Publisher: Family Practice News
Chicago – A simple form of hypnosis reduced the average non emergency procedure time by 17 minutes and the average cost by $130 in a Harvard Medical School study of 161 patients undergoing angiography, angioplasty, and kidney drainage.
Patients were more likely to be hemo-dynamically stable, have fewer complications, and require significantly less medication if they were hypnotize, said Dr. Elvira V. Lang at the annual meeting of the Radiological Society of North America.
"We were amazed when we looked at the data," admitted primary investigator Dr. Lang, chief of cardiovascular and interventional radiology at the Beth Israel Deaconess Medical Center in Boston.
"It's not as though every patient was in LaLa land. I wondered (during the study) if this was just an exercise in futility," she said.
But when the numbers were tallied, it became clear that the 82 patients randomized to use imagery and relaxation techniques had smoother, quicker procedures than did the 79 who underwent a standard prep that did not include hypnosis.
Twilight sedation was administered to any patient who desired it. A bell was provided for patients to ring at any time if they wanted more anesthesia.
Almost half (38 of 82) of hypnotized patients requested no conscious sedation, compared with 18% (14 of 79) of patients in the control group, Dr. Lang reported.
Even with the added time spent hypnotizing patients, an average time savings of 17 minutes was realized in patients who were coached to relax by breathing deeply and imagining themselves in a safe and comfortable place.
The extra minutes spent on non-hypnotized patients were consumed with addressing complications that arose from under medicating or overmedicating patients, or with delays prompted by their calls for more drugs.
"These are the 17 minutes that give you gray hair," she said in an interview.
The cost reduction in hypnotized patients stemmed from less medication use and shorter post-procedures stays.
The evidence of benefit was so overwhelming that Harvard's entire interventional radiology team is undergoing training to incorporate hypnosis into procedures that induce anxiety or pain, Dr. Lang said.
Anxiety leads to direct and indirect complications, she explained. A patient who seems anxious receives more medication, upping the chance of side effects or dosing problems. But pain rises in an anxious patient no matter how much pain medication is given, and many patients report more pain even when stimuli are withdrawn.
Hypnosis is one way to reduce anxiety from the start, so patients maintain control of their coping mechanisms.
In the study, a trained nurse, the technologist, or physician reads from a script that asks patients whether they have ever been so engrossed in something-such as a book or movie-that they were only vaguely aware of events around them. Hypnosis similarly "changes your state of consciousness," they are told.
Patients are then asked to close and relax their eyes while breathing deeply. They focus on the sensation of floating, then create a pleasant imagined scenario.
"Interestingly enough, everyone immediately come up with something right away," Dr. Lang said. One patient built a birdhouse in his mind, another canned vegetables. Some choose to float on a cloud with loved ones, now deceased.
Patients of all ages welcomed the intervention, with the most anxious patients benefiting most. Perhaps this is because they conjured up the most engrossing dream-like scenarios, she mused.
"You have to have a good imaginative mind to become anxious," she said.
Copyright 2000 International Medical News Group in association with The Gale Group and LookSmart.copyright 2001 Gale Group.