Zusammenfassung
Patienten in Extremsituationen wie einem medizinischen Notfall oder vor einem operativen Eingriff zeigen eine erhöhte Aufmerksamkeit und Empfänglichkeit für Suggestionen. In diesem Trance-ähnlichen Zustand können unbedacht ausgesprochene Negativsuggestionen Angst und Schmerzen verstärken, können aber andererseits auch Positivsuggestionen zum Wohl der Patienten eingesetzt werden. Erfahrungen und Methoden aus der Hypnotherapie wie Utilisation, „reframing“, indirekte Suggestion, innerer Ruheort, Dissoziation, Metapher oder posthypnotischer Auftrag und ebenso nonverbale Kommunikation lassen sich auch ohne formelle Hypnoseinduktion und ohne zusätzlichen zeitlichen, räumlichen und personellen Bedarf nutzen, um generell den Umgang mit ängstlichen Patienten bei schmerzhaften und belastenden medizinischen Maßnahmen zu verbessern. Indikationen für ein solches Vorgehen sind v. a. das Narkosegespräch, die Narkoseeinleitung sowie Eingriffe in Lokal- oder Regionalanästhesie bis hin zur Patientenbegleitung bei Wachkraniotomie unter kranialen Leitungsblockaden und in Wach-Wach-Technik ohne zentral wirksame Medikamente. Hypnotische Kommunikation erlaubt es, dem Patienten Selbstkontrolle zurückzugeben und innere Ressourcen zugänglich zu machen.
Abstract
In extreme situations, for example during emergencies or when facing surgery, patients exhibit heightened and focused attention and increased susceptibility to suggestion. In this trance-like state negative suggestion, usually spoken unintentionally can aggravate anxiety, stress and pain. On the other hand words can offer an opportunity to benefit the patient via positive suggestion. In order to improve communication with anxious patients during stressful and painful medical procedures, certain hypnotherapeutic insights and methods can be employed, such as utilization, reframing, indirect suggestion, safe place, dissociation, metaphors, posthypnotic instructions and non-verbal communication and this without requiring formal hypnotic induction and without need for additional time, premises or personnel. Indications for such approaches are the preoperative visit, induction of anaesthesia, as well as operations under local or regional anaesthesia. An extreme example of the latter is awake craniotomy employing cranial nerve blocks and an awake-awake technique avoiding centrally acting drugs. Such hypnotic communication can help the patient to regain self-control and access to inner resources.
Literatur
Barolin GS (2006) Integrierte Psychotherapie: Anwendung in der Gesamtmedizin und verwandten Sozialberufen. Springer, Wien
Bejenke CJ (1990) Operating room equipment: useful hypnotic induction aids in anesthesiology. In: Dyck R van, Spinhoven P, Does AJW van der, Rood YR van, De Moor W (eds) Hypnosis: current theory, research, and practice. V.U. University Press, Amsterdam, pp 199–205
Bejenke CJ (1996) Painful medical procedures. In: Barber J (ed) Hypnosis and suggestion in the treatment of pain. Norton, New York, pp 209–266
Bejenke CJ (1996) Can patients be protected from the detrimental consequences of intraoperative awareness in the absence of effective technology? In: Bonke B, Bovill JG, Moerman N (eds) Memory and awareness in anaesthesia. Van Gorcum, Netherlands, pp 125–133
Bejenke CJ (2001) Vorbereitung von Patienten bei medizinischen Eingriffen. In: Revenstorf D, Peter B (Hrsg) Hypnose in Psychotherapie, Psychosomatik und Medizin. Springer, Berlin Heidelberg New York Tokio, S 596–604
Bejenke CJ (2004) Das Essen war ziemlich phantasielos: Eine schwierige Knieoperation – Vorbereitung in Hypnose. In: Ebell H, Schuckall H (Hrsg) Warum therapeutische Hypnose? Aus der Praxis von Ärzten und Psychotherapeuten. Pflaum, München, S 16–24
Benedetti F, Rainero I, Pollo A (2003) New insights into placebo analgesia. Curr Opin Anaesthesiol 16:515–519
Benedetti F, Lanotte M, Lopiano L, Colloca L (2007) When words are painful: unraveling the mechanisms of the nocebo effect. Neuroscience 147:260–271
Cheek DB (1959) The unconscious perception of meaningful sounds under surgical anesthesia as revealed under hypnosis. Am J Clin Hypn 1:101–112
Cheek DB (1962) Importance of recognizing that surgical patients behave as though hypnotized. Am J Clin Hypn 4:227–231
Cheek DB (1994) Hypnosis: the application of ideomotor techniques. Allyn & Bacon, Boston
Colloca L, Benedetti F (2007) Nocebo hyperalgesia: how anxiety is turned into pain. Curr Opinion Anesth 20:435–439
Cowan GS, Buffington CK, Cowan GS, Hathaway D (2001) Assessment of the effects of a taped cognitive bahavior message on postoperative complications (therapeutic suggestions under anesthesia). Obes Surg 11:589–593
Defechereux T, Degauque C, Fumal I et al (2000) Hypnosedation, a new method of anesthesia for cervical endocrine surgery. Prospective randomized study. Ann Chir 125:539–546
De Pascalis V, Magurano MR, Bellusci A (1999) Pain perception, somatosensory event-related potentials and skin conductance responses to painful stimuli in high, mid, and low hypnotizable subjects: effects of differential pain reduction strategies. Pain 83:499–508
De Pascalis V, Cacace I, Massicolle F (2008) Focused analgesia in waking and hypnosis: effects on pain, memory, and somatosensory event-related potentials. Pain 134:197–208
Disbrow EA, Bennett HL, Owings JT (1993) Effect of preoperative suggestion on postoperative gastrointestinal motility. West J Med 158:488–492
Eberhart LH, Doring HJ, Holzrichter P et al (1998) Therapeutic suggestions given during neurolept-anaesthesia decrease post-operative nausea and vomiting. Eur J Anaesthesiol 15:446–452
Edgette JH, Edgette JS (1995) The handbook of hypnotic phenomena in psychotherapy. Brunner & Mazel, New York
Enqvist B, Konow L von, Bystedt H (1995) Pre-and perioperative suggestion in maxillofacial surgery: effects on blood loss and recovery. Int J Clin Exp Hypn 43:284–294
Enqvist B, Bjorklund C, Engman M, Jakobsson J (1997) Preoperative hypnosis reduces postoperative vomiting after surgery of the breasts: a prospective, randomized and blinded study. Acta Anaesthesiol Scand 41:1028–1032
Faymonville ME, Fissette J, Mambourg PH et al (1995) Hypnosis as adjunct therapy in conscious sedation for plastic surgery. Reg Anesth 20:145–151
Faymonville ME, Mambourg PH, Albert A et al (1997) Psychological approaches during conscious sedation. Hypnosis versus stress reducing strategies: A prospective randomized study. Pain 73:361–367
Faymonville ME, Laureys S, Degueldre C et al (2000) Neural mechanisms of antinociceptive effects of hypnosis. Anesthesiology 92:1257–1267
Hansen E (2004). Wirklich sehr beruhigt: Hypnotische Kommunikation zur Narkoseeinleitung bei einer ängstlichen Patientin. In: Ebell H, Schuckall H (Hrsg) Warum therapeutische Hypnose? Aus der Praxis von Ärzten und Psychotherapeuten. Pflaum, München, S 71–75
Hansen E, Zimmermann M, Dünzl G (2010) Hypnotische Kommunikation mit Notfallpatienten. Notfall Rettungsmed (im Druck)
Harms C, Young JR, Amsler F et al (2004) Improving anaesthetists‘ communication skills. Anaesthesia 59:166–172
Hermes D, Trübger D, Hakim SG, Sieg P (2004) Perioperativer Einsatz von medizinischer Hypnose: Therapieoption für Anästhesisten und Chirurgen. Anaesthesist 53:326–333
Jacobs DT (1991) Patient communication for first responders and EMS personnel. Brady, Englewood Cliffs
Junker S (2004) Hypnose und Magenspiegelung. Auer, Heidelberg
Kaiser-Rekkas A, Schwender D, Pöppel E (1997) Akustisch evozierte Potentiale und Hypnose in der Untersuchung akustischer Wahrnehmung während Allgemeinanästhesie. Exp Klin Hypnose 13:137–154
Kaiser-Rekkas A (2005) Klinische Hypnose und Hypnotherapie, 3. Aufl. Auer, Heidelberg
Keltner JR, Furst A, Fan C et al (2006) Isolating the modulary effect of expectation on pain transmission: a functional magnetic resonance imaging study. J Neurosci 26:4437–4443
Kerscher C, Zimmermann M, Graf BM, Hansen E (2009) Kraniale Leitungsanästhesien – Hilfreiche Techniken für Neurochirurgie, Dermatologie, Plastische Chirurgie und Schmerztherapie. Anaesthesist 58:949–958
Lang EV, Benotsch EG, Fick LJ et al (2000) Adjunctive nonpharmacological analgesia for invasive medical procedures: a randomised trial. Lancet 355:1486–1490
Lang EV, Hatsiopoulou O, Berbaum K et al (2005) Can words hurt? Patient-provider interactions during invasive procedures. Pain 114:303–309
Liossi C, White P, Franck L, Hatira P (2007) Parental pain expectancy as a mediator between child expected and experienced procedure-related pain intensity during painful medical procedures. Clin J Pain 23:392–399
Liossi C, White P, Hatira P (2009) A randomized clinical trial of a brief hypnosis intervention to control venepuncture-related pain of paediatric cancer patients. Pain 142:255–263
Lown B (2004) Die verlorene Kunst des Heilens. Schattauer, Stuttgart
Maquet P, Faymonville ME, Degueldre C et al (1999) Functional neuroanatomy of hypnotic state. Biol Psychiatry 45:327–333
Marc I, Rainville P, Masse B et al (2008) Hypnotic analgesia intervention during first-trimester pregnancy termination: an open randomized trial. Am J Obstet Gynecol 199:469e1–469e9
Mathews A, Ridgeway V (1981) Personality and surgical recovery: a review. Br J Clin Psychol 20:243–260
Molton IR, Graham C, Stoelb BL, Jensen MP (2007) Current psychological approaches to the management of chronic pain. Curr Opinion Anaesthesiol 20:485–489
Montgomery GH, David D, Winkel G et al (2002) The effectiveness of adjunctive hypnosis with surgical patients: A meta-analysis. Anesth Analg 94:1639–1645
Nilsson U, Rawal N, Unestahl LE et al (2001) Improved recovery after music and therapeutic suggestions during general anaesthesia: a double-blind randomised controlled trial. Acta Anaesthesiol Scand 45:812–817
Peter B (1998) Möglichkeiten und Grenzen der Hypnose in der Schmerzbehandlung. Schmerz 12:179–186
Revenstorf D (2001) Trance und die Ziele und Wirkungen der Hypnotherapie. In: Revenstorf D, Peter B (Hrsg) Hypnose in Psychotherapie, Psychosomatik und Medizin. Springer, Berlin Heidelberg New York Tokio, S 12–31
Revenstorf D (2006) Expertise zur Beurteilung der wissenschaftlichen Evidenz des Psychotherapieverfahrens Hypnotherapie. Hypnose 1:7–164
Rockenbauch K, Decker O, Stöbel-Richter Y (2006) Kompetent kommunizieren in Klinik und Praxis. Pabst, Lengerich
Rossi EL, Cheek DB (1988) Mind-body therapy: Methods of ideodynamic healing in hypnosis. Norton, New York
Rossi EL (1993) 20 Minuten Pause. Junfermann, Paderborn
Saadat H, Drummond-Lewis J, Maranets I et al (2006) Hypnosis reduces preoperative anxiety in adult patients. Anesth Analg 102:1394–1396
Savulescu J, Foddy B, Rogers J (2006) What should we say? J Med Ethics 32:7–12
Schenk PW (2008)“Just breathe normally”: Word choices that trigger nocebo responses in patients. Am J Nurs 108:52–57
Schmierer A, Schütz G (2006) Zahnärztliche Hypnose. Quintessenz, Berlin
Schulz U, Keh D, Fritz G et al (2007) „Schlaf-Wach-Schlaf“-Technik zur Wachkraniotomie. Anaesthesist 55:585–598
Schulz-Stübner S (2007) Medizinische Hypnose. Schattauer, Stuttgart
Schweickhardt A, Fritzsche K (2007) Kursbuch Ärztliche Kommunikation. Deutscher Ärzteverlag, Köln
Schwender D, Kaiser A, Klasing S et al (1994) Midlatency auditory evoked potentials and explicit and implicit memory in patients undergoing cardiac surgery. Anesthesiology 80:493–501
Sebel PS, Bowdle TA, Ghoneim MM et al (2004) The incidence of awareness during anesthesia: A multicenter United States study. Anesth Analg 99:833–839
Sharav Y, Tal M (2004) Focused analgesia and generalized relaxation produce differential hypnotic analgesia in response to ascending stimulus intensity. Int J Psychophysiol 52:187–196
Sokoloff I (1981) Localisation of functional activity in the central nervous system by measurement of glucose utilization with radioactive de-oxyglucose. J Cereb Blood Flow Metab 1:17–36
Spiegel H (1997) Nocebo: The power of suggestibility. Prev Med 26:616–621
Székely A, Balog P, Benkö E et al (2007) Anxiety predicts mortality and morbidity after coronary artery and valve surgery – a 4-year follow-up study. Psychosom Med 69:625–631
Tarnow J (2004) Über den Umgang des Anästhesisten mit Patienten. Anaesthesiol Intensivmed 45:163–164
Trippe RH, Weiss T, Miltner WHR (2004) Hypnotisch induzierte Analgesie – Mechanismen. Anaesthesiol Intensivmed 45:642–647
Wobst AHK (2007) Hypnosis and surgery: past, present, and future. Anesth Analg 104:1199–1208
Interessenkonflikt
Es besteht kein Interessenkonflikt.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hansen, E., Bejenke, C. Negative und positive Suggestionen in der Anästhesie. Anaesthesist 59, 199–209 (2010). https://doi.org/10.1007/s00101-010-1679-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00101-010-1679-9