Keep Calm and Head into Surgery

Why relaxation techniques can work far better than pills

Most people find surgery so nerve-wracking that doctors often give their patients medication to soothe nerves even before the anesthesia or operation begins.

A new study, however, suggests that a few calming words from a physician may do more to ease a patient’s anxiety than taking a pill.

Led by Dr. Emmanuel Boselli, a physician anesthesiologist at Édouard Herriot Hospital in Lyons, France, the study examined the use of a technique called “conversational hypnosis” in relieving preoperational anxiety and fear.

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The researchers presented their findings this past month at the annual conference of the American Society of Anesthesiologists.

In conversational hypnosis, a doctor talks calmly and positively with the patient – saying things like “Keep calm and quiet,” rather than “Please don’t move.” The physician focuses the patient’s attention on something other than the surgical and anesthesia preparations.

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It’s essentially a way of tranquilizing the patient through words and positive suggestion, not what we commonly think of as “hypnosis.”

“Hypnosis is gaining interest in the operating theater, in particular to decrease patient anxiety and increase patient comfort without using medication,” Boselli told LifeZette. “Calming patients before surgery is important to provide better comfort and satisfaction.

Moreover, using conversational hypnosis changes the way the physician interacts with the patient (and adds) human contact to the very technical environment of the operating room.”

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Some preoperational nervousness and stress is normal. But when a patient’s anxiety becomes too great, it can actually trigger a physiological response, making the patient more sensitive to pain and necessitating more anesthesia.

An overly anxious patient can make the surgeon’s job more difficult.

It can also impede the patient’s healing and increase the chance of infection. An overly anxious patient also has a harder time following directions and can make the surgeon’s job more difficult.

“Some patients may feel really uncomfortable and even panic before surgery,” Boselli said.

Physicians tend to give nervous patients an anti-anxiety medication such as hydroxyzine to help them relax before surgery. Yet medication isn’t always the best option, particularly in outpatient surgical settings and with elderly patients who experience greater side effects like dizziness and confusion, according to Boselli.

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He explained that the “systematic use of premedication” has been debated within the anesthetic community, and that “there is a clear trend to decrease its use among practitioners.”

Boselli and his team examined 100 patients undergoing hand surgery and divided them into two groups. Half underwent “conversational hypnosis” before being given local anesthesia for the procedure.  The remaining 50 patients were given 25 milligrams of oral hydroxyzine, an anti-anxiety medication.

“I talk to patients and say, ‘I’m here, I’m going to take care of you,’ and then they relax.”

To compare the two groups, the researchers asked patients to provide a subjective rating of their comfort level on a scale of 0 (no comfort) to 10 (maximum comfort), and also rated patient anxiety using a test based on heart-rate variability.

The researchers found that patients who received “conversational hypnosis” reported feeling less anxious afterward than those who took the pill.

“The main finding of this study is that conversational hypnosis induced (a) greater increase in comfort scales … than oral premedication,” Boselli told LifeZette.

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Dr. Arno von Ristow, a practicing surgeon and professor of vascular surgery at Catholic University of Rio de Janeiro, Brazil, agrees that a pill is not always the best answer, and that it’s important to meet with patients before surgery, to answer patient questions and work to allay their fears.

“You have to talk to the patient and ‘tranquilize’ them with a calm approach and reassure (them) that everything is going to be okay, that they will feel well, that they won’t have pain in the post-operative period,” von Ristow told LifeZette.

“I go in and I talk to the patients and say, ‘I’m here, I’m going to take care of you,’ and then they relax.”

Another recent study out of the United Kingdom found that surgery patients who listened to music before, during or after their procedures showed reduced pain scores, anxiety, and need for painkillers. Music even worked when patients were under general anesthesia, the researchers found.

One thing is clear: A pill isn’t always the best option.

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