Preparing for Surgery

August, 2006

Scope and Cost of the Problem
In the year 2000, there were almost 40 million surgeries performed in U.S. hospitals (Hall & Owings, 2000). There were also 32.5 million in-office surgery procedures in 1998, many of which routinely use some sedation (M Hall & L Hall, 1998).

Mind-Body Approaches to Coping with Surgery
Patients are often given drugs (sedation) to reduce and calm them before surgery or other medical procedures. However, sedation often increases the risk of low blood pressure or getting too little oxygen. As a result, researchers have looked at other ways to reduce pre-surgical anxiety.

Some of the most effective techniques include relaxation with guided imagery, self-hypnosis, and providing reassuring information prior to the procedure (Ashton, Whitworth, et al, 2000; Dreher, 1998; Faymonville, Fissette, et al, 1995; Lang and Hamilton, 1994; Lang, Joyce, et al, 1996; Ludwick-Rosenthal, Neufeld, 1993).

Used before surgery, non-pharmacologigic, mind-body techniques can reduce anxiety in adults (Bennett, 1996; Bugbee, Wellisch, et al, 2005; Good, 2004; McCaffrey, Taylor, 2005; Pellino, Gordon, et al, 2005), and children (Calipel, Lucas-Polomeni, et al, 2005).

Relaxation with guided imagery or self-hypnosis before and during surgery can shorten procedures (Butler, Symons, et al, 2005; Halpin, Speir, et al, 2002; Lang, Benotsch, et al, 2000; Tusek, Church, et al, 1997). These techniques can also significantly reduce procedural and post-surgical pain and the need for pain medication (Antall & Kresevec, 2004; Ashton, Whitworth, et al, 2000; Faymonville, Fissette, et al, 1995; Good, Anderson, et al, 2005; Halpin, Speir, et al.; Huth, Broome & Good, 2004; Lambert, 1996; Lang, Benotsch, et al, 2000; Lang & Hamilton, 1994; Lang, Joyce, et al, 1996; Laurion & Fetzer, 2003; Manyande, Berg, et al, 1995; Meurisse, Hamoir, et al, 1999; Montgomery, Weltz, et al, 2002; Patterson, Wiechman, et al, 2006; Rensi, Peticca & Pescatore, 2000; Syrjala, Donaldson, et al, 1995; Tusek, Church, et al, 1997; Weinstein & Au, 1991), even when only used post-surgically (Nilsson, Rawal, et al, 2003).

These techniques can shorten the time it takes for patients’ intestinal motility to return to normal (Disbrow, Bennett & Owings, 1993; Tusek, Church, et al, 1997), and shorten their hospital stay (Bennett, 1996; Cowan, Buffington, et al, 2001; Disbrow, Bennett & Owings, 1993; Lambert, 1996; Meurisse, Faymonville, et al, 1996; Rapkin, Straubing & Holroyd, 1991; Tusek, Church, et al). There is also some evidence that these techniques can reduce blood loss (Bennett; Enqvist, von Konow & Bystedt, 1995; Lucas, 1975; Meurisse, Faymonville, et al), and speed wound healing (Holden-Lund, 1988; Ginandes, Brooks, et al, 2003; Jones, 1977).

Improvements have been shown in sleep (Gross,Kreitzer, et al, 2005), and other psychological parameters such anxiety (Ashton, Whitworth, et al, 2000; Gross, Kreitzer, et al; Kanji, White & Ernst, 2004), and post-surgical anger and depression (de Klerc, de Plessis, et al, 2004).

Several sources, including Blue Shield of California and Cedars Sinai Medical Center (Los Angeles), have reported that patients who used guided imagery tapes to prepare for surgery were very satisfied with them – plus, it reduced their bills (Fontana, 2000; Holden-Lund, 1988; Naiditch, 2000). In addition, guided imagery audio tapes are routinely used and recommended by many well respected physicians, including Mehmet Oz, M.D., heart surgeon and Director of the Complementary Care Center at New York’s Columbia Presbyterian Medical Center (Oz, 2000).

Research available to date supports the conclusion that a low-cost guided imagery-based program to prepare patients for surgery can help to lower pre-surgical anxiety, reduce pain and the need for post-operative medication, shorten procedure time and hospital stay, and possibly reduce surgical bleeding, and speed recovery.

Antall GF, Kresevic D. The use of guided imagery to manage pain in an elderly orthopaedic population. Orthop Nurs. 2004 Sep-Oct;23(5):335-40.

Ashton C. Jr, Whitworth GC, Seldomridge JA, Shapiro PA, Weinberg AD, Michler RE, Smith CR, Rose EA, Fisher S, Oz MC. Self-hypnosis reduces anxiety following coronary artery bypass surgery. A prospective, randomized trial. J Cardiovasc Surg. 2000 Apr;41(2):335-6.

Baglini R, Sesana M, Capuano C, Gnecchi-Ruscone T, Ugo L, Danzi GB. Effect of hypnotic sedation during percutaneous transluminal coronary antioplasty on myocardial ischemia and cardiac sympathetic drive. Am J Cardiol. 2004 Apr 15;93(8):1035-8.

Bennett HL. A comparison of audiotaped preparations for surgery: evaluation and outcomes. Paper presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, 1996. Tampa, FL.

Bugbee ME, Wellisch DK, Arnott IM, Maxwell JR, Kirsch DL, Sayre JW, Bassett LW. Breast core-needle biopsy: clinical trial of relaxation technique versus medication versus no intervention for anxiety reduction. Radiology. 2005 Jan;234(1):73-8. Epub 2004 Nov 24.

Calipel S, Lucas-Polomeni MM, Wodey E, Ecoffey C. Premedication in children: hypnosis versus midazolam. Paediatr Anaesth. 2005 Apr;15(4):275-81.

Cowan GS Jr, Buffington CK, Cowan GS 3rd, Hathaway D. Assessment of the effects of taped cognitive behavior message on postoperative complications (therapeutic suggestions under anesthesia. Obes Surg. 2001 Oct;11(5):589-93.

Crawford AH, Jones CW, Perisho JA, Herring JA. Hypnosis for monitoring intraoperative spinal cord function. Anesth Analg. 1976 Jan-Feb;55(1):42-4.

Disbrow EA, Bennett HL, Owings JT. Effect of preoperative suggestion on postoperative gastrointestinal modility. West J Med. 1993 May;158(5);488-92.

de Klerk JE, du Plessis WF, Steyn HS, Botha M. Hypnotherapeutic ego strengthening with male South African coronary artery bypass patients. Am J Clin Hypn. 2004 Oct;47(2):79-92.

Dreher H. Mind-body interventions for surgery: evidence and exigency. Advances in Mind-Body Medicine. 1998. 14:207-222.

Enqvist B, von Konow L, Bystedt H. Pre-and perioperative suggestion in maxillofacial surgery: effects on blood loss and recovery. Int J Clin Exp Hypn. 1995 Jul;43(3):284-94.

Faymonville ME, Fissette J, Mambourg PH, Roediger L, Joris J. Lamy M. Hypnosis as adjunct therapy in conscious sedation for plastic surgery. Reg. Anesth. 1995 Mar-Apr;20(2):145-51.

Fontana GP, M.D. Acupuncture, Massage, Guided Imagery Ease Pain After Bypass Surgery. (News release, Westport, Conn: Reuters Health Information, June 9. 2000) 1-2.

Ginandes C, Brooks P, Sando W, Jones C, Aker J. Can Medical Hypnosis Accelerate Post-Surgical Wound Healing? Results of a Clinical Trial. American Journal of Clinical Hypnosis. 2003 45:4, April, pp. 333-351.

Good M, Anderson GC, Ahn S, Cong X, Stanton-Hicks M. Relaxation and music reduce pain following intestinal surgery. Res Nurs Health. 2005 Jun;28(3):240-51.

Gross CR, Kreitzer MJ, Russas V, Treesak C, Frazier PA, Hertz MI. Mindfulness meditation to reduce symptoms after organ transplant: a pilot study. Adv Mind Body Med. 2004 Summer;20(2):20-9.

Hall MJ, Owings MF. 2000 National Hospital Discharge Survey. Advance data from vital and health statistics; no 329. Hyattsville, Maryland: National Center for Health Statistics. 2002. Table 8.

Hall MJ, Hall L. Ambulatory surgery in the United States, 1996. Advance data from vital and health statistics; no. 300. Hyattsville, Maryland: National Center for Health Statistics. 1998. Table 4.

Halpin LS, Speir AM, CapoBianco P, Barnett SD. Guided imagery in cardiac surgery. Outcomes Manag. 2002 Jul-Sep; 6(3):132-7.

Holden-Lund C. Effects of relaxation with guided imagery on surgical stress and wound healing. Research in Nursing and Health. 1988 11 Aug. 235-244.

Huth MM, Broome ME, Good M. Imagery reduces children's post-operative pain. Pain. 2004 Jul;110(1-2):439-48.

Jones CW. Hypnosis and spinal fusion by Harrington instrumentation. Am. Journal of Clinical Hypnosis. 1977 Jan;19(3):155-7.

Lambert S. The Effects of Hypnosis/Guided Imagery on the Postoperative Course of Children. Developmental and Behavioral Pediatrics. 1996 17 (5) 307-310.

Lang EV, Benotsch, EG, Fick, LJ, Lutgendorf S, Berbaum ML, Berbaum, KS, Logan H, Spiegel D. Adjunctive non-pharmacological analgesia for invasive medical procedures: a randomised trial. Lancet. 2000 Apr 29;355(9214) :1486-90.

Lang EV, Hamilton D. Anodyne imagery: an alternative to i.v. sedation in interventional radiology. AJR Am J Roentgenol. 1994 May;162(5):1221-6.

Lang EV, Joyce JS, Spiegel D, Hamilton D, Lee KK. Self-hypnotic relaxation during interventional radiological procedures: effects on pain perception and intravenous drug use. Int J Clin Exp Hypn. 1996 Apr;44(2):106-19.

Laurion S, Fetzer SJ. The effect of two nursing interventions on the postoperative outcomes of gynecological laparoscopic patients. J of Perianesthesia Nursing. 2003 Aug;18(4)254-61.

Lucas ON. The use of hypnosis in hemophilia dental care. Ann N Y Acad Sci. 1975 Jan 20;240:263-6.

Ludwick-Rosenthal R, Neufeld RW. Preparation for undergoing an invasive medical procedure: interacting effects of information and coping style. J Consult Clin Psychol. 1993 Feb;61(1):156-64).

Manyande A, Berg S, Gettins D, Stanford SC, Mazhero S, Marks DF, Salmon P. Preoperative rehearsal of active coping imagery influences subjective and hormonal responses to abdominal surgery. Psychosom Med. 1995 Mar-Apr;57(2):177-82.

Meurisse , M, Faymonville ME, Joris J, Nguyen Dang D, Defechereux T, Hamoir E. Endocrine surgery by hypnosis. From fiction to daily clinical application. Service de Chirurgie des Glandes Endocrines et Transplantation, Centre Hospitalier Universitaire de Liege, Belgique. Ann Endocrinol (Paris). 1996 57(6):494-501.

Meurisse M, Hamoir E, Defecheueux T, Gollogly L, Derry O, Postal A, Joris J, Faymonville ME. Bilateral neck exploration under hypnosedation: a new standard of care in primary hyperparathyroidism? Ann Surg. 1999 Mar;229(3):401-8.

Montgomery GH, Weltz CR, Seltz M, Bovbjerg DH. Brief presurgery hypnosis reduces distress and pain in excisional breast biopsy patients. Int J Clin Exp Hypn. 2002 Jan;50(1):17-32.

Naiditch M. Blue Shield Announces Guided Imagery Program to Help Members Have an Easier Surgery & Recovery. News release. Blue Shield, 2000 May 4.;jsessionid=TWTS43ZYCWIJHJP3YYSSGLNF5XDCEITT
Accessed: September, 2006.

Nilsson U, Rawal N, Enqvist B, Unosson M. Analgesia following music and therapeutic suggestions in the PACU in ambulatory surgery; a randomized controlled trial. Acta Anaesthesiol Scand. 2003 Mar;47(3):278-83.

Oz M, M.D. Healing from the Heart: A Leading Heart Surgeon Explores the Power of Complementary Medicine. New York: EP Dutton, 1998.

Patterson DR, Wiechman SA, Jensen M, Sharar SR.Hypnosis delivered through immersive virtual reality for burn pain: A clinical case series. International Journal of Clinical and Experimental Hypnosis. 2006 Apr; 54 (2):130-42.

Pellino TA, Gordon DB, Engelke ZK, Busse KL, Collins MA, Silver CE, Norcross NJ. Use of nonpharmacologic interventions for pain and anxiety after total hip and total knee arthroplasty. Orthopedic Nursing. 2005 May-Jun; 24 (3):182-90.

Rapkin DA, Straubing M, Holroyd JC. Guided imagery, hypnosis and recovery from head and neck cancer surgery: an exploratory study. Int J Clin Exp Hypn, 1991 Oct;39(4) :215-26.

Rensi C, Peticca L, Pescatori M. The use of relaxation techniques in the periopperative management of proctological patients: preliminary results. Int J Colorectal Dis. 2000 Nov;15(5-6):313-6.

Syrjala KL, Donaldson GW, Davis MW, Kippes ME, Carr JE. Relaxation and imagery and cognitive-behavioral training reduce pain during cancer treatment: a controlled clinical trial. Pain. 1995 Nv;673 (2):189-98.

Tusek DL, Church JM, Strong SA, Grass JA, Fazio VW Guided imagery: a significant advance in the care of patients undergoing elective colorectal surgery. Dis Colon Rectum. 1997 Feb;40(2):172-8.

Weinstein EJ, Au PK Use of hypnosis before and during angioplasty. Am J Clin Hypn. 1991 Jul;34(1):29-37.