Breast cancer survivor Zelma Reid won’t be sidelined by a painful side effect. MD Anderson doctors used innovative surgical solutions to relieve her lymphedema, which is associated with the treatment of many cancers.
Summer 2018 : A conscious decision in the operating room
A conscious decision in the operating room
Clinical trial tests the use of hypnosedation instead of general anesthesia during some breast cancer surgeries.
A surgeon, anesthesiologist, mind-body specialist and other members of the health care team work together to perform a breast biopsy on a patient who chose hypnosedation over general anesthesia. Photo by Adolfo Chavez III
Most people think of hypnosis as a kind of party trick — a mischievous way to make somebody unconsciously do your bidding.
But at MD Anderson, a groundbreaking study is evaluating the use of hypnosis as a substitute for general anesthesia during certain kinds of breast cancer surgery.
The study has the potential to revolutionize the way hospitals across the country conduct surgery.
“People think that when you're hypnotized you're going to be instructed to do things you wouldn't otherwise do, like get up on stage and cluck like a chicken, or reveal deeply hidden secrets,” says the study's principal investigator, Lorenzo Cohen, Ph.D., professor of Palliative, Rehabilitation and Integrative Medicine and director of the Integrative Medicine Program. “Actually, it just allows people to dissociate from the place they're in and achieve a deep relaxation.”
Like meditation, hypnosis is a simple skill that almost anyone can learn. And in the ongoing trial, it's proving to be a remarkably effective alternative to general anesthesia in patients undergoing a simple breast lumpectomy. Today, standard practice at MD Anderson and most other American hospitals is to fully sedate patients during operations. But there's a growing body of research pointing to the health risks of general anesthesia.
“For many people it can cause postoperative nausea and vomiting,” Cohen says. “It can cause short- and long-term cognitive deficits. And there's evidence that it causes immune suppression, something we do not want happening when we're trying to control cancer growth.”
Given the current opioid crisis, there’s also been a backlash against what some consider an over-reliance on drugs in pain management.
Dalliah Black, M.D., is leading a study of hypnosedation in lieu of general anesthesia for women undergoing breast biopsies. Photo by Wyatt McSpadden
Right now there's a movement all over the world questioning how much medicine we give patients,” says Dalliah Black, M.D., associate professor of Breast Surgical Oncology and leader of the surgical part of the study. “Do we really need to knock out everyone who has surgery?”
Finding cancer patients willing to try hypnosedation in lieu of general anesthesia was easier than the doctors anticipated. Rosalinda Engle, a trained mind-body therapist at MD Anderson, meets with each patient during two 20-minute sessions prior to the surgery to introduce herself and explain the process. She tells them to practice closing their eyes, relaxing their hands, feet and jaw, and taking deep, slow breaths. Engle then asks them to think of a place where they were truly relaxed — a vacation spot or a childhood home.
“Your brain is receiving the message that you’re at ease,” she explains.
“There is no state of alert, there is no crisis, and you can relax even more deeply.”
Patients remain conscious during surgery but in a dissociated state, similar to the feeling of not remembering the details of driving a car to a destination.
“We do this every single day when we split our attention while we're driving somewhere, or sitting at our desk imagining a future vacation,” Engle says.
Hypnosedation can't completely replace more traditional pain treatments. Local anesthetics are still used to numb the breast during the operation, and the patient receives some IV pain medications tailored to their needs. An anesthesiologist is always standing by to administer general anesthesia if necessary.
But out of the study's more than 50 surgeries, general anesthesia had to be used only one time. The reaction from patients has been overwhelmingly positive.
“Patients come out of these surgeries asking for a recap of what I did, because they want to use it again during future treatments,” Engle says.
For the study, each patient is hooked up to an EEG machine that tracks their brains' electrical activity during surgery. The researchers have noticed a pattern of altered activity in the visual cortex and pain receptors of people under hypnosedation.
“The pain is being controlled and the visual image components of the brain are being affected,” says Elizabeth Rebello, M.D., an associate professor of Anesthesiology and Perioperative Medicine, and the study’s lead anesthesiologist.
Several study participants originally were skeptical about hypnosedation, but all have been impressed by the results.
“It's really interesting to see how awake our patients are as they're leaving the operating room, as opposed to having general anesthesia, where they take significant time to wake up in the recovery room,” Rebello says. “I don't think hypnosedation will replace general anesthesia for all types of surgery, but for a certain percentage of patients, this is a great option. It also may offer immune-related benefits, which we're exploring.”
Although many people still request to be put under during surgery, more and more have been expressing interest in alternatives. Some with high-pressure jobs, like airline pilots or police officers, worry about the lingering effects of general anesthesia. Others, such as those with vascular problems, may not be healthy enough to tolerate general anesthesia. And many simply don’t want to take more drugs than necessary.
“Especially in the midst of the current opioid epidemic, it's worth noting that this is an example of a non-pharmacological approach to pain and recovery,” Cohen says. “Patients can take this new recovery technique with them, and use it in the following days and months. That's more important now than ever before.”
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