Les processus hypnotiques modifient la façon d’être conscient au monde. Ils sont initiés par la focalisation de l’attention qui permet de rendre le sujet sensible aux suggestions qui lui sont faites. L’observation ou l’obtention d’un tel état permet au médecin anesthésiste de délivrer lors des suggestions en rapport avec son objectif de soin. Dans le cadre de l’anesthésie locorégionale, des suggestions de confort, d’analgésie et de facilité peuvent ainsi être dispensées et aider à la réalisation de l’anesthésie. Parallèlement, pendant toute la réalisation de l’anesthésie, l’hypnose permet de focaliser l’attention du patient sur des éléments neutres ou agréables choisis par lui ou le médecin. Tout est rendu plus facile par des techniques simples qui évitent le recours à des médicaments.

Hypnosis has shown an effect on the regulation of the autonomic nervous system by increasing parasympathetic activity. The Analgesia/Nociception Index (ANI) is derived from heart rate variability and represents the relative parasympathetic tone. We investigated the effects of hypnosis on ANI in healthy volunteers. Participants to the 2016 International Hypnosis congress, Saint Malo, France were recruited in this prospective observational study. After comfortable positioning of the subject in the sitting position (T0), the hypnotic trance was induced (T1) then conducted with suggestions of comfort (T2) before return to normal consciousness (T3). The ANI, heart rate (HR) and respiratory rate (RR) were recorded at the different time-points. Forty subjects were enrolled (31 women, 9 men). The mean ± SD ANI at T2 (84 ± 12) was significantly greater than at T0 (60 ± 10), T1 (62 ± 9) and T3 (59 ± 11). The median [25th–75th percentile] ANI values at T2 were significantly greater in women (90 [83–95]) than in men (74 [68–83]). There were no significant variations of HR during time. The median [25th–75th percentile] RR at T1 (16 [14–18] breaths/min) and T2 (14 [12–16] breaths/min) were significantly smaller than at T0 (18 [16–20] breaths/min) and T3 (18 [16–20] breaths/min). This study shows that hypnosis induces an increase in the relative parasympathetic tone assessed by ANI in healthy volunteers, with greater ANI values observed in women. These results suggest that ANI monitoring may provide an objective tool for the measurement of the intensity of the hypnotic process, although this should be confirmed by further studies.

This two-center quasiexperimental pilot study was to determine the effect of conversational hypnosis on patient comfort and parasympathetic tone, which may represent a quantitative measure of hypnotic depth, during regional anesthesia. The patients received conversational hypnosis in one center and oral premedication in the other. The patients' subjective comfort (0-10 rating scale) and objective parasympathetic tone, as assessed by the Analgesia/Nociception Index (ANI), were measured before and after regional anesthesia. The parasympathetic tone and comfort scores evidenced a significantly greater increase in the hypnosis patients than in controls. These findings suggest that using conversational hypnosis during regional anesthesia may be followed by a subjective increase in patient comfort and an objective increase in parasympathetic tone, monitored by ANI.

The purpose of this study was to evaluate the effects of a hypnotically-based intervention for pain and fear in women undergoing labor who are about to receive an epidural catheter. A group of 155 women received interventions that included either (a) patient rocking, gentle touching, and hypnotic communication or (b) patient rocking, gentle touching, and standard communication. The authors found that the hypnotic communication intervention was more effective than the standard communication intervention for reducing both pain intensity and fear. The results support the use of hypnotic communication just before and during epidural placement for women who are in labor and also indicate that additional research to evaluate the benefits and mechanism of this treatment is warranted.

L’hypnose au bloc opératoire permet de réduire l’anxiété périopératoire [1]. L’Analgesia/Nociception Index (ANI) est un index variant de 0 à 100, reflet du tonus parasympathique relatif pouvant être modifié avec les émotions [2]. Nous avons évalué de manière objective avec l’ANI et subjective avec une échelle de confort l’effet de l’hypnose conversationnelle lors de la réalisation d’anesthésie locorégionale (ALR) chez l’adulte. Il s’agit d’une étude bicentrique quasi expérimentale de type “Ici-Ailleurs”. Après accord du CPP Sud-Est IV (réf. L14–80) et recueil du consentement éclairé signé, 100 patients consécutifs opérés du membre supérieur avec bloc axillaire en ambulatoire ont été inclus. Cinquante patients à Lyon ont reçu 25 mg d’hydroxyzine en prémédication et n’ont pas été accompagnés par hypnose pendant l’ALR et 50 patients à Saint-Grégoire n’ont pas reçu de prémédication mais ont été accompagnés par hypnose conversationnelle. Les patients âgés de > 75 ans, traités par bêta-bloquant ou atteints d’arythmie étaient exclus. L’ANI a été recueilli à l’aide du moniteur PhysioDoloris™ (MDoloris Medical Systems, Lille, France) avant et après l’ALR dans les deux groupes. Le confort des patients, évalué par échelle numérique simple de confort (ENSc) allant de 0 (aucun confort) à 10 (confort maximal) a été évalué avant et après l’ALR dans les deux groupes. L’ANI et l’ENSc avant et après ALR ont été comparés entre les groupes par ANOVA à mesures répétées avec un test post-hoc de Bonferroni. Les variables quantitatives ont été comparées par test-t de Student ou U de Mann-Whitney selon leur distribution. Les données qualitatives ont été comparés par test de χ2. Une valeur de p < 0,05 était considérée comme statistiquement significative. Les caractéristiques des patients étaient similaires entre les groupes (Tableau 1). L’ANI et l’ENSc étaient significativement plus bas avant ALR dans le groupe avec hypnose mais significativement plus élevés après ALR que dans le groupe sans hypnose avec prémédication (Fig. 1). Résultats en moyenne ± DS, médiane [IQ 25–75] ou n (%) L’hypnose conversationnelle pratiquée lors de la réalisation de bloc axillaires induit une augmentation significativement plus importante de l’ANI et de l’ENSc que chez les patients sans hypnose. Les valeurs initialement plus basses d’ANI et d’ENSc chez les patients avec hypnose sont probablement liées à l’absence de prémédication. L’utilisation de l’hypnose conversationnelle pourrait permettre d’améliorer le bien-être des patients non prémédiqués lors d’ALR en ambulatoire. Un effet centre ne peut cependant pas être exclu de cette étude en raison de son plan quasi-expérimental et ces résultats préliminaires méritent d’être confirmés par un essai comparatif hasardisé contrôlé.

Objective - Implant placement Essure (TM) sterilization procedure for women were performed under hypnosedation (HYP) and compared to the operative anxiety and analgesia of 12 patients operated-on under general anesthesia (GA)Study design - Prospective and comparative group studyPatients and methods - Two groups of twelve patients were matched and compared based on the choice of anesthetic technique hypnotics (HYP) with possible additional sedation by propofol and remifentanil or GA involving propofol sevoflurane and remifentanil The assessment of anxiety and pain based on a visual analogy scale (0-10) and use of analgesics were studied in the recovery room and at discharge of hospital The statistical analysis relies on nonparametric tests for paired data (Wilcoxon test)Results - All patients were operated The two groups are statistically comparable The preoperative anxiety before premedication is lower in the HYP group (p < 0 05) No conversion to general anaesthesia is necessary in the HYP group but five patients were using sedatives drugs but doses are very low compared to general anaesthesia The analgesic consumption was equivalent in both groupsConclusion - We conclude that hypnosedation is a valuable alternative to traditional anesthetic techniques for ambulatory Essure (TM) implant The use of hypnotic tool is an interesting alternative for the management of patients during invasive medical procedures or surgical providing psychological benefits to the patient (C) 2010 Published by Elsevier Masson SAS

Local anesthetics when injected intravascularly result in serious cardiac complications including therapy-resistant cardiac arrest. We report a case of cardiac arrest after lumbar plexus block using a combination of 0.5% bupivacaine and 2% lidocaine with epinephrine (1:200.000). Resuscitation was performed by a combination of chest compression, repeated external countershocks and i.v.epinephrine. Clonidine had poor effect. The whole resuscitation required 90 minutes. The patient was discharged four days later without any sequelae. Blood sampling at 10 minutes showed a concentration of 2.02 mg/l lidocaine and 0.87 mg/l bupivacaine. Prolonged resuscitation is necessary in local anesthetic-induced cardiac arrest.

Objectives. - During many years the approach to the lumbar plexus has been the anterior paravascular technique described as a "3-1" block by Winnie. The posterior approach results in a complete block of the principal nerves of the lumbar plexus. The goal of the study was to evaluate the performance of the psoas compartment block with general anaesthesia.Study design. - Prospective, descriptive, non randomized study.Patients and methods. - Ninety-three patients scheduled for hip surgery were studied after informed consent. Demographic data, technical aspects of the puncture, complications, and intra- and postoperative analgesics were recorded.Results. - The block was performed by resident alone, senior alone, both in respectively 44%, 45, and 11% of cases. The mean duration of the procedure was 6 +/- 3 min for the residents, 5 +/- 2 min for the seniors, and 9 +/- 4 min for both, The transverse process was reach in 72% of cases during the first approach, after reorientation of the needle in the others cases, except 3 failures of attempt. The lumbar plexus was assessed within 60-90 min of depth, with a median of 75 mm. The motor response was mainly a femoral response; the minimal intensity of stimulation was ranged between 0.3 and 1 mA, with a median of 0.6 mA. The duration of analgesic block was 16.5 +/- 4.5 hours, with a median of 18 hours. The morphine use during the first postoperative 24 hours was 8 +/- 8 mg, with a median of 5.6 mg. No neurologic complication was recorded at discharge from the hospital.Conclusion. - The psoas compartment block with general anaesthesia have shown it feasibility and efficiency on intra- and postoperative analgesia during hip surgery. (c) 2007 Elsevier Masson SAS. Tous droits reserves.