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t m c » p u l s e | m a r c h 2 0 1 8 33 this experience," Engle said. "They can train themselves to be as relaxed and calm as possible. They can guide themselves. They can walk through this experience with surgery and take it throughout the treatment process, the whole contin- uum of cancer care." While general anesthesia is very safe for most people, it can have unpleasant side effects. The most common are temporary nausea and vomiting, dry mouth, a sore throat and grogginess. Older patients who receive general anesthesia are more likely to experience longer-term cognitive and memory impairments, a condition called post-operative cognitive dysfunction (POCD) that can last anywhere from a few days to a few months. Those with a history of POCD have a higher risk of expe- riencing the condition again with repeated anesthetic. "[Hypnosedation] is a nice alternative," said Elizabeth Rebello, M.D., associate professor in the department of anesthesiology and perioperative medicine at MD Anderson. "The patient doesn't require an extended period of time in the recovery room. They're able to go on with the rest of their life." * * * According to Cohen, more than 34 clinical trials and numerous papers published in scientific jour- nals have shown that hypnosedation works. But he says there is still some doubt among his colleagues. "Although a physician may think, 'I don't believe in hypnosis,' that is a scientifically unsound state- ment. Science is not about personal belief. It's about evidence," Cohen said. "Your religious practices are part of a belief system. Science is evidence-based. Unfortunately, there are some people who approach science from a belief per- spective, as well, and they're wrong." Most surgeons were initially reluctant to participate in the clini- cal trial, said Dalliah M. Black, M.D., a breast surgical oncologist at MD Anderson. Because the standard approach at MD Anderson is to use general anesthesia for surgeries large and small, most surgeons are accustomed to having their patient sleep throughout every procedure. "Surgeon interest was very slow up front, but I would offer them to come in to watch my cases," Black said. "Many colleagues have been so surprised." Using hypnosedation, patients like Levinson can gain some semblance of control during an otherwise stressful experience. "It's amazing how complex we are as humans and how complex the mind is. A lot of times, it's mind over matter," Black said. "Hypnosedation is a way we've applied mind over matter to a situation in the operat- ing room for a specific population of the patients here. That mental forti- tude and the strength that we have, that has to be carried through and has better outcomes if we use that path throughout our cancer care." No matter how effective the clinical trial shows hypnosedation to be for surgeries, Rebello stressed that hypnosedation will not become a new standard approach for pain management. "I think there's a concern that this is going to replace general anesthesia. It is not going to replace general anesthesia," Rebello said. "But for a certain niche of patients, there are certainly some benefits that could exist and we need to find out if that is, indeed, the case." I felt very, very safe. It was like [going] into someone's house where they're baking a cake. It smells good, and they welcome you in. — BEVERLY LEVINSON Hypnosedation patient • Houston area's only MPH program in healthcare management • One of only !ve MPH programs in healthcare management in the nation accredited by the Commission on Accreditation of Healthcare Management Education (CAHME) • Located in the heart of the Texas Medical Center • Diverse faculty includes researchers, consultants, former executives and current administrators of major healthcare organizations • Offers degree and certi!cate programs in the fast-growing !eld of healthcare management Housed in UTHealth School of Public Health, the George McMillan Fleming Center for Healthcare Management provides rigorous training in healthcare management paired with a one-of-a-kind focus on population health. Learn more about our programs go.uth.edu/!emingcenter L E A R N F R O M L E A D E R S I N H E A LT H C A R E M A N A G E M E N T

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