Using hypnosedation instead of general anesthesia during some breast
Most people think of hypnosis as a kind of party trick — a mischievous way to make somebody unconsciously do your bidding.
But at MD Anderson, a groundbreaking study is evaluating the use of hypnosis as a substitute for general anesthesia during certain kinds of breast cancer surgery.
The study has the potential to revolutionize the way hospitals across the country conduct surgery.
“People think that when you're hypnotized you're going to be instructed to do things you wouldn't otherwise do, like get up on stage and cluck like a chicken, or reveal deeply hidden secrets,” says the study's principal investigator, Lorenzo Cohen, Ph.D., professor of Palliative, Rehabilitation and Integrative Medicine and director of the Integrative Medicine Program. “Actually, it just allows people to dissociate from the place they're in and achieve a deep relaxation.”
Like meditation, hypnosis is a simple skill that almost anyone can learn. And in the ongoing trial, it's proving to be a remarkably effective alternative to general anesthesia in patients undergoing a simple breast lumpectomy. Today, standard practice at MD Anderson and most other American hospitals is to fully sedate patients during operations. But there's a growing body of research pointing to the health risks of general anesthesia.
“For many people it can cause postoperative nausea and vomiting,” Cohen says. “It can cause short- and long-term cognitive deficits. And there's evidence that it causes immune suppression, something we do not want happening when we're trying to control cancer growth.”
Right now there's a movement all over the world questioning how much medicine we give patients,” says Dalliah Black, M.D., associate professor of Breast Surgical Oncology and leader of the surgical part of the study. “Do we really need to knock out everyone who has surgery?”
Dalliah Black, M.D., is a leader on a study of hypnosedation in lieu of
general anesthesia for women undergoing breast biopsies. Photo by
Finding cancer patients willing to try hypnosedation in lieu of general anesthesia was easier than the doctors anticipated. Rosalinda Engle, a trained mind-body therapist at MD Anderson, meets with each patient during two 20-minute sessions prior to the surgery to introduce herself and explain the process. She tells them to practice closing their eyes, relaxing their hands, feet and jaw, and taking deep, slow breaths. Engle then asks them to think of a place where they were truly relaxed — a vacation spot or a childhood home.
“Your brain is receiving the message that you’re at ease,” she explains. “There is no state of alert, there is no crisis, and you can relax even more deeply.”
Patients remain conscious during surgery but in a dissociated state, similar to the feeling of not remembering the details of driving a car to a destination.
“We do this every single day when we split our attention while we're driving somewhere, or sitting at our desk imagining a future vacation,” Engle says.
Hypnosedation can't completely replace more traditional pain treatments. Local anesthetics are still used to numb the breast during the operation, and the patient receives some IV pain medications tailored to their needs. An anesthesiologist is always standing by to administer general anesthesia if necessary.
But out of the study's more than 50 surgeries, general anesthesia had to be used only one time. The reaction from patients has been overwhelmingly positive.
“Patients come out of these surgeries asking for a recap of what I did, because they want to use it again during future treatments,” Engle says.
Read more about the clinical trial and the use of hypnosedation during surgery in Conquest magazine.