Standardised Hypnosis in Oral and Maxillofacial Surgery. - Asociatia ...

Dirk Hermes, Samer G. Hakim, Peter Siegof surgery under hypnosis was less than 30minutes.During post-operative interviews patients reportednotieeable relaxation, anxiolysis. anda general feeling of mental distanee from thesurgical situation. Although some patientsexperienced temporary painful intraoperativesensations, subjeetive distancing fromthe procedure meant that hardly any patientsrequired additional doses of local anaesthetic.As a result of the typical time distortionoccurring from the hypnotic trance, durationof surgery was estimated mueh shorter bythe overwhelming majority of patients. A seriesof patients eould only remember parts ofthe procedure due to the amnesiac effects ofhypnosis, while five patients did not remembersurgery at all.All patients having a positive trance experiencewould consent to another operation performedunder medical hypnosis. 26 patientshad multiple procedures (2-,'S) under combinedlocal anaesthesia / hypnosis during thestudy interval.On the surgeon's side, the specific effects ofhypnosis improved treatment modalities signifieantly.Patients with a history of severetreatment anxiety eould be operated underloeal anaesthesia. In seleeted eases, majorsurgery on very cooperative and susceptiblepatients with a high risk for general anaesthesiawas possible under stand-by conditions.Nevertheless, the special requirements forhypnotic treatment {e.g. consistent reductionof noise and moving inside the operatingtheatre) initially required serious restructuringof treatment sequences. In brief proeedures(e.g. extraetions performed on patientswith severe treatment anxiety), good therapyconditions were acquired through extendedpreoperative preparation time due to hypnosis.In the daily routine of a surgical department,the use of hypnosis is limited by theavailability of specially trained staff members:although therapeutie measures werehighly standardised, tape recorded hypnosiscombined with preoperative preparation andintraoperative aecompanimcnt of the patientsby a surgeon without hypnosis qualiheationsfrequently resulted in certain mental relaxation,but not stable intraoperative tranee.In direet eomparison with treatment eircumstancesin other surgical fields, a furtherminor but specific disadvantage of the use ofmedical hypnosis in oral and maxillofacialsurgery became evident: at least patients inthis group who needed oral surgery (e.g. surgicalremoval of third molars, apieeetomy)had to endure intraoperative stimuli suchas extraction motions and/or low frequencynoise or vibrations that resonate by bone conduction(e.g. drilling). Neither live hypnosisnor hypnotic recordings adequately shieldedthe patient from such irritants. Consequently.such stimuli (at least with iirst-timc application)regularly led to a short-lived re-orientationwith a remission of the hypnotie tranee.Patients undergoing more invasive and timeconsumingoncological or reconstructivesoft tissue surgery (n=61; figure 4,5) did notshow this phenomenon and success criteriawere met in each procedure.First Study ResultsAcceptance of hypnosis by oral and maxillofacialpatientsBefore introducing hypnosis into the clinicalroutine in 2002. it seemed advisable to eollectinformation concerning the individualmotivation of patients for accepting sueh atreatment option. 310 in and out-patients ofour department completed a questionnaireconsisting of 21 questions. It turned out thatalthough a very low percentage of thosequestioned had detailed knowledge or personalexperience of hypnosis, the procedurehad a high level of theoretieal aeceptanee.1^.4% of all patients believe that hypnosisis an enrichment of medical therapy. 86.5 %find further research on the use of hypnosisin medicine useful, and only a small minorityrejects the adjuvant use of hypnosis insomatie medicine on the whole (Hermes andSieg. 2004).Treatment anxiety and susceptibility oforal and maxillofacial patientsSusceptibility as a characteristie feature ofpersonality is one basic condition for hypnosis,which could be modified by treatmentstress and anxiety. To investigate this possi-European Journal of Climcdi Hypnosis: 2006 volume 6 - issue 4