Neck Surgery with Hypnosis: An Evaluation Based Upon Patient's Self Assessment

Awake stapedectomy under hypnoanalgesia: Efficacy and safety in the treatment of otosclerosis

OBJECTIVE

To evaluate the efficacy and safety of awake stapedectomy under hypnoanalgesia (HA) compared to general anesthesia (GA) and local anesthesia (LA) in patients with otosclerosis.

METHODS

A single-center retrospective study included 131 adult patients (mean age: 49 years; 78% female) who underwent laser stapedectomy between 2020 and 2022: 58 GA, 23 LA, 50 HA. Primary outcome measures comprised operative room occupancy time, anesthetic consumption, and postoperative audiometric results.

RESULTS

HA significantly reduced operative room occupancy time (73.5±18.6min vs 103.7±24.6min in GA, P<0.001; vs 81.8±20.5min in LA, P=0.092), stapedectomy duration (39.9±12.4min vs 48.9±21.5min in GA, P=0.0252; vs 38.9±13.2min in LA, P=0.4601), preoperative time (30.2±9.5min vs 45.7±9.5min in GA, P<0.001; vs 38.6±12.2min in LA, P=0.0022), and recovery room time (26±15.1min vs 67.5±20.7min in GA, P<0.001; vs 47.4±20.7min in LA, P<0.001). HA also significantly reduced remifentanil consumption (169.8±101.6μg vs 848.6±308.8μg in GA, P<0.001; vs 323.9±94.4μg in LA, P<0.001). Postoperative audiometric outcomes showed no significant differences between groups.

CONCLUSION

Hypnoanalgesia for awake stapedectomy provided significantly greater efficacy compared to general anesthesia, reducing operative time and anesthetic consumption, with comparable audiometric outcomes.

The use of hypnotic communication in PICC placement: randomized controlled trial study

Every time a patient undergoes a medical procedure, unpredicted personal stress occurs. According to the available literature, the hypnotic communication technique has been used to reduce stress and pain during several major invasive procedures. The primary goal of this study was to compare the effectiveness of hypnotic communication combined with buffered Lidocaine, versus buffered Lidocaine alone, on patients' negative emotions while undergoing Peripherally Inserted Central Venous Catheter (PICC) placement. Secondary aims were evaluating patients' pain, satisfaction, and procedure timing and costs. A randomized controlled trial was conducted in an Italian Hospital involving patients who needed a PICC, with any disease or condition, aged over 18, cognitively oriented, able to hear, and willing to give consent. Emotional assessment was performed using the Emotion Thermometer Tool. Sixty-seven subjects were enrolled: 17 refused to participate, and 25 were randomly assigned to each group. The results showed a statistically significant higher decline in the total Emotion Thermometer Tool score for the experimental group using hypnotic communication. A significant mean reduction in anger and depression was also observed, while both groups reported low levels of perceived pain. Hypnotic communication appears to be a successful method for reducing emotional stress during PICC placement. However, further research is needed to determine the relationship between hypnotic communication, emotional distress, and pain perception in patients undergoing central vascular catheter insertion.

Treating Hot Flashes with Hypnosis: Does Hypnotizability Modulate Reductions?

Hypnosis is an effective treatment option for a variety of concerns. Past research has suggested that those who score in the high range of hypnotizability initially show greater improvement than those in the low range. A post hoc analysis was conducted to examine the extent to which hypnotizability modulates the reduction of hot flash frequency. Average number of hot flashes reported during hypnosis treatment and a 12-week follow-up were grouped according to participants' level of hypnotizability. Using baseline data, the reduction percentage of hot flash frequency was plotted and visually examined to determine when a clinically significant reduction (50%) in hot flashes was reached. Our results suggested that, regardless of hypnotizability, participants ultimately obtained a 50% reduction in hot flash frequency. Interestingly, participants who were rated as either moderately or highly hypnotizable achieved a 50% reduction by Week 3 while those of low hypnotizability did not cross the 50% reduction threshold until the 12-week follow-up. Implications from these findings include the importance of assessing hypnotizability in clinical settings to better tailor treatment dose and expectations.

Hypnosis and superficial cervical anesthesia for total thyroidectomy in a high-risk patient - A case report

•

Total thyroidectomy can be challenging in high-risk patients.

•

Local superficial anesthesia combined with a hypnosis-analgesia technique instead of intravenous sedation.

•

Because of difficulties controlling the thyrotoxic state.

•

Given the multiple cardiac and large vessel malformations, a possible variant of the inferior laryngeal nerve was expected.

•

Locoregional deep cervical anesthesia can be associated with breathing problems when performed bilaterally.

Introduction

Total thyroidectomy can be challenging in high-risk patients. Local cervical anesthesia with sedation is an alternative to general anesthesia.

Case presentation

A 33-year old male patient with cyanotic congenital heart disease due to unrepaired tricuspid atresia type Ic and associated pulmonary arterial hypertension presented with tachycardic atrial fibrillation and amiodarone-induced thyrotoxicosis resulting in recurrent hemodynamic instability. Because of difficulties controlling the thyrotoxic state, the indication for total thyroidectomy was established. Total thyroidectomy was subsequently performed using local anesthesia combined using a hypnosis-analgesia technique instead of intravenous sedation. The intervention and the post-operative course were uneventful.

Discussion

A well-established therapist-patient relationship is crucial for a successful induction of hypnosis. Patient motivation and expectations are equally important for a successful implementation of this approach.

Conclusion

We conclude that hypnosis combined with local anesthesia provides an effective alternative in selected patients with very high anesthesiological risk.