The Effects of Hypnotic Suggestions in Sedation and Anesthesia Part 1 of 10
M. Ron Eslinger
• Define hypnotic suggestions
• identify the difference between a positive hypnotic suggestion and a negative hypnotic suggestion.
• List sedation and anesthesia medications that are classified as hypnotics.
• Review the effect of pre-surgical stress on possible patient intraop responses and postop outcomes.
• Identify the brain mechanisms that respond to suggestions and anxiolytic medications.
• Discuss examples and benefits of hypnotic suggestions and hypnotic language.
“The difference between the almost right word and the right word is really a large matter. ’tis the difference between the lightning bug and the lightning.” Mark Twain
1. What is a hypnotic Suggestion?
Hypnotic suggestion is the act of offering an idea for action or for consideration of action.1 Subjectively, hypnosis is a form of self-induced, focused attention. Patients when focused on their anxiety and fear meet the definition of focused attention or they are in hypnosis.
It is easy to integrate the principles of therapeutic suggestion into daily conversations with patients and families. Unfortunately, as you will read later, it is just as easy to integrate toxic suggestions into the conversation.
By definition, hypnotic language is designed to produce a hypnotic trance. However, the purpose of this text is to introduce the reader to a language that is positive in nature and suggestive to patient safety, comfort, and wellness. Even though, hypnosis or anything hypnotic is seen by many as dark and sinister, a magical power, and even mind control; it is in reality a natural mental state of focused attention experienced when daydreaming, reading, watching TV and driving. We become so involved in the activities we zone out, and we pay little or no attention to what is going on around us. Highway hypnosis is a good example. It is a mental state in which a person can drive great distances, responding to external events in the expected, safe and correct manner with no recollection of having consciously done so.2 In this state, the driver’s conscious mind is apparently fully focused elsewhere, while seemingly still processing the information needed to drive safely. In these trance like states the automatic subconscious self is more open to suggestions.
During sedation and anesthesia, medications classified as hypnotics may be given to patients to decrease anxiety. Benzodiazepines and propofol are classified as hypnotics. Patients receiving hypnotic medications are more responsive to what they hear and see. Therefore, the suggestions we give patients receiving hypnotic medications, are hypnotic suggestion. The brain responds literally to the suggestion creating a biological and physiological reaction that is influenced by past experiences and memories. A bad or painful hospital experience in the past can greatly affect a patient’s anxiety levels to future hospital visits.
Patients in an altered state of consciousness respond to words as hypnotic suggestions. An example is a 34-year old lady referred for hypnosis with a two-year history of painful chronic cystitis, post-abdominal hysterectomy. She woke up in the PACU two years earlier, screaming in pain. The treatment plan was to admit her for three days of drug detoxification followed with hypnosis. The first session would be followed in three days by the second while she was still in the hospital. She would then be discharged from the hospital with follow up sessions at one-week intervals as needed. She emerged from her first session asking, “Why didn’t they send me to you two years ago? My pain is gone!”
In one session the pain was gone. During a later hypnosis session, the patient was asked if she was willing to uncover the cause of the pain. She stated she was and during the session she learned that while her surgeon was dissecting the uterus from the bladder, she had heard someone say. “This will be one hurting bladder when she wakes up!” She had no conscious memory of those words but her subconscious heard and did what it was told to do, and she hurt for two years. She had four hypnosis sessions and when contacted three years later the pain had not returned.3
In their book, Patient Sedation Without Medication, Elvira Lang, MD and Eleanor Lasser, PhD note the works of Rosabeth Moss Kanter of Harvard business school describing her research in areas of self-confidence and self-fulfilling prophecies, stating that positive expectations can become self-fulfilling prophecies.4 Nursing suggestions are capable of creating positive or negative expectations. Would you agree that what is true for positive suggestions would also be true for negative suggestions? Which would you rather have said to you after a procedure? You are looking comfortable. Can I get you anything? Or on a scale of zero to ten how much pain are you having? You choose.
I worked at a hospital that changed the pain scale to the comfort scale. Rather than asking, on a scale of zero-ten with zero being no pain and ten the most pain you ever had, how much pain are you having? The comfort scale was asked by saying, “from zero-ten what is your comfort level or how comfortable are you?” The Joint Commission’s doesn’t dictate how pain is measured just that it is measured the same throughout the facility.
Table 1 gives examples of negative verses positive language.5
Negative language Positive Language
Don’t worry. What are your concerns?
Hurt or pain Comfort
Doctor is cutting. Incision or getting started
Putting you to sleep. It’s okay to take a nap.
It won’t be long. In a short time
Are you having pain? Are you comfortable?
Labor pains or contractions Baby hugs
Are you feeling sick? You should be hungry.
“A picture is worth a thousand words.” Chinese proverb