One of the first attempts to perform surgery under hypnosis took place in France in 1821; 8 years later (also in France) Jules Cloquet removed the breast of a 64-year-old woman while she was mesmerized. Surgery took 12 minutes and was without incident in terms of movement or complaints of pain. In 1842, M. Squire Ward, an English surgeon, performed a mid-thigh amputation while the patient was hypnotized.
By 1851, James Esdaile had performed several thousand minor surgical procedures and approximately 300 major surgical procedures in which the only anesthetic used was hypnosis In 1880, J. Milner Bromwell gave a demonstration of hypnotic anesthesia to a group of physicians at Leeds, England.
In spite of these impressive reports, medical interest turned away from hypnosis in surgery and toward the new, developing field of chemical anesthesia. Prime factors for this rejection of hypnosis were the reliability of chemical agents as well as the frequent lack of psychological skills needed to induce and manage the hypnotic state.
A renaissance in hypnosis for anesthetic purposes has occurred in the United States only since the 1950s. The renewed interest was reviewed by Manner (1959). In another essay. Manner (1963) listed eight cogent reasons for the use of hypnosis in anesthesiology:
1. To overcome fear, apprehension, and anxiety in order to reduce the tension associated with the anticipated anesthesia and surgery.
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2. For sedation, either in conjunction with or as a substitute for drug medication.
3. To increase patient cooperation and bring about peace of mind.
4. To produce analgesia and anesthesia.
5. To make for a more pleasant and more comfortable recovery from anesthesia and surgery.
6. To permit the use of posthypnotic suggestions to aid in the post-operative recovery of the patient by reducing the incidence of postoperative nausea and vomiting and by permitting deep breath-ing and necessary coughbreath-ing, thereby helpbreath-ing to reduce postopera-tive pulmonary complications. Also, to raise the pain threshold and reduce the need for postoperative narcotics as well as to encourage earlier fluid intake and easier urinary output.
7. To produce operative amnesia.
8. To help establish better postoperative morale and motivate the patient toward getting well.
M a n n e r ' s reasons are all valid. It is important to note that he often suggests the possibility of combining hypnosis with other techniques.
In his opinion the primary disadvantage of hypnosis as a method of anesthesia was that not all patients could be hypnotized; he estimated that only 10 percent could achieve a level necessary for surgery under
hypnoanesthesia alone. Another disadvantage is that hypnosis often requires considerably more time than chemical anesthesia, since sev-eral training sessions may be needed. Also, for some surgical proce-dures the hypnotic trance will not produce the deep degree of muscular
relaxation needed to maintain a quiet operative field for the surgeon.
In addition we would stress that there is a possibility that hypnosis may activate emotional conflicts if these are present but unsuspected in a neurotic or borderline subject (Rosen, 1957), As a precaution we have employed psychiatric screening before using hypnosis for anesthesia.
Manner suggests that those patients undergoing intensive psycho-therapy or psychoanalysis should not be hypnotized for anesthesia without the express permission of the therapist.
Rodger (1962) suggests that in using hypnosis the anesthesiologist
"can escape from the limitations of an impersonal drug orientation and enter into a significant communicative relationship with his patient."
This is doubtless the goal of good anesthesiology, even without hyp-nosis, but may be enhanced with the use of hypnotic procedures, particularly since they allow for more psychological interaction when the patient is in altered states of consciousness during induction for
surgery, during surgery, and in the immediate postoperative phase of recovery.
Hypnosis was never intended to replace chemical anesthesia, Rather, it should be seen as a useful modality in making psychological and emotional contact with the patient, who is always apprehensive about surgical procedures. This is equally true with children (Antitch, 1967; Betcher, 1958; Daniels, 1962; Klopp, 1961). Since emotions, no matter what kind, have a definite influence on bodily function, Wallace (1959) feels that the modification of emotion by hypnosis may be a distinct aid in anesthesiology. Many others have attested to the utility of hypnosis as a part of anesthesiology practice (Anderson, 1957;
Bartlett, 1975; Bernstein, 1965; Betcher, 1960; Cohen, 1980; Ewin, 1983; Lassner, 1964; Marmer, 1969; Succar, 1963).
T h e analgesic effect is obtainable in a number of persons and in apparently light stages of hypnosis (Horvai, 1959), though surgical anesthesia by hypnosis alone may require a greater depth. Evans and
Paul (1970) conclude experimentally that an adequate clinical evalu-ation of hypnotic analgesia has not yet been done, though some of their objections seem to have been met by Hilgard's work (1967). There is some evidence (Halliday and Mason, 1964) that the loss of sensation in hypnoanalgesia and hypnoanesthesia is not attributable to attenuation of the sensory messages in the afferent pathways on their way to the cortex; therefore, by implication, it is most likely to be at a cortical level.
Those clinicians who have studied the use of hypnosis in anes-thesia seem to have agreed on its utility in facilitating preoperative and postoperative care. Anxiety and pain can be prevented or diminished (Corley, 1965; Finer, 1966; Tinterow, 1960). In some cases postopera-tive pain seems greatly diminished (Paris, Mosgedis, and Durante,
1960). Autohypnosis has been employed for this purpose also. Vom-iting may be controlled (Tyson, 1964), an advantage when fractures are reduced in the emergency room, particularly with children. In reporting 100 cases in which hypnotic suggestions were given in the recovery room for improved posthypnotic recovery, Bensen (1971) reported that 72 percent had little or no postoperative pain, bleeding was 90 percent controlled, and 98 percent had normal thirst and appetite. T h e series of 100 surgical procedures consisted largely of hemorrhoidectomies, di-lettage and curettement, and tonsillectomies, with some removal of growth and tumors.
At present there is wide acceptance of hypnosis as an important adjunct in the practice of anesthesia (Carli, 1982; Cheek, 1981;
Crasil-neck, 1980; Erickson, 1979; Finer, 1980; Fredericks, 1980; Gherardi, 1982; Guantieri, 1982; Kasasian, 1982: Kroger. 1977; and Scott, 1974).
Hypnoanesthesia and hypnoanalgesia now are also utilized with chil-dren (Gardner and Olness, 1981).