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t m c » p u l s e | m a r c h 2 0 1 8 31 Hypnosis in the Operating Room Doctors and researchers at MD Anderson are exploring hypnosedation to manage pain and anxiety during certain breast cancer surgeries W hen Beverly Levinson's doctor noticed two unusual spots on her dense breasts, she was sent to The University of Texas MD Anderson Cancer Center for a lumpectomy—a surgical procedure to remove abnormal or cancerous tissue along with a small portion of the surrounding healthy tissue. Levinson, 64, wasn't as con- cerned about the surgery as she was about undergoing general anes- thesia. She had received general anesthesia for previous surgeries, but because of her temporoman- dibular joint (TMJ) disorder, she suffered severe jaw pain from open- ing her mouth wide enough for the breathing tube to be inserted down her throat. Luckily, an unconventional solution presented itself to Levinson. Her surgeon approached her about an ongoing clinical trial that would allow her to avoid gen- eral anesthesia by using hypnosis. Levinson, who had been hypnotized for jaw pain years ago, immediately jumped at the opportunity. "In my eyes, I had nothing to lose," Levinson said. "I could try something new or I could go the old-fashioned way. I'm the middle child. I always try new things. That's my personality." Led by Lorenzo Cohen, Ph.D., director of the Integrative Medicine Program at MD Anderson, the ongo- ing clinical trial aims to determine whether or not a method of deep relaxation, called hypnosedation, is safe and effective for patients with stage 0/1 breast cancer who are undergoing lumpectomies with or without sentinel lymph node dis- sections. The study, still in its pilot phase, will examine 50 patients who are randomly selected to receive either general anesthesia or a combination of local anesthesia and hypnosedation before and during surgery. In both cases, a patient has an intravenous line placed in her arm and an anesthesiologist is present to administer a cocktail of drugs used to put her under. For patients receiv- ing hypnosis, the anesthesiologist monitors their vitals, calculates the appropriate dose of local anesthetic medication, administers medication for pain and nausea and stands by to convert to general anesthesia if the B y S h a n l e y P i e r c e Rosalinda Engle, a mind-body specialist at MD Anderson Cancer Center, prepares a patient for surgery. As part of the clinical hypnosedation trial, an electroencephalography (EEG) cap is placed on a patient's head to record neurological activity before, during and after the surgery. patient experiences any discomfort. "Over the past couple of decades there is a very solid evidence base that incorporating hypnosis during invasive conscious sedation medical procedures reduces anxiety, helps to control pain, decreases recovery time, and helps lower medical costs," Cohen said. General anesthesia is still the standard approach at MD Anderson, even for smaller surgeries, such as lumpectomies. But the drugs used for general anesthesia can poten- tially weaken the body's immune system and slow the recovery pro- cess, Cohen said. Cancer patients, in particular, cannot afford to have their immune systems compro- mised. Cohen and his team want to find out if hypnosedation would be a viable replacement for general anesthesia during smaller, less invasive surgeries. * * * The practice of hypnosis, in one form or another, has been around for centuries. (continued) My sole job is to sit at the head of the bed and focus on the patient. Any changes to breathing patterns [or] facial muscles is an alert to me that I need to check in. Periodically, I'll ask the patient, 'How's your comfort level?' — ROSALINDA ENGLE Mind-body specialist at MD Anderson Cancer Center