Skip to main content
Log in

Negative und positive Suggestionen in der Anästhesie

Verbesserte Kommunikation mit ängstlichen Patienten bei Operationen

Negative and positive suggestions in anaesthesia

Improved communication with anxious surgical patients

  • Leitthema
  • Published:
Der Anaesthesist Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. Barolin GS (2006) Integrierte Psychotherapie: Anwendung in der Gesamtmedizin und verwandten Sozialberufen. Springer, Wien

  2. 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

  3. Bejenke CJ (1996) Painful medical procedures. In: Barber J (ed) Hypnosis and suggestion in the treatment of pain. Norton, New York, pp 209–266

  4. 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

  5. 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

  6. 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

  7. Benedetti F, Rainero I, Pollo A (2003) New insights into placebo analgesia. Curr Opin Anaesthesiol 16:515–519

    Article  PubMed  Google Scholar 

  8. Benedetti F, Lanotte M, Lopiano L, Colloca L (2007) When words are painful: unraveling the mechanisms of the nocebo effect. Neuroscience 147:260–271

    Article  CAS  PubMed  Google Scholar 

  9. Cheek DB (1959) The unconscious perception of meaningful sounds under surgical anesthesia as revealed under hypnosis. Am J Clin Hypn 1:101–112

    Google Scholar 

  10. Cheek DB (1962) Importance of recognizing that surgical patients behave as though hypnotized. Am J Clin Hypn 4:227–231

    CAS  PubMed  Google Scholar 

  11. Cheek DB (1994) Hypnosis: the application of ideomotor techniques. Allyn & Bacon, Boston

  12. Colloca L, Benedetti F (2007) Nocebo hyperalgesia: how anxiety is turned into pain. Curr Opinion Anesth 20:435–439

    Article  Google Scholar 

  13. 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

    Article  PubMed  Google Scholar 

  14. 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

    Article  CAS  PubMed  Google Scholar 

  15. 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

    Article  Google Scholar 

  16. 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

    Article  Google Scholar 

  17. Disbrow EA, Bennett HL, Owings JT (1993) Effect of preoperative suggestion on postoperative gastrointestinal motility. West J Med 158:488–492

    CAS  PubMed  Google Scholar 

  18. 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

    CAS  PubMed  Google Scholar 

  19. Edgette JH, Edgette JS (1995) The handbook of hypnotic phenomena in psychotherapy. Brunner & Mazel, New York

  20. 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

    Article  CAS  PubMed  Google Scholar 

  21. 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

    Article  CAS  PubMed  Google Scholar 

  22. Faymonville ME, Fissette J, Mambourg PH et al (1995) Hypnosis as adjunct therapy in conscious sedation for plastic surgery. Reg Anesth 20:145–151

    CAS  PubMed  Google Scholar 

  23. 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

    Article  CAS  PubMed  Google Scholar 

  24. Faymonville ME, Laureys S, Degueldre C et al (2000) Neural mechanisms of antinociceptive effects of hypnosis. Anesthesiology 92:1257–1267

    Article  CAS  PubMed  Google Scholar 

  25. 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

  26. Hansen E, Zimmermann M, Dünzl G (2010) Hypnotische Kommunikation mit Notfallpatienten. Notfall Rettungsmed (im Druck)

  27. Harms C, Young JR, Amsler F et al (2004) Improving anaesthetists‘ communication skills. Anaesthesia 59:166–172

    Article  CAS  PubMed  Google Scholar 

  28. Hermes D, Trübger D, Hakim SG, Sieg P (2004) Perioperativer Einsatz von medizinischer Hypnose: Therapieoption für Anästhesisten und Chirurgen. Anaesthesist 53:326–333

    Article  CAS  PubMed  Google Scholar 

  29. Jacobs DT (1991) Patient communication for first responders and EMS personnel. Brady, Englewood Cliffs

  30. Junker S (2004) Hypnose und Magenspiegelung. Auer, Heidelberg

  31. 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

    Google Scholar 

  32. Kaiser-Rekkas A (2005) Klinische Hypnose und Hypnotherapie, 3. Aufl. Auer, Heidelberg

  33. 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

    Article  CAS  PubMed  Google Scholar 

  34. Kerscher C, Zimmermann M, Graf BM, Hansen E (2009) Kraniale Leitungsanästhesien – Hilfreiche Techniken für Neurochirurgie, Dermatologie, Plastische Chirurgie und Schmerztherapie. Anaesthesist 58:949–958

    Article  CAS  PubMed  Google Scholar 

  35. Lang EV, Benotsch EG, Fick LJ et al (2000) Adjunctive nonpharmacological analgesia for invasive medical procedures: a randomised trial. Lancet 355:1486–1490

    Article  CAS  PubMed  Google Scholar 

  36. Lang EV, Hatsiopoulou O, Berbaum K et al (2005) Can words hurt? Patient-provider interactions during invasive procedures. Pain 114:303–309

    Article  PubMed  Google Scholar 

  37. 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

    Article  PubMed  Google Scholar 

  38. 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

    Article  PubMed  Google Scholar 

  39. Lown B (2004) Die verlorene Kunst des Heilens. Schattauer, Stuttgart

  40. Maquet P, Faymonville ME, Degueldre C et al (1999) Functional neuroanatomy of hypnotic state. Biol Psychiatry 45:327–333

    Article  CAS  PubMed  Google Scholar 

  41. 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

    Article  Google Scholar 

  42. Mathews A, Ridgeway V (1981) Personality and surgical recovery: a review. Br J Clin Psychol 20:243–260

    CAS  PubMed  Google Scholar 

  43. Molton IR, Graham C, Stoelb BL, Jensen MP (2007) Current psychological approaches to the management of chronic pain. Curr Opinion Anaesthesiol 20:485–489

    Article  Google Scholar 

  44. 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

    Article  PubMed  Google Scholar 

  45. 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

    Article  CAS  PubMed  Google Scholar 

  46. Peter B (1998) Möglichkeiten und Grenzen der Hypnose in der Schmerzbehandlung. Schmerz 12:179–186

    Article  CAS  PubMed  Google Scholar 

  47. 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

  48. Revenstorf D (2006) Expertise zur Beurteilung der wissenschaftlichen Evidenz des Psychotherapieverfahrens Hypnotherapie. Hypnose 1:7–164

    Google Scholar 

  49. Rockenbauch K, Decker O, Stöbel-Richter Y (2006) Kompetent kommunizieren in Klinik und Praxis. Pabst, Lengerich

  50. Rossi EL, Cheek DB (1988) Mind-body therapy: Methods of ideodynamic healing in hypnosis. Norton, New York

  51. Rossi EL (1993) 20 Minuten Pause. Junfermann, Paderborn

  52. Saadat H, Drummond-Lewis J, Maranets I et al (2006) Hypnosis reduces preoperative anxiety in adult patients. Anesth Analg 102:1394–1396

    Article  PubMed  Google Scholar 

  53. Savulescu J, Foddy B, Rogers J (2006) What should we say? J Med Ethics 32:7–12

    Article  CAS  PubMed  Google Scholar 

  54. Schenk PW (2008)“Just breathe normally”: Word choices that trigger nocebo responses in patients. Am J Nurs 108:52–57

    PubMed  Google Scholar 

  55. Schmierer A, Schütz G (2006) Zahnärztliche Hypnose. Quintessenz, Berlin

  56. Schulz U, Keh D, Fritz G et al (2007) „Schlaf-Wach-Schlaf“-Technik zur Wachkraniotomie. Anaesthesist 55:585–598

    Article  Google Scholar 

  57. Schulz-Stübner S (2007) Medizinische Hypnose. Schattauer, Stuttgart

  58. Schweickhardt A, Fritzsche K (2007) Kursbuch Ärztliche Kommunikation. Deutscher Ärzteverlag, Köln

  59. 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

    Article  CAS  PubMed  Google Scholar 

  60. 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

    Article  PubMed  Google Scholar 

  61. 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

    Article  PubMed  Google Scholar 

  62. 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

    Google Scholar 

  63. Spiegel H (1997) Nocebo: The power of suggestibility. Prev Med 26:616–621

    Article  CAS  PubMed  Google Scholar 

  64. 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

    Article  PubMed  Google Scholar 

  65. Tarnow J (2004) Über den Umgang des Anästhesisten mit Patienten. Anaesthesiol Intensivmed 45:163–164

    Google Scholar 

  66. Trippe RH, Weiss T, Miltner WHR (2004) Hypnotisch induzierte Analgesie – Mechanismen. Anaesthesiol Intensivmed 45:642–647

    Google Scholar 

  67. Wobst AHK (2007) Hypnosis and surgery: past, present, and future. Anesth Analg 104:1199–1208

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Es besteht kein Interessenkonflikt.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to E. Hansen.

Rights and permissions

Reprints 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

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00101-010-1679-9

Schlüsselwörter

Keywords

Navigation