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The Impact of Scripted Self-Hypnotic Relaxation on the Periprocedural Experience and Anesthesiologist Sedation Use in
Jacqueline Viegas1, Helen Holtby2, Kyle Runeckles3
1Cardiac Diagnostic and Interventional Unit, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Reading a pre-procedure self-hypnotic relaxation script before anesthesia reduced the need for intraoperative sedatives in children undergoing cardiac catheterization. This finding suggests a subconscious interaction influencing pain management, independent of patient-reported anxiety or pain.
Area of Science:
- Pediatric Anesthesiology
- Psychological Interventions
- Pain Management
Background:
- Anxiety and pain are common in children undergoing invasive procedures.
- Self-hypnotic relaxation scripts are a potential non-pharmacological intervention.
- The impact of such scripts on periprocedural experience needs further evaluation.
Purpose of the Study:
- To assess the impact of self-hypnotic relaxation scripts on children's periprocedural experience.
- To evaluate the effect of scripts read before anesthesia induction and/or extubation.
- To determine if scripts reduce anxiety, pain, or sedative requirements.
Main Methods:
- 160 children (7-18 years) undergoing cardiac catheterization were randomized into four groups.
- Interventions included pre-procedure script (PP-script), post-extubation script (PX-Script), both, or no script.
- Anxiety and pain were measured using self-report scales and the modified Yale Preoperative Anxiety Scale. Statistical analysis used linear and logistic regression.
Main Results:
- Reading the PP-script before anesthesia significantly reduced intraoperative sedative use (30% to 14%, OR 0.40).
- This reduction was independent of children's self-reported anxiety and pain levels.
- The PX-script did not significantly alter outcomes, nor were there differences in room time, recovery time, or pain.
Conclusions:
- Pre-procedure self-hypnotic relaxation scripts can decrease the need for anesthesiologist-administered sedation.
- This effect may be mediated by subconscious patient-physician interactions rather than solely on patient-reported distress.
- Further research is warranted to explore these subconscious mechanisms in pain management.
Purpose:
To assess the impact on children of self-hypnotic relaxation scripts read by trained staff prior to the induction of anesthesia and/or extubation on the periprocedural experience.
Patients And Methods:
A total of 160 children aged 7-18 years undergoing a cardiac catheterization intervention under general anesthesia were randomized into 4 groups: (1) a pre-procedure (PP-script) read prior to entering the procedural room, (2) a script read prior to extubation (PX-Script), (3) both PP- and PX-Scripts read and (4) no script read. Anxiety and pain were rated on self-reported 0-10 scales. The modified Yale Preoperative Anxiety Scale was used for preoperative anxiety. The effect of script reading was associated with outcomes by linear regression for continuous variables, and logistic regression for binary variables in two-sided tests at a significance level of 0.05. Results are given in odds ratios (OR) and 95% confidence intervals (CI).
Results:
Data were available for 158 patients. Reading the PP-Script prior to anesthesia was associated with a significant reduction in the use of intraoperative sedatives from 30% to 14% (OR 0.40; CI 0.18-0.88; p = 0.02) by the anesthesiologists, who were blinded to group attribution until extubation. This was despite the children not self-reporting significantly lower levels of anxiety or pain. The PX-Script did not change outcomes. Among groups, there was no significant difference in room time, postoperative recovery time and pain.
Conclusion:
Reading a PP-Script for guidance in self-hypnotic relaxation can result in less need for intravenous sedation in the judgment of the anesthesiologist, independent of the children's self-reported anxiety and pain. This raises interesting questions about subconscious patient-physician interactions affecting pain management.
Clinicaltrialsgov Identifier:
NCT02347748.
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