Background and Goal of Study:
Hypnosedation combining hypnosis, conscious sedation and locoregional anesthesia has been evaluated as a valuable alternative to general anesthesia. This technique has been shown to decrease medication, to reduce adverse effects and to fasten postoperative rehabilitation. By minimizing effects of anesthesia on vital functions while preserving the patient's well being, it contributes to a sustainable development of anesthesia. We report the current use of this innovative technique in a cancer center.

Materials and Methods:
We performed a retrospective study on 150 patients operated on under hypnosis between 2011 and 2017 in the Curie Institute. No experience in hypnosis was required from the patients. Usual anesthetic safety conditions and monitoring were respected. The procedure excluded all premedication or hypnotic drugs. A continuous analgesic infusion of target-controlled remifentanil was adjusted to the patient’s comfort. The patient received usual preventive antiemetics and painkiller. Local or loregional anesthesia was performed depending to the surgery: a tumescent technique or a paravertebral block was performed for breast surgeries, a cervical block for gynecological surgeries. 

Results and Discussion:
Hypnosedations are reported for breast surgeries including total mastectomies and axillary clearance, gynecological surgeries, colonoscopies, superficial plasties. The mean surgical duration was 60 min (30 to 160 min). The mean length of stay in the recovery room was 35 min. The patients were aged between 18 and 100, with 60.5 being the average [figure 1]. 22% were older than 75 years old. 32% were classified ASA1, 36% ASA2, 30% ASA3. 2% ASA4 patients presented severe cardiac, respiratory or renal failures that questioned seriously the benefit of general anesthesia. For 98.6% of the patients, the hypnosedation let to achieve surgery under comfortable conditions for the patient as well as for the surgeon. In two case of discomfort, the procedure was easily converted to general anesthesia.

Conclusion:
Hypnosedation can be proposed as a useful alternative to a general anesthesia in various types of surgeries including major breast surgeries. By minimizing effet of anesthesia, this technique contributes to preserve the ecology of the patient and is particularly valuable for vulnerable patients.

References:
Meurisse M. Ann Surg 1999
Defechereux T. Ann Chir 2000

05 / 150 cancer surgeries under hypnosis: a valuable alternative to preserve the ecology of the patients.