Preoperative Hypnosis in Gynecology

What Is Preoperative Hypnosis in Gynecology?

Hypnosis is when a person experiences suggested changes in sensation, perception, thought, or behavior. According to the American Society of Clinical Hypnosis, it is a condition of intense inner absorption, concentration, and focus, even though the person experiencing it is fully conscious and in pain.

Hypnosis has many uses in medicine, and it may be used as-

1. A preoperative anesthetic during childbirth and surgeries like hysterectomy, breast cancer, etc.

2. To reduce pain during menstrual cramps.

3. To manage symptoms of menopause like hot flashes, night sweats, mood swings, and sleep disturbances.

4. As a tool to study human problems such as conflict, which result in anxiety and tension.

5. In rehabilitation.

6. In the control of appetite, smoking, etc.

7. As an adjunct to psychiatric management.

8. In the management of headaches, impotence, allergies, colitis, alcoholism, speech problems, hyperemesis gravid arum, etc.

In anesthesiology, hypnosis can be an exceedingly valuable tool. It is not a substitute for chemical anesthesia but is used as an adjunct to conventional anesthetic techniques. Pain, in general, can be separated into two components-

1. The physical stimulus which causes the pain.

2. The total emotional response to the pain.

The secondary anxiety, muscle tension, and apprehension compound the physical symptoms and intensity of the pain. Hypnosis plays a vital role in reducing or eliminating these secondary modifiers of pain.

It does not make the pain disappear, but it aids in reprocessing pain perception to a less annoying level by blocking neurophysiological paths. Other uses of hypnosis in anesthesia include-

1. Conditioning the patient against fear, surprise, and apprehension, especially if the patient is undergoing labor. The operating room scene may be rehearsed; this results in a more tranquil patient, leading to soother induction and management of the anesthetic. This is preferred to drug-induced tranquility in an anxious patient.

2. To assist induction of anesthesia.

3. A sole anesthetic in minor surgeries and painful periods.

4. To treat post-op hiccups, nausea, and other problems.

5. To ease post-op tension, fear, pain, and fear of coughing and thus decrease the need for analgesics.

6. In pain states of all kinds, including pregnancy and childbirth.

7. To assist patients who must be treated by immobilization with appliances or in uncomfortable or bizarre positions (e.g., birthing positions like kneeling with the birthing ball, squatting position, side-lying position, etc.).

8. To improve overall attitude toward the total surgical experience.

How Does Hypnosis Work?

Hypnosis can be self-induced (auto-hypnosis) or mediated by a hypnotist (hetero-hypnosis). An individual undergoing hypnosis will experience various manifestations like-

1. Alteration of awareness and memory.

2. Anesthesia.

3. Muscle relaxation.

4. Fatigue.

5. Alteration in taste and other senses.

Hypnosis works by directing the utilization of the subject's concentration and suggestibility to lead them into the hypnotic trance. There are some people who are poor hypnotic subjects, like-

1. Those who lack the ability to concentrate and those with short attention spans.

2. Mentally disturbed patients.

3. Highly intelligent people who refuse to concentrate or accept the idea of hypnosis.

Apart from these, there are modifying factors such as exhaustion, tension, fear, pain, and worry that can alter one’s hypnotizability index. It is important to note that the depth of the trance is not the most important factor, but sustaining the trance during the entire process defines the outcome.

How Is Hypnosis Achieved Preoperatively?

Preoperative hypnosis takes place in several sessions; the number of sessions depends on the patient's emotional well-being and the type of procedure being performed. Before induction of hypnosis, the subject's mind must be placed in a receptive posture, and their field of consciousness must be restricted to a narrow area.

There are many methods of achieving this, like fixing the eyes on an object, the use of lights, hypnodisks, pendulums, etc. Most hypnotists use a combination of the above plus vocal suggestions. The different suggestions are as follows-

• Suggestions and images that have a high probability of being appealing to the patient and can encourage the patient to give up criticality. The goal is to reinforce, create, and allow for an environment where the person feels relaxed, is in control of her images, and feels the experience is hers to create.

• The person is then taught a simple exercise that includes self-induction, imagination, and reorientation. She is encouraged to practice this every day for about a week; after this, the induction will be recorded on tape. When the patient is in a trance, specific information related to her surgery will be created. A specific amount of time is spent on the suggestions relative to the night before surgery.

• It is very important to create a scenario that allows the patient to become involved in the images of a relaxed evening sleep. Images are suggested that utilize the sense of sound, smell, touch, vision, and sometimes, taste.

• Arrival at the hospital or surgery center is used as a deepening cue, and the patient is taught that she needs to pay attention only to things that require her response. Suggestions then focus on what may happen in the particular surgery; they are also made to facilitate a normal range of vital signs, remain comfortably still during the procedure, and minimize bleeding.

• Suggestions are also made to recognize the psychological experiences as normal so that the patient realizes that the procedure is over, her body is returning to normal, and now is the time to start healing. The patient is encouraged to create a healing image that she will utilize during the postoperative period.

• Suggestion is created for the postoperative period in and out of the hospital. Emphasis is placed on the visualization of being discharged from the hospital, smiling, and doing something pleasurable after a week.

• The final session will be conducted a week before the surgery and will be focused on creating suggestions for managing the pain and associated nausea.

• Finally, a trance-relaxation tape for general use is created to encourage the patient to continue using hypnosis as a stress-reduction technique.

Patients who prepare for surgery using this protocol are required to inform their anesthesiologists about the hypnosis. She will also have to request the surgeon to tell her that it is time to begin healing at the conclusion of the surgery.

Conclusion:

Hypnosis is often regarded as supernatural or occult due to its unexplainable nature, but it has been used in childbirth for nearly two hundred years. Researchers have observed that patients who undergo hypnosis before the surgery are often relaxed and understand the full nature of the surgery, which makes them better surgical risks with excellent outcomes.