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October 22, 2017
43030.541667 - 43030.625
Room Exhibit Hall B2 - Area A
Hypnosedation for Cancer Surgery: How? For What? For Whom?
Aurore MARCOU, M.D., Séverine Alran, M.D., Philippe Goater, M.D.
Institut Curie, Paris, France
Disclosures: A. Marcou: None. S. Alran: None. P. Goater: None.
Hypnosis allows to perform awaken surgeries, when combined with local anesthesia and continuous intravenous analgesia. Hypnosedation has been previously evaluated for various superficial surgeries as a valuable alternative to general anesthesia [1][2]. We report here its use in breast surgery in a cancer center.

We performed a retrospective study on 125 patients operated on under hypnosis between 2011 and 2017. The surgical and anesthetic data were extracted from the medical database. 18% of these patients spontaneously requested this technique. For the others, hypnosedation was offered as an alternative to general anesthesia. No previous experience in hypnosis was required from the patients. The safety conditions and monitoring were the same as for a general anesthesia. The procedure included the tumescent technique, consisting in injecting large volumes of low concentrated local anesthetic in the dissection plans [3][4]. The total amount remained below 8 mg/kg. A continuous analgesic infusion of target controlled remifentanil was adjusted to the patient’s comfort. Usual preventive antiemetics and pain killers were given before the end of the surgery. The procedure excluded all premedication or hypnotic drugs.

The surgeries included partial mastectomies and total mastectomies (TM), sentinel lymph node dissection and axillary clearance [table 1]. 3 interventions covered both sides. The mean surgical duration was 63 min (30 to 160 min). The mean length of stay in the recovery room was 38 minutes.

The median age of the patients was 59.8 years (from 18 to 100 years) [figure 1]. 31% of the patients were classified ASA 1, 40% ASA 2, 25% ASA 3 and 4% ASA 4. Among the ASA 3 patients, 45% were older than 80 years and 15% older than 90 years. For the ASA 4 patients, severe cardiac, respiratory and renal failures questioned the benefit of surgery under general anesthesia.

For 98.4% of the patients, hypnosedation allowed to perform breast surgery under comfortable conditions for the surgeon and for the patient. In one case of discomfort, the technique was easily converted to general anesthesia. In another case, a pneumothorax, possibly related to the injection, required immediate drainage and postoperative observation in intensive care unit. In conclusion, hypnosedation can be proposed as an alternative to general anesthesia for breast cancer surgeries for patients of all ages. By sparing drug use and their effects on the vital functions, this technique is particularly beneficial for vulnerable patients.

[1] Meurisse M et al. Ann Surg. 1999;229(3):401-8

[2] Defechereux T et al. Ann Chir. 2000;125(6):539-46.

[3] Klein JA. J Dermatol Surg Oncol 1990;16:248-63.

[4] Carlson GW. Breast J 2005;11:100-2.

Figure 1
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