Procedure for Using Hypnosis as Anesthesia in Surgery

Hypnosis has been used in patient surgeries as the sole form of, as an adjunct to
anesthesia, and as preparation for surgery and recovery.
Houge presents a practical model of hypnosis that has been used as the sole form of
anesthesia in surgeries (Houge D R, 2002). Houges model, which translates Shors three
dimensions of hypnosis into laymans language, consists of two phases:

Preparation and mental training before the surgery

Activities on the day of surgery.

Phase 1: Before the Surgery

Step 1: Assess the Patient
The provider conducts a brief psychological assessment and establishes the following
items.
Item
Patients reasons for
hypnosis and his or
her expectations

Details
The major goal is to have the best possible surgical outcome.
You need to discuss if hypnosis is the best approach.
Determine:
Are the patient expectations realistic?
Does the patient want to use hypnosis as an adjunct, for
preparation to general anesthesia, or as the sole anesthesia?
Has the patient discussed this with his or her surgeon?

Patients prior
experience with
surgery

Determine:
Was it a positive or negative experience?
What kinds of reactions did the patient have?
What needs to be dealt with?

Patients prior
experience with
hypnosis

Does the patient have skills that can be drawn upon or are they
new to mind/body techniques?

Copyright Center for Spirituality and Healing, 2003

Permission to talk
with patient's
physician, surgeon,
and anesthesiologist

If the provider is going to be in the operating room using

hypnotic techniques as an adjunct, or if hypnosis will be the sole
anesthesia, the surgeon, anesthesiologist, and provider need to
establish a professional working relationship.
It is best if the hypnosis provider is a member of the department
of anesthesiology or a related department in the hospital. The
surgeon has to believe that doing the procedure with hypnosis is
appropriate, as does the anesthesiologist. It is best if the three
have a long-standing working relationship and understand how
the process works.

Step 2: Explain What will Happen

The provider explains the model of hypnosis to the patient so that the patient clearly
understands the hypnotic techniques and their role. This understanding is critical for an
informed patient consent.
For example, the provider could say:
We will work together in an individualized manner on three dimensions of hypnosis:
Trance, Suggestion and Relationship.
The dynamics of the hypnosis will change over the duration of the surgery, and we will
work together to deal with these, for example strong sensations should they occur. We
will work on strategies and techniques unique to you and your surgery.
We will use your hypnotic strengths and personal characteristics that we have practiced
in our meetings prior to the surgery. You will practice these skills at home using
audiotapes of our meetings. This is a form of mental training that lets you rehearse the
surgery. It is useful on both a physical and mental level.

Step 3: Plan for Surgery with the Patient

It is very important that the patient understand that the major goal is to have the best
possible surgical outcome. There is no pressure to complete the surgery using hypnosis.
The patient may have prepared, and then on the day of the surgery, decide to use some
other form of anesthesia. They should feel good about having prepared for the surgery
and that the preparation may help with whatever form of anesthesia they use. They may
also use hypnosis for part of the surgery and decide on a local anesthetic or general
anesthesia. Be sure to communicate that however the process plays out, it is a win-win
situation.
The provider works with the patient to develop personal strategies for the three
dimensions of hypnosis (trance, suggestions, relationship) as outlined in the table below.

Copyright Center for Spirituality and Healing, 2003

Dimension
Trance

Example
The provider and patient explore a variety of situations in which the
patient becomes engrossed. It could be a trip, a safe place, a meditation
routine they like, or simple induction techniques such as counting down
from 10 to 1 or going up from 1 to 10.
There are infinite possibilities and from practice and experience, the two
work out a plan.

Suggestions

The provider begins the process of pain control suggestions by showing

the patient that they tune out physical sensations all the time. Point out
that the patient has tuned out the awareness of shoes on their feet,
eyeglasses, rings, or clothing.
The provider explains the protective function of pain: if someone
accidentally puts their hand on a hot range burner, the body sends a
signal to respond. The provider then poses the idea that during
surgery, strong sensations are O.K, and in fact, what is happening is the
same whether the patient is anesthetized or not.
The provider presents direct suggestions such as numbness, as well as
suggestions that are more metaphorical or analogies. All this calls into
play the clinical skills of the provider.

Relationship

The intra and interpersonal relationship is probably the most critical

dimension when it comes to helping the patient experience trauma--be it
physical or emotional.
In interviews with the patient, the provider draws upon the patients
accomplishments, mentors, or parental figures, friends, and sometimes
even pets. Together patient and provider explore spirituality (not
necessarily religion) as a means of feeling connected and having worth.
It is especially crucial for the patient to realize that the surgeon,
anesthesiologist, and the whole operating room team care about their
health and take pride in their work.

The techniques used in this phase build on all of the patients senses (visual, auditory,
kinesthetic, smell and taste) and draw on their personal life experiences and beliefs. The
patient rehearses the techniques that he or she will use during surgery.
The provider tapes the meetings so the patient can practice the strategies at home and
provide feedback about what was useful. The provider then refines the techniques.
In addition, the provider can show the patient videotapes of similar procedures done

Copyright Center for Spirituality and Healing, 2003

using hypnosis.
Below is a table that summarizes what to cover and how to say it.
Item
What to
cover

Details
CHECKLIST BEFORE surgery
sleeping the night before the surgery
arriving at the hospital
checking in and meeting with staff
going to pre-op area
CHECKLIST DURING surgery
moving into the operating room
having an IV inserted as well as a blood pressure cuff and other
monitoring devices
preparing the area of the body to be operated on
reaffirming a safe healing environment with everyone involved in the
surgery
talking to the surgeon and giving the go ahead to begin
practicing tone of voice and verbalizations
using touch to establish trust and safety
feeling a sense of pressure from the incision (rather than pain)
enjoying the sense of accomplishment as the surgery moves forward
handling any sensations with the prearranged strategies
feeling free to ask questions as the process evolves
working with information from the surgeon
asking for a pillow or some other form of support
experiencing the surgery as gentle sculpturing done by a highly skilled
surgeon
experiencing a sense of control in being involved in healing
working with their breathing as a way to relax and feel in control
letting time be irrelevant
seeing the surgery as a transition time to health
building upon positive feeling of letting go of sensations
hearing the surgeon indicating that they have accomplished the surgery
feeling satisfaction as they experience the sutures being completed
leaving the operating room with a sense of accomplishment

Copyright Center for Spirituality and Healing, 2003

CHECKLIST AFTER surgery

following the guidelines for post surgery
going about the rest of the day
sleeping that night feeling good about having done something positive
about their health
experiencing the sensations after the surgery as healing rather than pain
dismissing sensations rather than focusing on them
noticing any complications that occur and contacting the surgeon if any do
How to
say it

The language is Ericksonian in style and includes:

Reframing
For example, the incision is experienced as a sense of pressure rather than
pain.
Pacing and Leading
For example, as the surgeon completes the incision, the provider affirms
youve just done a wonderful job of letting go of the sensations from the
incision (pacing) and now that youve done that you can experience other
gentle sensations (leading).
Using patient characteristics and the phenomena that take place during a
surgery
For example, if the patient has expressed that they have a strong spiritual
belief, the provider might gently squeeze the patients hand while saying just
as you have comfort with your sense of spirituality, you can take comfort in
knowing that everyone working the operating room has a healing sense of
concern for you and that the environment and energy of everyone is directed
towards your having a wonderful surgery.

Phase 2: Day of the Surgery

Prepare Before the Surgical Procedure
In the hospital, the provider meets with the nursing staff, surgeon, and anesthesiologist.
They should all have talked about the case previously and have a trusting professional
relationship where each understands the role of hypnotic techniques and who is leading
the chain of command in the operating room. At this point, they review the case and
update each other on pertinent facts about the case.
The provider meets with the patient and initiates the hypnosis strategies developed in
earlier meetings with the patient.

Copyright Center for Spirituality and Healing, 2003

Step 2: Act During the Surgical Procedure

The provider implements the planned strategies using the three dimensions of hypnosis.
While the patient has rehearsed the procedure, it is impossible to prepare for the surgery
in every detail. The patient understands that little surprises are to be expected along the
way.
The patient and build the images he or she has practiced using the providers touch, voice
tone, attitude and verbalizations as a stimulus.
The patient understands that controlling pain is a dynamic process that varies over the
duration of the surgery -- some parts may be demanding and many parts are uneventful.
The team monitors vital signs such as heart rate and blood pressure and the surgeon
provides feedback as the surgery evolves. The patient also can provide feedback as to his
or her needs, since he or she is, in a sense, participating in the surgery.
For example, the patient may be a distance runner who has done the Twin Cities
marathon. The provider and patient have practiced imagining going up the hill to St.
Thomas University fully focused, relaxed, coordinated, and comfortable as a pain control
technique. So, as the surgeon moves into the difficult area, the provider supportingly
squeezes the patients hand and says: just as you did the Saint Thomas hill, you can
move through the surgery effortlessly be there now, be aware of the crowd cheering
you, feel your body moving, sense your stride, be aware of all the parts of your body
moving together in harmony. Just as you dealt with that hill, you are dealing with body
sensations in the operating room, in a sense everyone here is cheering you on as they did
during the marathon.
As the surgeon completes the sensitive part and moves on to something less demanding,
the provider says: "good, youve made it up the hill, and with the upcoming downhill,
you can let your body recover, just as you can do here now in the operating room.

Step 3: Process after the Surgical Procedure

This can occur either on the same day as the surgery or soon after. The provider should:
Review the patients experience.
Affirm the patient and implement the plan for post-operative recovery.
Deal with any situations that were problematic.

Copyright Center for Spirituality and Healing, 2003