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Lorenzo Cohen and Rosalinda Engle at MD Anderson

Image: Daniel Kramer

What if your surgeon told you that you would be awake for your next operation? It wouldn’t be unreasonable to picture the whiskey-fueled bullet-biting and hot-iron cauterization of a Civil War battlefield amputation. Anesthesia, in its varying forms from 19th-century chloroform and ether to today’s propofol and Amidate, has been working just fine for nearly 200 years. But Lorenzo Cohen, director of the integrative medicine program at MD Anderson Cancer Center, thinks we’re ready to move past it, using an ancient technique: hypnosis.

He and surgical staff at MD Anderson are working on a study he thinks will prove that forgoing drugs in favor of a guided state of deep relaxation is the way ahead. “The very cutting of the body is traumatic, whether you’re awake or asleep. The same with anesthesia, especially if you’re an older patient. It’s an assault to the system,” says Rosalinda Engle, a mind-body interventionist employed by the hospital, whose methods are the replacement for general anesthesia in the study.

Engle meets with patients undergoing hypno-sedation a day or two before surgery, establishing rapport and coaching them in the techniques she’ll use on the big day. Patients are selected by surgeons, based on their perceived suggestibility and other research criteria; those whose minds are likely to resist hypnosis aren’t good candidates.

All chosen patients will have segmental mastectomies, better known as lumpectomies, which remove breast lumps and nearby glands. All are eager to try hypnosis, too, but only half, selected at random, get to; the other half go under using anesthesia. In order to allow the researchers to study their brainwave patterns accurately, neither group receives an epidural or perivertebral block, typically employed to cut off the message between spine and brain.

Engle stays with the anesthesia group before, during and after surgery, offering supportive attention and care. She guides the others, meanwhile, through deep muscle relaxation, inducting them into a state of deep ease. There is no Freudian pocket watch. Instead, she describes the mental state she hopes her charges will achieve as “like on a Saturday or Sunday morning when you’re waking and you don’t have to bolt out of bed.”

Which is amazing, when you think about it. “This is happening in a cold operating room with lots of beeping going on and they’re being cut into and they’re smelling the burning of their flesh, and they’re having the blood pressure cuff go on and off,” says Cohen, “and they’ve got an EEG cap going on and there’s a catheter, and someone is touching them.” And yet, “Rosalinda’s there just whispering into their ear and they’re off in the south of France.”

The potential advantages are clear: Hypno-sedated patients emerge from surgery awake and ready for discharge. The ones who’ve gone under with anesthesia, meanwhile, usually wake up in fight-or-flight mode (EEGs show brain activity increases during surgery) or in a state of distress. Even anesthesiologists admit that the drugs themselves are harmful—especially for immunosuppressed cancer patients.

Cohen and Engle have had success previously with psycho-oncological studies into the efficacy of Tibetan yoga in lung and breast cancer patients and their caregivers. While the jury is still out regarding the new study, the two believe that offering local anesthesia with hypno-sedation would provide long-term benefits to patients fighting cancer. And they’re not alone. 

“When our surgeons and our clinicians are as on board with this project as actively as they are, it really means the world to us,” says Engle. And why wouldn’t they be? Procedures done without anesthesia are quicker and cost either the same or less than conventional surgery. “We know it works,” says Cohen. “But it’s not the standard of care at most hospitals.”

Policies, among both hospitals and insurance companies, need to change to make that happen. With studies like this one, we’re one cut closer.

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