Blepharoplasty under hypnosis: a personal experience.

This paper is a first hand account of my experience undergoing upper and lower Blepharoplasty surgery in which hypnosis was used as the primary sedative agent. It describes the basics of hypnosis. It also includes a description of how l prepared myself for surgery as well as how I helped the surgical team prepare for the surgery. Recommendations are offered for nurses who would like to incorporate hypnotherapy into the operating room.

This event came about due to a number of events: (a) I am a RNFA with many years experience in plastic surgery, (b) I have a familial predisposition for excess skin and fat herniation of both upper and lower eyelids, (c) I am a trained hypnotherapist, and (d) the surgeon I worked with embraces holistic adjuncts to traditional surgery. In addition, the nursing manager and the staff at the hospital were open-minded and their support created an atmosphere conducive to this innovative approach to surgery.

Contrary to popular belief, hypnosis is not asleep state. It is a relaxed state in which the subconscious mind remains active and receptive to suggestion. This allows a person's conscious and subconscious minds to believe in the same message, thus promoting and reinforcing this message at the same time. In this ulna-relaxed state, the person is able to suspend critical judgment and exercise selective thinking (Dunphy, 1990). In such a state, fear and the perception of pain can also be suspended. This allows the patient to become an active participant in the surgical procedure, as well as in the postoperative recovery period.

Mind Over Matter

The power of the human mind has long been recognized. Stories of spontaneous recovery from terminal illness, super-human feats of strength, and the like, can be found in both secular and religious contexts. Examples range from the Bible's laying on of hands to the urban myth of the frail grandmother who lifts a car off her grandchild to save him. Regardless of the context, few would dispute the assertion that the human mind has the capacity or ability to influence such physical realities. Although most of these stories are anecdotal in nature and with spotty documentation, nurses and medical personnel are in a particularly good vantage point to see the mind's abilities in action.

As nurses, we have all seen the miracle recovery of an extremely ill patient who possessed a positive and optimistic attitude and, conversely, the slow decline and eventual death of patients who have given up hope.

Hypnosis, simply defined, is merely a process by which the power of the subconscious mind can be accessed and used for the benefit of the individual. By suggesting to the subconscious mind that positive outcomes can be easily achieved, the mad to surgical recovery can be a smooth and rewarding one.

A Brief History

The use of hypnosis in healing and surgery predates recorded history. According to William J. Bryan, MD, (1963), In the religious and healing ceremonies of all primitive peoples on the face of the earth, there exist the elements essential to place the subjects into a hypnotic trance ... all world travelers are familiar with the Hindus, Fakirs, Yogis, snake charmers, and eastern magicians who induce themselves and others in cataleptic states by eye fixation and other mesmeric techniques and were able to perform unusual physical feats and eliminate pain. (Bryan, 1963, p. 1).

The principles of hypnosis have been used for millennia, but the word hypnosis (derived from the Greek hypnos meaning sleep) was not coined until 1842 by James Braid. Later in his life, Braid realized that hypnosis was not a true sleep state, but an intense concentration of the mind.

The modern use of hypnosis in surgery began in the mid 1800s with the work of Dr. James Esdalie, who performed more than 300 major surgeries under hypnosis while working for the British East India Company. This coincides with the discovery and use of chloroform and ether as the first chemical anesthetic agents. This may lead one to wonder how drastically different our approach to modern anesthesia would be without the discovery of these chemicals. As we enter this new millennium, can modern medicine incorporate the power of the mind in the enhancement of the art of healing? I believe the answer is Yes!

A Personal Perspective

I had long been considering a blepharoplasty, but had not seriously formed any plan to have it done. Some of my concerns revolved around having seen many surgical complications, possible problems with anesthesia, and the idea of surrendering complete control of my body to someone else. These concerns delayed a decision on my part and any commitment to surgical intervention.

In 1998, I met Anne H. Spencer, PhD, the premier Hypnotherapist in metropolitan Detroit and founder and executive director of the International Medical and Dental Hypnotherapy Association[TM]. Like most lay people, I had a very distorted view of hypnosis, which had no basis in fact. Under the instruction of Dr. Spencer, I learned how hypnosis works and how it could be used in the operating room. I saw that hypnosis during a blepharoplasty was a solution for me and addressed the concerns I had about having the blepharoplasty. I was intrigued with the idea of having awareness during surgery, not needing chemical anesthesia and narcotics to cloud my perception, and, most of all, maintaining some control over my own surgery. I was excited about the ability to become an active participant in the surgical process. I decided to proceed with the surgery.

Preoperative Period

With the collaboration between Dr. Michael H. Freedland, the plastic surgeon, and Dr. Spencer, a plan was developed. Since this was the first procedure done under hypnosis at our hospital, the cooperation and support of the surgical staff was elicited. The nurse manager, who is a CRNA, was immediately positive. Her response gave me a sudden feeling of empowerment. She allowed Dr. Spencer to be in the operating room and allowed the use of various monitoring equipment, which included the standard monitors (ECG, respiratory and pulse ox) to monitor my physical state, and the BIS monitor which acts much like a simplified EEG to monitor the level of consciousness. A representative from the hospital's biomedical engineering department was present during the procedure since we did not routinely use Bispectral Index Monitoring. The nurse manager allowed me to select the progressive and open-minded surgical staff who would be present during my surgery. All of these things created an atmosphere conducive to hypnoanesthesia, which is a deeper state of hypnosis known as somnambulism or selective amnesia state.

In this state of hypnoanesthesia, reality is momentarily suspended and a suggestion is made in which the hand is numbed, as if being immersed in ice water. This numbness can be transferred to any body part by touching the part with the numbed hand. This is also known as glove anesthesia. This technique has been used very successfully in many medical and dental procedures.

Next, the plastic surgeon and I developed the actual surgical plan. Having performed this surgery together countless times, we were in concert on the technological aspects of the surgery. This plan seemed so different without the consideration of regular anesthesia. In our plan, it was important to control the atmosphere in the operating room (OR)--providing a quiet, safe place with pleasing, relaxing music; limiting the distracting noise associated with the bustle and activity in the OR; and the elimination of unnecessary table talk. Controlling the environment allowed Dr. Spencer to induce hypnosis and maintain it with positive imagery and relaxation techniques.

Once the plan was made, we chose the surgical date, and it felt like there was little time for me to practice the hypnoanesthesia.

As the date approached, Dr. Spencer and I had three hypnosis sessions. First, I was familiarized with the somnambulism or selective amnesia state. We went through the entire process of glove anesthesia and deepening of the relaxation state. After these sessions, I was able to induce the glove anesthesia state in myself through self-hypnosis and deepen my relaxation through imagery. In the OR I imagined myself lying in a hammock in my backyard. I completed six practice sessions where I actually did lie in the hammock in the back yard. This technique has been used very successfully in many medical and dental procedures. The sessions to learn this, as well as practicing this technique, gave me the confidence I needed to control and negate the conscious response to pain.

The Surgery

On the day of my surgery, I assisted the plastic surgeon, Dr. Freedland, in four surgeries using traditional anesthesia. I was the fifth of his patients that day. Because of all of the prior preparation and my intimate involvement with the entire process, I felt empowered rather than anxious. The surgical staff that I had hand selected was present and ready, and there was great excitement over the prospect of this surgery with new age hypnoanesthesia. Would I be overwhelmed with pain and require unplanned general anesthesia?

The CRNA for my surgery insisted that I have an intravenous line (Heplock) inserted in the event of a vagal response secondary to the oculomotor stimulation of the surgical technique. I allowed this only to appease my co-workers and then reclined on the OR table. Dr. Spencer quickly placed me in a relaxed state, then the deeper somnolent state, and then applied the glove anesthesia effect.

I was prepped and draped in the usual sterile fashion. Throughout the procedure, I was aware of my surroundings. Relaxing music, that I chose ahead of time, was playing. All voices were intelligible. The typical sounds of the OR were recognizable, and my sense of touch was intact. Because I had so much experience first-assisting with this particular procedure, I was aware of each individual step. The sensations of pain and time were absent. (I later learned that actual skin-to-skin time was an hour and a half.)

The first test of the hypnoanesthesia was with the injection of approximately 5cc of 1% lidocaine with 1:150,000 epinephrine for each eye. (Dr. Freedland and I had already agreed on the minimal use of local agents). I felt no discomfort, only slight pressure, as the spinal needle entered above and below my orbits. Next, I was aware of the scalpel moving along the lash of my right lower lid, followed by the tug of retraction and the sound of the Bovie. Again, I felt no pain or anxiety as I listened to the usual OR table manners while equipment is requested and passed. I felt the pressure of the mosquito clamping the fat pads of my lower lids. At this point, I was registering alpha and theta levels of consciousness on the Bispectral Index Monitor. The alpha level is a subconscious or innerconscious state associated with emotional feeling and intuition. The theta level is an even deeper subconscious state that is associated with creativity. These states do not necessarily connote sleep.

Although everyone enters these states during sleep, through practice one can achieve such states during wakefulness. The beta or waking state reflects the outerconscious with cognitive and logical thought with a full realization of space and time. These are the thought processes suspended during hypnoanesthesia.

Suddenly, I was startled to feel an electrical shock arching to my forehead through the ground pad of the Bispectral Index monitor. Due to this shock, I brought myself out of the hypnotic state to tell the surgical staff of this shocking experience. From that point on, a hot temp coagulation device was used instead of the Bovie. Then, Dr. Spencer quickly returned me to my hypnotic state through voice and therapeutic touch. Since she had been holding my hand throughout the surgery, she was consciously aware of my state.

The remainder of the surgery was uneventful until the end when I heard a voice say, I don't like this. I felt no pain but had a bit of anxiety related to this statement. (I later learned that my left lower lid closure was less than perfect and was subsequently revised). The next thing I remember in this state of hypnosis was Dr. Spencer telling me to return to full consciousness.

I then sat up on the edge of the OR table, hopped down, removed my unused Heplock and walked to the lounge where I pranced around in triumph and reveled with my colleagues. Half an hour later, I had dinner with the first assistant and drove myself home (a 70-minute drive).

Postoperative

Due to the post-hypnotic suggestions given prior to surgery, I had no post-op discomfort and little swelling and bruising. I took only Vioxx each morning, more for its anti-inflammatory action rather than for discomfort. I applied Arnica Montana gel several times a day. Arnica Montana is an herbal extract recognized to reduce bruising and swelling and is used by many athletes. It has been used in holistic medical practices successfully. I took no narcotics.

On postoperative day (POD) #1, I went to a weekend seminar, and on POD #3, I returned to work, assisting in a full day of surgeries. Within two weeks, there was no sign of surgical intervention, with the exception of my improved appearance. The entire experience was very positive, and I thank the doctors and my OR staff wholeheartedly.

I have reflected a lot about my surgical experience and have come to some conclusions regarding hypnosis and surgery, in general. First, the environment of the OR and the attitude maintained during surgery is paramount. I know now that an unconscious patient is fully aware of his or her surroundings regardless of the anesthetic agents used. Patients can hear all the sounds and statements made in the OR and register them mentally. Statements such as, We're losing him He's bleeding like a stuck pig, or This looks like a ,tab practice suit waiting to happen may be self-fulfilling prophecies. As nurses in the OR, we need to be particularly aware of what we say in the OR and how we say it. A patient's post-op recovery can be influenced by inadvertent comments. Conversely, positive and reassuring statements made to patients can speed recovery and promote healing. This is also true of touch. Although a patient cannot respond, he can recognize rough handling or a gentle, more therapeutic touch. The entire surgical team, from the pre-op holding area to the recovery room, can be instrumental in facilitating positive outcomes simply by maintaining positive postures and attitudes.

Epilogue

Since my own surgical experience, I have used the principles of hypnosis in my practice. I routinely give post-hypnotic suggestions after administration of Versed (a powerful chemical hypnotic agent). These may result in the need for less anesthesia, ease of awakening from anesthesia, less post-op pain and nausea, etc. Using these principles has appeared to improve patient outcomes and increase overall patient satisfaction. Hopefully, as the trend towards a holistic approach to patient care expands, it will some day permeate the sterile environment of the operating room.

Conclusion

As we enter this new millennium, it is my hope that modern medicine and nursing embrace a more holistic approach to patient care and combine age-old techniques and treatments with modern technology. As nurses, we use many techniques used in hypnosis daily (e.g., therapeutic touch, guided imagery). Nurses can become educated through weekend seminars, books and other educational materials, and practice of the technique. Then, they may integrate hypnosis into their clinical practices with very positive results: improved pain management, speedier healing, behavioral changes, etc. In the future, I see an office in every hospital with a sign on the door saying, Hypnotherapist!

Chris Haskins is a graduate of Infinity Institute, an IMDHA member, and night nurse in Davidson, MI where he also resides, at 9468 East Potter Rd (48423).

Dear Dr. Anne.

Thank you for having me speak at the IMDHA 2001 Conference. I met so many nice people, and really enjoyed the time. The Hypnoanesthesia class was enjoyable and the other students were a delight. Jerome is a warm and informative teacher. The hypnosis show at the dinner was outstanding. I was very proud of Laura.

Bless you,
Dr. Sally Witt
[e-mail]-Morrisville, Pa