Integrating Hypnosis Into Pre-Operative Anesthesia: Q&A With Lynette Bear, CRNA, of the Laser Spine Institute
Lynette Bear is a certified registered nurse anesthetist at the Laser Spine Institute ambulatory surgery center in Philadelphia, where she provides anesthesia for minimally invasive spine surgery. Ms. Bear is also a trained hypnotist and creator of "Integration of Hypnosis into Anesthesia Care," a program adopted by the Laser Spine Institute across all of its facilities.
Dr. Bear has had an interest in hypnosis for many years, and her hypnosis work met requirements for her doctoral dissertation from Rush University in Chicago. Dr. Bear says her findings were comparable to other hypnosis leaders and cited a 2000 study conducted by Elvira Lang, MD, and a 2002 study by Guy Montgomery, PhD, who used "live hypnosis" rather than a recording.
Question: What exactly is hypnosis and how do you hypnotize patients before surgery?
Lynette Bear: Basically the formal definition most people in hypnosis accept is that hypnosis bypasses the critical factor. The critical factor is your conscious thought. We focus the patient's attention on something other than what is going on.
We are offering patients a recording for the pre-operative area for stress relief. Their focus is on a relaxing recording combined with music rather than everything going on around them. I developed the recording so patients could leave stress behind. Listening to it pre-operatively and in recovery is very relaxing. We have found that when a patient's blood pressure or heart rate is high, hypnosis helps. If you are using the hypnosis recording while starting an IV, the patient is focused on imagery and different things other than a needle going in their arm.
A surgery-specific hypnosis recording is used with anesthesia during surgery. Medication helps to put patients in a trance. The recording gives patients powerful suggestions for healing and well-being. The suggestions are focused in the "positive." For example, [the recording may say], "You'll have a nice appetite after surgery," rather than, "You won’t throw up."
With medication advances, anesthesia providers don't use hypnosis as often as they used to. Even as advances occur, there is growing population of patients asking for complementary adjuncts along with medication.
Q: Why did you look into implementing hypnosis at the Laser Spine Institute in Scottsdale, Ariz.?
LB: At Laser Spine Institute, we were faced with how we could do two things at once — improve patient satisfaction and minimize costs. I had always wanted to do hypnosis research, and I was working at a progressive company that strongly supported an idea to improve patient satisfaction and overall care. In addition, we were facing a propofol shortage and needed a way to conserve medication without sacrificing patient comfort. In my doctoral research, I found 35 percent of patients were requesting complimentary medicine in addition to anesthesia and patients were open to the idea of hypnosis.
A researcher in 2000 used hypnosis [in conjunction with anesthesia] and found that patients had decreased pain and anxiety, increased hemodynamic stability and required less medication. A similar study in 2007 found patients were ready for surgery more quickly with hypnosis and found a cost savings of $772 per patient. Once patients were more comfortable, they could start surgery more quickly and use less operating room time. A meta-analysis also showed 89 percent of patients could benefit with combined hypnosis and anesthesia.
Hypnosis in conjunction with anesthesia seemed like a win-win situation. We had a way that, according to research, could decrease our cost, would be effective for most patients and that any anesthesia provider could implement. Anesthesia providers were able to effectively use hypnosis with minimal hypnosis training.
Q: As a trained hypnotist, you conducted your own study on hypnosis with anesthesia. What was your process and findings?
LB: My hypnosis study was done on patients at Laser Spine Institute having minimally invasive spine surgery in our ASC in Arizona. I studied 123 patients in a control group and compared them to 130 patients in the hypnosis group. My study results showed that postoperative nausea and vomiting was statistically reduced with hypnosis; the rate of 1.5 percent while the Ambulatory Surgery Center Association reported rate was 2.5 percent in 2010.
In addition, my results showed a statistically significant decrease in recovery room time. Recovery time was reduced by 11.7 percent with hypnosis. Patients were more alert after anesthesia and recovered more quickly. Ninety-three percent of patients said that they would request hypnosis for future surgeries. Recovery room staff reported using less pain medication and anti-emetics, resulting in a cost savings. Recovery room staff overtime decreased due to quicker recovery and discharge of patients.
Q: How did you implement your findings once the study concluded?
LB: I relocated to the Laser Spine Institute in Philadelphia and started the program here. Our key emphasis is patient satisfaction. We have found that hypnosis decreases pain and anxiety during their surgical process and patients are comfortable when they are discharged.
Since we started using [hypnosis] in Philadelphia, our average patient satisfaction is 95 percent throughout all of our ambulatory surgery facilities. Ninety-seven percent of Philadelphia patients would recommend Laser Spine Institute to others, and our Philadelphia anesthesia satisfaction rates are consistently 96 percent or greater. Our high satisfaction rates are similar throughout most of our facilities. Our satisfaction surveys are performed by EdgeSurvey and compared to other ambulatory surgery centers.
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