Dirk Hermes. Samer G. Hakim, Peter Siegshowed that a similar teehnique significantlyreduced <strong>in</strong>traoperative treatment anxiety <strong>and</strong>postoperative consumption of analgesicsafter surgical removal of third molars underloeal anaesthesia. Ghoneim <strong>and</strong> co-workers(2000) described identical anxioiytic effectsof preoperative Tape Recorded <strong>Hypnosis</strong><strong>in</strong> the experimental group of a study whichunderwent dental extraetions or surgical removalof teeth under local anaesthesia <strong>and</strong>eonseious sedation (fentanyl. midazolam.nitrous oxide). For no apparent reason therewas also a significant <strong>in</strong>crease of postoperativevomit<strong>in</strong>g <strong>in</strong> the experimental group.The <strong>in</strong>tent of own <strong>in</strong>vestigations was to ga<strong>in</strong><strong>in</strong>formation about the effeets of st<strong>and</strong>ardisedhypnosis dur<strong>in</strong>g a wider range of oral <strong>and</strong>maxillofaeial operations on locally anaesthetised<strong>and</strong> non-sedated patients. The basic underly<strong>in</strong>gquestions were, <strong>in</strong> how far subjective<strong>and</strong> cl<strong>in</strong>ical effects of such a procedurejustify the <strong>in</strong>tensification of its therapeuticuse <strong>in</strong> oral <strong>and</strong> maxillofaeial surgery <strong>and</strong> furthermore,require scientific evaluation us<strong>in</strong>gcontrolled cl<strong>in</strong>ical studies.In this respect, systematic applications ofhypnosis <strong>in</strong> our department <strong>in</strong>dicated <strong>in</strong>terest<strong>in</strong>gperspectives. <strong>Hypnosis</strong> is a suggestiveprocedure for perioperative stress reduetionshow<strong>in</strong>g a high degree of theoretical <strong>and</strong>practical patient consent. Procedural st<strong>and</strong>ardisationfor special purposes (e.g. tape recordedhypnosis vs. live hypnosis) m<strong>in</strong>imisesnecessary ehanges <strong>in</strong> the surgical sett<strong>in</strong>g <strong>and</strong>reduces variables <strong>in</strong> the design of possiblecl<strong>in</strong>ical studies. Meta-analysis of the adjunctiveuse of hypnosis <strong>in</strong> surgery (Montgomeryct al., 2002) proved that such st<strong>and</strong>ardisationis not accompanied by reduced effectivenessof hypnosis. Interpretation of our maxillofacialstudy supports this thesis as the datamatches the success rates of <strong>in</strong>traoperativehypnosis <strong>in</strong> the literature. Furthermore, itshows that the specific treatment situation <strong>in</strong>oral <strong>and</strong> maxillofacial surgery does not createa negative <strong>in</strong>fiuenee on trance ability <strong>and</strong><strong>in</strong>tensity of patients.Positive <strong>in</strong>traoperative effects of hypnosis<strong>in</strong>clude sedation, anxiolysis. <strong>in</strong>hibited motorskills <strong>and</strong> <strong>in</strong>creased tolerance towardsphysically <strong>and</strong> psychologically dem<strong>and</strong><strong>in</strong>gsurgieal procedures. Overall preparationtime (<strong>in</strong>formation, seed<strong>in</strong>gs <strong>and</strong> <strong>in</strong>duction)of approximately \5 m<strong>in</strong>utes, complete postoperativereorientation of the patient with<strong>in</strong>less than 1 m<strong>in</strong>ute <strong>and</strong> low technical costsare further advantages of hypnosis <strong>in</strong> direetcomparison with established pharmaeologiealprocedures.Nevertheless, hypnosis cannot serve as a serioussubstitute for pharmacological sedationor general anaesthesia. Specific limitations<strong>and</strong> contra<strong>in</strong>dications have to be taken <strong>in</strong>toaecount. surgeons with detailed knowledge,<strong>in</strong>dividual patient preparation <strong>and</strong> specialtreatment modalities are necessary. Its therapeuticuse is limited to mentally healthy <strong>and</strong>fully co-operative patients who are at leastopen to the procedure.ConclusionIntraoperative hypnosis is an <strong>in</strong>terest<strong>in</strong>gsupplementation to anxioiytic <strong>and</strong> sedativepharmacological procedures. It showedseveral positive <strong>in</strong>tra- <strong>and</strong> postoperative effeetsfor both patient <strong>and</strong> surgeon dur<strong>in</strong>g athree-year evaluation period. Its potentialfor surgeons should be evaluated <strong>in</strong> furthercl<strong>in</strong>ical studies.Correspond<strong>in</strong>g author:Dirk Hermes, M.D.. D.M.D.Department of <strong>Maxillofacial</strong> <strong>Surgery</strong>University Hospital Schleswig-Holste<strong>in</strong> /Campus LuebeekRatzeburger Allee 16023538 LuebeckGermanyPhone: 0049 451 500 2269email: hermesddd@aol.comEuropean Journal of Cl<strong>in</strong>ical <strong>Hypnosis</strong>; 2006 volume 6 - issue A
<strong>Hypnosis</strong> <strong>in</strong> <strong>Oral</strong> <strong>and</strong> <strong>Maxillofacial</strong> <strong>Surgery</strong>Transcript of the <strong>Hypnosis</strong> CD"Somehow it is quite normal that you are still feel<strong>in</strong>g a little uneasy here dur<strong>in</strong>g this dental treatment <strong>and</strong> that you areth<strong>in</strong>k<strong>in</strong>g about what we <strong>in</strong>tend to do with you <strong>and</strong> how long it is go<strong>in</strong>g to take <strong>and</strong> whether you are go<strong>in</strong>g to feel anyth<strong>in</strong>g<strong>and</strong> it is a very normal reaction that you tense up wait<strong>in</strong>g for someth<strong>in</strong>g lo happen, <strong>and</strong> il is really difficult to leisonicbod\ come so ne;ir. but <strong>in</strong> your m<strong>in</strong>d you know that you will do it to be able to laugh afierwards <strong>and</strong> show yourlovely leelh <strong>and</strong> have no more pa<strong>in</strong> <strong>and</strong> ihis subconscious cl<strong>in</strong>g<strong>in</strong>g to the dental chair <strong>and</strong> brciith<strong>in</strong>g faster <strong>in</strong> thissituation is a very normal th<strong>in</strong>g which we learned from om ancestors who always, when there Wiis danger around, hadto be on the go <strong>and</strong> when suddenly a bird or iirioihcri<strong>in</strong>imal llcw away or made a noise <strong>and</strong> luiknown sounds werearen<strong>in</strong>d. our ancestors had lo be able to jump up al any lime <strong>and</strong> run away or to lake on the opponent <strong>and</strong> we took overthis reaction <strong>and</strong> whenever someth<strong>in</strong>g starts we are afraid at least subconsciously, adrenal<strong>in</strong>e is set free, our pulse goesfasler <strong>and</strong> we prepare lo run away, <strong>and</strong> if we cannol manage, we hold on <strong>and</strong> the more we lensc up the more <strong>in</strong>lensely weexperience what is happen<strong>in</strong>g.And ihe more we relax <strong>and</strong> ihe more relaxed our muscles are <strong>and</strong> the calnu'r our brciith<strong>in</strong>g is. the less we experiencewhat is go<strong>in</strong>g on. <strong>and</strong> so be guided lo relax your bod> more <strong>and</strong> more trvon more quiet <strong>and</strong> relaxed, iuid you c;<strong>in</strong>lislen to the music You can listen lo my voice, or you caii use all the sounds you hear <strong>in</strong> Ihe background to feel more<strong>and</strong> more eomfortable <strong>in</strong> your body, <strong>and</strong> you ean feel l<strong>in</strong>gers touch<strong>in</strong>g your head, your eheek, but you ean feel as wellhow your back <strong>and</strong> your buttocks are ly<strong>in</strong>g on the chair, how your legs <strong>and</strong> feet are ly<strong>in</strong>g there <strong>and</strong> lei your h<strong>and</strong>s becomerelaxed, shoulders soft, <strong>and</strong> you can close your eyes <strong>and</strong> create images <strong>in</strong> front of your <strong>in</strong>ner eye whieh eonespund lo allihis <strong>and</strong> you can use all you hear lo remember very beautiful <strong>and</strong> coml'orlable images.Imag<strong>in</strong>e your holiday resort, your favourite holiday reson. of which you have always been dream<strong>in</strong>g <strong>and</strong> tiivc yourselfall [he freedom lo use all your imag<strong>in</strong>ation to really recall yourself [here or th<strong>in</strong>k forward where you will have fell veryeomfonable. those days <strong>in</strong> the fuiure. when you were ly<strong>in</strong>g on this wonderful beach wiih the salty smell of the sea.ihe air smell<strong>in</strong>g so delicious <strong>and</strong> whal there was to eat there. Imag<strong>in</strong>e all these wonderful pleasures you eould enjoy.nol to forget dr<strong>in</strong>k<strong>in</strong>g, <strong>and</strong> how you enjoyed il <strong>and</strong> how you are enjoy<strong>in</strong>g it now <strong>in</strong> your imag<strong>in</strong>aiion. whiie you arc relax<strong>in</strong>gyour btidy more <strong>and</strong> more And you ean relax systematically, <strong>and</strong> you beg<strong>in</strong> down at your feel, experienc<strong>in</strong>g howit feels when f<strong>in</strong>e s<strong>and</strong> is trickl<strong>in</strong>g between your toes, how il gives under your steps how warm il is <strong>and</strong> how heavyyour feel are becom<strong>in</strong>g meanwhile .... <strong>and</strong> Ihis heav<strong>in</strong>ess ean spread further And il might be that meanwhile, youexperience sounds iti your body, a lillle growl<strong>in</strong>g from yoursloiiiach. <strong>and</strong> il is a sign of relaxation, <strong>and</strong> yoti can iidd all thesounds you happen lo hear <strong>in</strong>to your most pleasant holiday experience .... <strong>and</strong> ihe sound of ihe Nuclit)ii couid be ibe w<strong>in</strong>dthai cools your forehead <strong>and</strong> an exotic bird could s<strong>in</strong>g <strong>and</strong> you eould change Ihe sound of the drill <strong>in</strong>to the bird's voice,or you could sil on a molorbike <strong>and</strong> ride along the beach <strong>and</strong> fee! the bumps <strong>and</strong> the vibralion <strong>and</strong> hold onto theh<strong>and</strong>lebars <strong>in</strong> your fan<strong>in</strong>sy <strong>and</strong> you can take all the sounds <strong>and</strong> touches with you to Ihis beautiful holiday resort <strong>and</strong>use ihem lo relax even niort-, lei your legs become even heavier feel your feet your lower legs yoiirihighslay<strong>in</strong>g Ihere noth<strong>in</strong>g lo do jusl lett<strong>in</strong>g your body feel very comfortable heavier, <strong>and</strong> heavier, <strong>and</strong> more <strong>and</strong>more heavy even more heavy, very heavy <strong>and</strong> il is a very pleasanl feel<strong>in</strong>g to feel how your body beeomesheavier your pelvis heavy even heavier your pelvis more <strong>and</strong> more heavy very heavy <strong>and</strong> warm stream<strong>in</strong>gwarmih <strong>in</strong> your stomach tot) <strong>and</strong> now search for ihc heaviest pail of your body your back heavy heavier<strong>and</strong> heavier very heavy And the heav<strong>in</strong>ess can spread to your shoulders lo your arms slowly over yourshoulders to your upper arms your lower arms your h<strong>and</strong>s heavy. Arms <strong>and</strong> shoulders heavy arms.shoulders <strong>and</strong> h<strong>and</strong>s heavy heavier <strong>and</strong> heavier even more heavy very heavy yes. And concentrate on thecalm of your brealh. lei il How deep down lo your stomach .... lett<strong>in</strong>g it flow \ery relaxed so ihat it breathes wiih<strong>in</strong>you .... <strong>in</strong> deep calm brealhs .... <strong>and</strong> meanwhile you can imag<strong>in</strong>e Ihe pendulum of an old cloek maybe the k<strong>in</strong>d of clockyou have seen <strong>in</strong> ihe house of an old person maybe al your gr<strong>and</strong>parents or <strong>in</strong> a museum A clock whosependulum sw<strong>in</strong>gs once <strong>in</strong> a second imag<strong>in</strong>e the calm pendulum of this clock, <strong>and</strong> just let it sw<strong>in</strong>g as you can seeit sw<strong>in</strong>g<strong>in</strong>g <strong>in</strong> front of your <strong>in</strong>ner eye .... <strong>and</strong> your breath becomes very calm <strong>and</strong> all those muscles <strong>in</strong> your body becomevery smooth <strong>and</strong> soft <strong>and</strong> relaxed muscle fibres smooth <strong>and</strong> relaxed like cooked spaghetti .... <strong>and</strong> you can havefun dur<strong>in</strong>g Ihis lime <strong>and</strong> remember funnj or pleasanl th<strong>in</strong>gs as you watched somebody <strong>and</strong> you were so pleased <strong>and</strong>were laugh<strong>in</strong>g from the bottom of your heart <strong>and</strong> you know that you can divert so easily when the th<strong>in</strong>gs you areth<strong>in</strong>k<strong>in</strong>g aboul arc just more beautiful .... more impttrtanl more pleasajil <strong>and</strong> you do nnl have to lell me afterwardswhal you were ih<strong>in</strong>k<strong>in</strong>g aboul Ihe ma<strong>in</strong> th<strong>in</strong>g is that your <strong>in</strong>ner experience is so beaulitul. so beautiful that youfeel all warm <strong>and</strong> pleasanl <strong>in</strong> your body <strong>and</strong> you can imag<strong>in</strong>e thai you gave away your mouth for repair, simply gaveil away, <strong>and</strong> you st<strong>and</strong> opposite yourself <strong>and</strong> crilically wateh .... <strong>and</strong> wateh yourself ly<strong>in</strong>g there the headphonesimply be<strong>in</strong>g calm lett<strong>in</strong>g th<strong>in</strong>gs happen <strong>and</strong> be<strong>in</strong>g lost <strong>in</strong> yourown Ihoughis which lead you away from this lime<strong>and</strong> this room .... far away to pleasanl coutilrics lo pleasant acliviiies, <strong>and</strong> choose the ones you would like to domosl <strong>and</strong> Icl your imag<strong>in</strong>aiion riui wild .... lo picluie ih<strong>in</strong>gs as mosl beautiful experienc<strong>in</strong>g each delail. And ihalyou watch yourself <strong>in</strong> the meantime, your surround<strong>in</strong>gs experienc<strong>in</strong>g them exactly wiih each detail <strong>and</strong> whethersoniebt)d}' L'Ise is with you The colour of vour sk<strong>in</strong>, your eyes, ihe v\armlh <strong>in</strong>side yiRir body, the pleasanl feel<strong>in</strong>g <strong>in</strong>sideyour body <strong>and</strong> the calmness simply do<strong>in</strong>g noth<strong>in</strong>g ctimplelely relaxed be<strong>in</strong>g carried, <strong>and</strong> the more youlet yourself be carried, ihe lighter you ean feel <strong>and</strong> il can be thai you feel like float<strong>in</strong>g on a cloud like <strong>in</strong> a pleasantdream see<strong>in</strong>g everyth<strong>in</strong>g from high above ihe litlle people <strong>and</strong> the little l<strong>and</strong>scape far away from your well-be<strong>in</strong>g,.... <strong>and</strong> wateh from up there, from that distance, happy <strong>and</strong> relaxed, what is happen<strong>in</strong>g down there, <strong>and</strong> it does nol havelo concern yoti on your beautiful, beauliful cloud any longer what is happen<strong>in</strong>g down there because il is brighl sun-•\Q European Journal of Cl<strong>in</strong>ical <strong>Hypnosis</strong>: 2006 volume 6 - issue 4
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