Hypnoanesthesia in the morbidly obese

The advent of chemical anesthesia relegated hypnosis to an adjunctive role in patients requiring major operations. Anesthesia can be utilized with acceptable risk in the great majority of patients encountered in modern practice. But an occasional patient will present--such as one with morbid obesity--who needs a surgical procedure and who cannot be safely managed by conventional anesthetic techniques. This report describes our experience with such a patient and illustrates some of the advantages and disadvantages of hypnoanesthesia. The greatest disadvantage is that it is unpredictable. Close cooperation between the patient, hypnotist, anesthesiologist, and surgeon is critical. However, the technique may be utilized to remove very large lesions in selected patients. Hypnoanesthesia is an important alternative for some patients who cannot and should not be managed with conventional anesthetic techniques.