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HYPNOSIS PRINCIPLES AND APPLICATIONS: AN ADJUNCT TO ANESTHESIA


by Michael R. "Ron" EslingerRN, CRNA, MA, APN, BCH, CICaptain, United States Navy, RetiredOwner Healthy Visions Wellness CenterOak Ridge, Tennessee

For all that we know in medicine there are so many things that we do not know. Hypnosis is nothing new, but it is still grossly misunderstood as an adjunct therapy to the majority of health care providers. However, providers educated in hypnosis and the power of suggestion realize its real value and nature in the healing arts. Most people go in and out of hypnosis several times a day. Day dreaming is so nearly like hypnosis, some authorities consider them one and the same. The difference is that thoughts are random in daydreaming where in hypnosis, suggestions are directed.1 The hypnotic state is something a person accomplishes by himself. It is a state of complete relaxation, physical and mental. It is an alternate state of consciousness characterized by profound relaxation. In this state the mind is more susceptible to suggestions. Hypnosis is accomplished by a combination of confidence and suggestion which can have marvelous results. It is not a medicine nor is it a "cure-all," but rather a "tool" which can benefit one immensely. Today, some twenty thousand physicians, dentists, psychologists, nurses, hypnotherapists in other medical professions, and hypno-technicians are using hypnosis in their practices. Hypnosis is being taught to members of the healing arts, police officers, lawyers, clergymen, students, salesmen and a host of others who have found it beneficial in their endeavors. Some medical schools are now including a course in hypnosis as part of their curriculum.

INTRODUCTION

Tommy was fourteen and a victim of hemophilia which is a defective or deficient blood coagulation molecule known as factor VIII. 3 Tommy required as many as six transfusions of cryoprecipitate weekly, a very expensive and time consuming treatment. Using hypnosis as an adjunct therapy, Tommy learned how to manage his bleeds drastically decreasing his need for transfusions. This was a significant change for the family financially and in Tommy's improved mental and physical health. Hypnosis was used in four ways. First, was ego-strengthening. Tommy was given suggestions that he no longer had to compete with his peer group to be accepted. Second, He was taught to recognize when he was bleeding into a joint very early. Early recognition of internal bleeding combined with increased selfesteem allowed him to stop what he was doing without embarrassment, decreasing the amount of injury. Third, Tommy used guided imagery to create
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Hemophilia - a case study 2

cold at the site of bleeding to slow down blood flow. He also visualized faucets on his blood vessels that could be switched on or off. Fourth, He learned autohypnosis which enabled him to reinforce the post-hypnotic suggestions given by the hypnotist.

The word hypnosis is derived from the Greek word "hypnos," meaning sleep. 4 In the hypnotic state, however, the individual is not asleep, so the word hypnosis is misleading. Health care practitioners today prefer the term "relaxation." How often have you said to a patient, "Relax, take a deep breath and relax?" Relaxation can be described, as a particular mental and physical state a person enters when he/she accepts suggestions uncritically and acts upon them. 5 Hypnosis or relaxation is a learning process in the therapist - patient relationship. Patients are treated in hypnosis, not with or by hypnosis. In the minds of some people the word "hypnosis" has connotations of black magic, or hocus-pocus. The media, movies and fiction books misrepresent it as well. Many people believe that the therapist has incredible powers, but nothing is farther from the truth. No one can be hypnotized without their consent. 6 Simply stated, it is an absolute, complete state of relaxation. This is commonly called the "trance state,"7 which is accomplished by suggestions given to a patient while he or she is in a hypnotic state.

What is Hypnosis

Imagination is an extremely important ingredient of hypnosis. The law of "will power and imagination"8 states: "When the imagination and will power conflict the imagination always wins out." When on a diet one may use will power to say they will not eat, but as soon as they start imagining how good their favorite desert would taste the mouth starts watering, gastric juices are secreted, and they have to have it. Normal sleep is an unconscious state, or a state of unawareness; hypnosis is a conscious state, or a state of awareness. 9 It is said that in hypnosis, one's awareness is increased by 1,000 percent. Patients in the operating room are most often induced into general anesthesia using hypnotic medications. What they hear in those few moments of hypnotic awareness may leave a lasting imprint that could effect their physical and emotional health. Therefore, positive comments such as, "you will feel better than you thought you would," or "you will have a warm and comfortable feeling as you wake up," encourage positive results to the healing process. One patient who was told to have a pleasant thought as she was induced into anesthesia later emerged from anesthesia saying, those were the most wonderful roses she had ever smelled. The human mind is extremely complex and there is still a great deal to be learned about it. However, we do know the mind has two levels; the conscious level and the subconscious level. The conscious level may be referred to as our objective mind, while the subconscious level may be considered as the subjective or autonomic mind.10 In the normal state, ideas or suggestions are presented to the conscious level; while in the hypnotic state they are presented to the
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Imagination and the Human Mind

subconscious level. The subconscious level accepts suggestions more readily and acts upon them. Since the subconscious level cannot analyze what it is told, it accepts everything as the truth. In the normal conscious state after hypnosis, all units of mind power are impregnated with the suggestions or ideas that were presented during the hypnotic state.11 The mind, stimulated by suggestion, is capable of great things through its imagination. As a result of various emotional reactions, remarkable physical and mental changes can occur;12 these same changes can be obtained through hypnosis and imagery conditioning.

Hypnosis is older that medicine itself and has been with us since mankind had its beginnings. Virtually every culture and race of people has used it. Cave drawings suggest that man was experimenting with hypnosis thousands of year's ago.13 In Biblical times, people went to "sleep temples" 14 to be cured of their illnesses by the Egyptian priests. The ancient Chinese employed hypnotic techniques in the form of prayer and meditation. There is evidence that the Romans used "magic sleep" for various purposes. The Greeks unknowingly used hypnosis, thinking that cures came from the Gods. Hippocrates wrote about impressing health on the ill by inducing trances and making passes over the body some what like the healing touch techniques used today.15 Throughout the centuries, many great medical men have studied, researched, and experimented with hypnosis. In doing so, they were usually labeled charlatans, quacks, or impostors. It is impossible to mention all of those individuals who contributed to the development and progression of modern hypnosis, but it seems necessary to mention a few. Some, two hundred years ago, Dr. Franz Anton Mesmer (1734-1815) formulated his own brilliant theory of "animal magnetism." 16 He believed that a magnetic fluid permeated the body and that this fluid could help diagnose, cure, as well as prevent illnesses. Dr. Mesmer never realized that his results were obtained by the power of suggestion. Many years later, Dr. James Braid (1785-1860) coined the word "hypnosis," because he was convinced that the trance-like state that he employed was akin to sleep.17 Later, he recognized that hypnosis was not sleep; but the term had already gained common currency. Braid's Theory or Doctrine of Suggestion earned him the title, "Father of Modern Hypnosis." In 1884, Dr. Sigmund Freud (1856-1939) started using hypnosis in his practice for the treatment of hysteria. 18 However, in the late 1890's he abandoned the use of hypnosis in favor of the free association method. As a result of his early work with hypnosis, psychoanalysis was born. Much of the credit for the development of modern hypnosis is given to a hardworking country doctor from Nancy, France, Dr. A.A. Leibeault (1823-1904). 19 His interest was focused mainly on the cure of the patient. He arrived independently at the conclusion that hypnotic phenomena were purely subjective in origin.
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History of Hypnosis

Hypnosis gained a great deal of popularity and acceptance during World Wars I and II and the Korean conflict because of the positive results from its use in treating war neuroses.20 On April 23, 1955, the British Medical Society, and on September 13, 1958, the American Medical Association, after much research and study, officially accepted hypnosis as a legitimate treatment method to be used by medicine and dentistry. Both groups strongly recommend that instruction in the use of hypnosis be included in the curricula of medical schools. It was mutually agreed upon that persons who were properly trained and qualified to use it. 21 should only use hypnosis

Jan weighed over two hundred and fifty pounds. During her first month of weekly hypnosis sessions she lost weight as expected. However, there was no additional weight loss noted at the end of her second month of therapy. When asked how she felt about no additional weight loss her reply was quite a surprise. She was not concerned because she had not had a migraine headache since she began hypnotherapy. When Jan recognized the relationship of relaxation and the disappearance of her headaches her focus changed from losing weight to relief from her migraine headaches. Future hypnosis sessions included suggestions that she no longer had migraines because she was eating properly and sparingly and for the nourishment of her body only. She was also given suggestions for confidence building. Confidence not only in what she had to do, but also in the things she needed to do; such as continuing to eat properly and exercising on a regular basis. She reported no headaches over the next four months and at the end of six months she had also lost approximately fifty pounds.

Migraine Headache, Case Study 22

The different levels of hypnosis vary from person to person and are measurable as light, medium and deep planes. These planes are divided into six stages. Characteristic signs note each stage. Each plane is made up of a pair of stages. Plane one consists of stages one and two and so on. Approximately 20% of the population can go no deeper than a light plane. Rapport and physical relaxation is the distinguishing characteristics of stages one and two that make up the light plane of hypnosis. This is very important in the relationship between the patient and the health care staff. The patient receives suggestions from all hospital staff in some manner. The simplest suggestion, such as a smile, can make a difference in a patient's response to treatment. In stage two complete cooperation and deep concentration are the dominant signs. Stages three and four make up the medium plane of hypnosis and are identifiable by olfactory and taste changes, aphasia, partial amnesia and analgesia. Glove anesthesia can be produced and then transferred to other parts of the body. Approximately sixty percent of the population can learn to reach the medium plane. Stages five and six are the deepest and produce the most dramatic phenomena
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Stages, Signs, and Planes 23

such as complete anesthesia, total amnesia, visual and auditory hallucinations. Approximately fifteen percent of the population can reach such a deep level. LeCron states that approximately twenty percent of the population can go no deeper into hypnosis than the light stages of rapport and relaxation. 24 That means that eighty percent of the population are at least adequate candidates for a positive response to hypnotherapy. Therefore, a kind word and a positive comment from a nurse or physician is beneficial in soliciting a positive patient response to medical treatment.

Hypnosis has been a part of medicine throughout the centuries. 25 It was found to be an effective method of inducing anesthesia long before the existence of chemical anesthetics. Anesthesia, as well as medicine in general, is a combination of art and science; equally so is hypnosis. In order to use this method of anesthesia more effectively, it is important for the anesthetist to understand that hypnosis is a method or technique, not an anesthetic agent. Toward the end of the nineteenth century, there was no longer any question as to the reality of hypnosis, and its use in producing analgesia and anesthesia. 26 Historically, natural or hypno-anesthesia preceded chemical anesthesia by approximately twenty-one years.27 The first operation using hypno-anesthesia reported in the United States was a nasal polypectomy, performed thirteen years before Crawford Long 28 started using ether as an anesthetic agent. To date, virtually every body cavity has been entered and almost every organ has been operated upon using hypno-anesthesia. Only recently, valid reports of operations performed under hypno-anesthesia made the nightly news.29 Hypno-anesthesia should not be considered a replacement for chemical anesthesia. Not all patients can be hypnotized as easily as they can be anesthetized.30 Nevertheless, hypnosis is a method which can be very useful to the anesthesia clinician before, during, and after a surgical procedure. An ideal anesthetic combines the use of hypnotic techniques with reduced doses of chemical anesthetic drugs. Propofol, Sodium Thiopental, and Etomidate are classed as hypnotics. These anesthesia induction medications when given slowly in combination with post-hypnotic suggestions greatly enhance patient recovery from both the anesthetic and the operative procedure. The combination of pre surgical hypnosis and chemical hypnosis at the time of anesthesia induction greatly reduces depression of the cardiovascular, pulmonary, renal, and hepatic systems. Medhmet C. Oz, M.D. of Columbia-Presbyterian Medical Center routinely offers hypnosis to his open-heart-surgery patients to reduce anxiety before the procedure.31 In contrast to chemical anesthesia, hypno-anesthesia has the advantage of being completely safe and harmless to the patient. The disadvantage of using this method is time. In order to use hypnosis as the sole and total means of anesthesia or even as the major portion of the anesthetic procedure, more time is generally required than just the pre-anesthetic visit or phone call. Though it may very well be the method of choice for many patients, it is not often used because
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Hypnosis and Anesthesia

most patients are not aware of hypnosis as an alternative or adjunct to their care. Also, medical personnel are not trained in alternatives such as hypnosis, and those trained do not want to spend the time required for conditioning the patient prior to the proposed procedure. The advent of epidural anesthesia for labor and delivery has also had a great impact on patient motivation toward both Lamaze and hypnosis for child birth. If the patient is disinterested the physician follows suit. In addition, the basic induction of hypnosis can require as long as fifteen to thirty minutes.32

Ann, at forty-three, elected to under go plastic surgery for a brow lift and laser exoneration of the face. She requested the procedure be done using hypnosis. In preparation for surgery, Ann under went weekly hypnosis sessions over a four week period. She was also taught self-hypnosis and a relaxation tape was used to reinforce suggestions at home. During the pre surgical hypnosis sessions Ann proved to be only a moderately suggestible patient. The decision was made to use hypnosis as an adjunct therapy with local anesthesia. This was a major departure from the general anesthetic requested by the surgeon. Post hypnotic suggestions using the technique of glove anesthesia were given for localized anesthesia about the face, neck and scalp. Suggestions were also given to incorporate all sounds heard and words said in the operating room to enhance a feeling of comfort and relaxation. The surgeon and the operating room staff were also prompted on how to interact with the patient. Simple conditions like keeping the room quiet and saying encouraging words to the patient was requested. Staff were asked to refrain from asking Ann unnecessary questions which might effect her ability to remain focused and in a relaxed hypnotic state during surgery. Ann was very happy with her experience and the surgeon who normally used general anesthesia on this type of patient asked if future patients could also use hypnosis with local anesthesia as an alternative to general anesthesia.

Plastic Surgery, Case Study 33

Hypnosis has been shown to be an effective tool for all specialties of the health care profession. The following are some of the practical applications of hypnosis. 1. To overcome fear, apprehension and anxiety so as to reduce the tension associated with anticipated anesthesia and surgery. 2. For sedation, either in conjunction with, or as a substitute for drug medication. 3. To increase patient cooperation and create peace of mind. 4. To produce analgesia and/or anesthesia by reducing the total amount of, or replacing, chemical anesthetic agents. 5. To make for a more pleasant and comfortable post operative period. 6. To permit the use of post-hypnotic suggestions: 7. reduce incidence of post-operative nausea and vomiting. 8. encourage deep breathing and necessary coughing, 9. raise the pain threshold thereby reducing the need for narcotics,
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Conclusion

10. encourage earlier fluid intake, and (e) increase urinary output. 11. To produce amnesia of the procedure. 12. To establish better morale, thus motivating the patient toward a faster recovery. Hypnosis can be used as the method of anesthesia for any surgical, obstetrical, or dental procedure for almost any age group. It is useful in emergency rooms for minor surgical and orthopedic procedures, especially when the patient has just eaten a heavy meal. When utilizing hypnosis for major procedures, it proved more beneficial when used as an adjunct to chemical agents. How does the anesthetist actually decide when to use hypno-anesthesia? The decision is usually made for him; it is resolved by the attitude of the patient and the attending physician. All available information regarding the patient's mental and physical condition and the planned procedure must be carefully evaluated. The final determination is made exactly as it would be if chemical anesthesia were to be used. From all this, it would appear that hypnosis is an ideal method of anesthesia for most operations. Why is it not used more widely? The answer is that although the technical aspects of inducing hypnosis are easy to learn, successful induction and maintenance of hypno-anesthesia depends largely upon the interaction of many factors in the personalities of the patient and the hypnotherapist. These factors are little understood at the present time, and many of them are not understood at all. Likewise, Sodium Thiopental has been around for a lot of years and the exact mechanism of action is still not completely understood, however, it is still used. Hypnosis is a valuable addition to the methods and techniques available to all health care providers. It is a safe and uncomplicated method of anesthesia, to be used only by competent, skillful, and ethical anesthetists within the limitations of their specialty and in the best interest of the patients. Ideal anesthesia can be achieved by combining hypnotic techniques with safer, smaller doses of chemical hypnotic anesthetic agents. Instruction in the use of hypnosis should be included in all health care training programs. As more people become educated in the subject, it will become more readily and widely accepted.34

Roger A. Straus, Ph. D., Strategic Self-Hypnosis (New Jersey: Prentice-Hall, 1982). P. 23. Personal experience of the Author. 3 Robert K. Stoelting, M.D. and Stephen F. Dierdorf, M.D., Handbook for Anesthesia and Co-Existing Disease (New York: Churchill Livingston, 1993), p.255. 4 William S. Kroger, M.D. and William D. Fezler, M.D., Hypnosis and Behavior Modification: Imagery Conditioning (Philadelphia: J. B. Lippincott Company, 1976), p. 8. 5 William S. Kroger, M.D., Clinical and Experimental Hypnosis In Medicine, Dentistry, and Psychology, 2nd ed. (Philadelphia: J. B. Lippincott Company, 1977), p. 7. 6 Harold A. Crasilneck, Ph.D. and James A. Hall, M.d., Clinical Hypnosis: Principles and Applications (New York: Grune and Stratton, 1975), p. 39-40. 7 William S. Kroger, M.D., Clinical and Experimental Hypnosis In Medicine, Dentistry, and Psychology, 2nd ed. (Philadelphia: J. B. Lippincott Company, 1977), p. 7. 8 William S. Kroger, M.D. and William D. Fezler, M.D., Hypnosis and Behavior Modification: Imagery Conditioning (Philadelphia: J. B. Lippincott Company, 1976), p. 28. 9 Harold A. Crasilneck, Ph.D. and James A. Hall, M.d., Clinical Hypnosis: Principles and Applications (New York: Grune and Stratton, 1975), p.19.
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REFERENCES

Joseph Murphy, D.R.S., Ph.D., D.D., L.L.d., The Power of Your Subconscious Mind (New Jersey: Prentice-Hall, 1977), p. 33. 11 S. J. Van Pelt, M.D., Secrets of Hypnotism 10th ed. (North Hollywood: Wilshire, 1958), p. 7. 12 Leslie M. LeCron and Jean Bordeaux, Ph. D., Hypnotism Today (North Hollywood: Wilshire, 1947), p. 150. 13 William S. Kroger, M.D., Clinical and Experimental Hypnosis In Medicine, Dentistry, and Psychology, 2nd ed. (Philadelphia: J. B. Lippincott Company, 1977), p. 1. 14 William S. Kroger, M.D. and William D. Fezler, M.D., Hypnosis and Behavior Modification: Imagery Conditioning (Philadelphia: J. B. Lippincott Company, 1976), p. 8. 15 Dorothea hover-Kramer, Ed. D., RN, Healing Touch A Resource for Health Care Professionals (New York: Delmar Publishers, 1996), p. 98. 16 Lesly Kuhn and Salvatore Russo, Ph.D., Modern Hypnosis, 2nd ed. (North Hollywood: Wilshire, 1958), p. 1. 17 Harold A. Crasilneck, Ph.D. and James A. Hall, M.d., Clinical Hypnosis: Principles and Applications (New York: Grune and Stratton, 1975), p. 7. 18 Harold A. Crasilneck, Ph.D. and James A. Hall, M.d., Clinical Hypnosis: Principles and Applications (New York: Grune and Stratton, 1975), p. 8. 19 Harold A. Crasilneck, Ph.D. and James A. Hall, M.d., Clinical Hypnosis: Principles and Applications (New York: Grune and Stratton, 1975), p. 7. 20 Harold A. Crasilneck, Ph.D. and James A. Hall, M.d., Clinical Hypnosis: Principles and Applications (New York: Grune and Stratton, 1975), p. 9. 21 Personal experience of the Author. 22 Leslie M. LeCron and Jean Bordeaux, Ph. D., Hypnotism Today (North Hollywood: Wilshire, 1947), p. 62. 23 Leslie M. LeCron and Jean Bordeaux, Ph. D., Hypnotism Today (North Hollywood: Wilshire, 1947), p. 74. 24 S. J. Van Pelt, M.D., Secrets of Hypnotism 10th ed. (North Hollywood: Wilshire, 1958), p. 9. 25 William S. Kroger, M.D., Clinical and Experimental Hypnosis In Medicine, Dentistry, and Psychology, 2nd ed. (Philadelphia: J. B. Lippincott Company, 1977), p. 1. 26 William S. Kroger, M.D., Clinical and Experimental Hypnosis In Medicine, Dentistry, and Psychology, 2nd ed. (Philadelphia: J. B. Lippincott Company, 1977), p. 2. 27 William S. Kroger, M.D., Clinical and Experimental Hypnosis In Medicine, Dentistry, and Psychology, 2nd ed. (Philadelphia: J. B. Lippincott Company, 1977), p. 2. 28 William S. Kroger, M.D., Clinical and Experimental Hypnosis In Medicine, Dentistry, and Psychology, 2nd ed. (Philadelphia: J. B. Lippincott Company, 1977), p. 2. 29 NBC Nightly News, June 1997. 30 William S. Kroger, M.D., Clinical and Experimental Hypnosis In Medicine, Dentistry, and Psychology, 2nd ed. (Philadelphia: J. B. Lippincott Company, 1977), p. 213. 31 Lena Kleiman, "The New American Medicine," SELF, April 1997. Pp. 159-226. 32 William S. Kroger, M.D., Clinical and Experimental Hypnosis In Medicine, Dentistry, and Psychology, 2nd ed. (Philadelphia: J. B. Lippincott Company, 1977), p. 213. 33 Personal experience of the Author. 34 Harold A. Crasilneck, Ph.D. and James A. Hall, M.d., Clinical Hypnosis: Principles and Applications (New York: Grune and Stratton, 1975), p. 88.
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