Impact of a preoperative conversational hypnotic session on propofol consumption using closed-loop anesthetic induction guided by the bispectral index

Abstract

Objective:The automated administration of propofol in a closed loop could be used to objectively evaluate the nonpharmacological anesthetic action of hypnotherapy. The objective of this study was to evaluate the impact of a conversational hypnosis session on the consumption of propofol for anesthetic induction.Design:A randomized, usual care-controlled, single-center, patient-blind trial.Setting:Tertiary care center in France from November 2012 to December 2013.Participants:Adult patients scheduled for a surgical procedure under general anesthesia.Interventions:Before surgery, patients were randomized with a computer-generated random list for a preoperative conversational hypnosis session or for usual care. The conversational hypnosis session was conducted and individualized by the therapist with an academic degree in hypnosis in a quiet environment. Anesthetic induction was automatically performed by propofol without opioids and was assisted by the bispectral index in a closed loop.Outcome:Primary endpoint was the propofol dose required for anesthesia induction, defined as a Bispectral index less than 60 for at least 30 seconds.Results:The study included 48 patients in the hypnosis group and 49 patients in the control group. No difference in propofol consumption to obtain anesthesia induction was observed between the groups (total dose: 138.6 [67.5] and 130 [47.9] mg, P = .47; adjusted dose: 2.15 [1.09] and 1.95 [0.66] mg/kg, P = .28, for the hypnosis and control groups, respectively). Hetero-evaluation of arm movement during propofol injection (no reaction: 98% and 74%; P = .004, in the hypnosis and control groups, respectively) and face reaction at venous access placement (no reaction 59% and 30%; P = .017, in the hypnosis and control groups, respectively) were lower in the hypnosis group. No adverse event was reported.Conclusions:No difference in propofol consumption was observed in this study designed to evaluate the effect of a hypnotic conversational session on anesthesia induction using an automated tool for propofol administration.

The Effect of Low-Dose Intraoperative Ketamine on Closed-Loop-Controlled General Anesthesia: A Randomized Controlled Equivalence Trial

“…Closed-loop anesthesia was used to quantify the propofol-sparing effect of dexmedetomidine, 34 to demonstrate that the transversus abdominis plane block reduces propofol and remifentanil consumption, 35 and to show that preoperative hypnosis does not reduce propofol requirements to achieve induction of anesthesia. 36,37 It has also been used to eliminate bias in anesthetic administration while evaluating dexamethasone and ondansetron as PONV prophylaxis in obese patients. 38 Incorporating a closed-loop system as a research tool in this way assumes that a fixed pEEG-based depth-of-hypnosis measure is targeted.…”

Nociceptive stimulation during Macintosh direct laryngoscopy compared with McGrath Mac videolaryngoscopy

“…Details, set of rules and gains constant of the controller are provided in the appendix of a previously published article. [ 2 ] The controller has been used in several controlled studies, in particular a study of adult patients undergoing routine surgery with better efficacy than manual control, [ 2 ] and studies which adressed its efficacy in some specific populations (pediatrics, [ 13 ] obese patients), [ 14 ] or during some specific surgical interventions (lung transplantation, [ 15 ] liver transplantation, [ 16 ] and bronchoscopy), [ 17 ] or as a method to evaluate the anesthetic effect of a conversational hypnotic session [ 3 ] or of drugs (nitrous oxide, [ 4 ] dexmedetomidine), [ 5 ] or to evaluate the analgesic effect of intraoperative use of epidural analgesia. [ 6 ]…”

“…To avoid any human bias, propofol and remifentanil were automatically administered using a closed-loop system which uses the bispectral index (BIS) as the input signal and modifies the effect site target concentrations of both drugs according to the BIS variations to maintain a target at 50. [ 2 ] This closed-loop system has previously been used to evaluate the anesthetic effect of a conversational hypnotic session [ 3 ] or of some drugs (nitrous oxide, [ 4 ] dexmedetomidine), [ 5 ] and to evaluate the analgesic effect of intraoperative use of epidural analgesia. [ 6 ]…”

Conversational hypnosis versus standard of care to reduce anxiety in patients undergoing marker placement under radiographic control prior to breast cancer surgery: A randomized, multicenter trial

“…Various methods exist for practicing hypnosis ( Short, 2018 ; Etienne et al, 2021 ). Among them, conversational hypnosis (CH) has not been widely studied in clinical research ( Izanloo et al, 2015 ; Bataille et al, 2017 ; Boselli et al, 2018 ; Sourzac et al, 2018 ). This approach aims to distract the patient’s attention away from a potentially painful experience.…”