for hypnotherapy.

  • Hypnopraxia was successfully used for 6 procedures, including 4 colonoscopies.

  • Hypnopraxia would therefore seem to be useful for hypnoanesthesia.

  • The hypnotic technique should be chosen with respect to a particular patient.

Abstract

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.

Introduction

Hypnosis was the first technique used successfully in modern times for surgical anesthesia: the Scottish surgeon Esdaile published in 1852 a series of more than 300 serious operations carried out under hypnoanesthesia in India [1]. This was for the most part rapidly forgotten when drug-induced anesthesia was invented in the second half of the 19th century. Hypnotic techniques started to be reintroduced in anesthesia a century later, thanks to the work of several teams, and in particular Faymonville et al [2]. Hypnosis is now used in all sorts of surgical and medical procedures, whether as the sole anesthetic technique or as an adjunct to drug-induced sedation. Standard hypnotic techniques usually include suggestions to relax, to imagine a “special or safe place,” and suggestions for pain and anxiety control. Faymonville et al [2] use the reviviscence of pleasant life experiences as a substratum for hypnosis. The work here reports on the introduction of hypnopraxia in anesthesia. This new hypnotic technique was developed by Chedeau et al [3] for hypnotherapy. First published in 2005 at the 4th World Congress of Psychotherapy, it is derived from Ericksonian hypnosis, and drew its inspiration from phenomenological writings and in particular those of Henry [4]. Although it may appear to be technically simpler than other hypnotic techniques used in hypnoanesthesia, it requires a greater involvement for the anesthetist accompanying the patient.

Section snippets

Hypnopraxia

Hypnopraxia is a hypnotic technique which has evolved from traditional Ericksonian hypnosis. It was inspired by phenomenology. A “phenomenon” [5] is the act of something appearing in one's consciousness or experience. The structure of these experiences involves intentionality; the human mind unconsciously selects what will be allowed to appear in the consciousness. Two people experiencing a same event will not experience the same phenomena. People express their intentionalities in their

Results

Five patients underwent 6 procedures, 1 patient having had 2 procedures using hypnoanesthesia, a colonoscopy followed 1 month later by a transobturator tape procedure. Three other patients in the same period had wished to undergo a colonoscopy with hypnoanesthesia. Their motivation was not adequate, and they decided to have drug sedation rather than hypnoanesthesia after their first or second hypnopraxia session: 1 had been contraindicated for general anesthesia by another anesthetist who did

Discussion

Various hypnotic techniques have been introduced in anesthesia. One such technique is hypnopraxia. Its main advantage is its apparent simplicity; the patient does not need to imagine anything, or to learn a technique. He just needs to live the present moment in his body, although being accompanied by a trained anesthetist who acts as a sort of mirror for the patient. It is for this reason that, as for all hypnoanesthesia, the patient's motivation is essential. Just wishing to avoid drug-induced

Acknowledgments

This study had no funding whatsoever, and there were no financial ties between the two authors.

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    Hypnosis and surgery: past, present, and future

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    (2007)
  • M.E. Faymonville et al.

    Hypnosedation: a valuable alternative to traditional anaesthetic techniques

    Acta Chir Belg

    (1999)
There are more references available in the full text version of this article.

Cited by (2)

  • Prostate brachytherapy under hypnosedation: A prospective evaluation

    2019, Brachytherapy
    Citation Excerpt :

    HS has been used for endocrine cervical surgery (12), bilateral neck explorations (13), plastic surgery (14, 15), evacuation of postpartum vulvar hematoma (16), implant placement procedure for women (17), extraction of third molars (18), breast cancer surgery (in combination with paravertebral block) (19), cholecystectomies and inguinal hernia repair (20) and skin tumor removal (21). HS may reduce bleeding, postoperative recovery time, pain medication, as well as potential side effects related to anesthesia and emotional distress (7,13–15,22–24) and can stabilize respiratory motion (25). Hypnotherapy has also been used with external beam radiotherapy to reduce anxiety, to improve the quality of treatment delivery and the quality of life in patients with cancer undergoing such therapy (25–28).

Statement of disclosure or conflict of interest: none.

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