Thiopental to desflurane - an anaesthetic journey. Where are we going next?
Br J Anaesth. 2017 Dec 01;119(suppl_1):i44-i52
Authors: Sneyd JR
Development targets in anaesthetic pharmacology have evolved from minimizing harm caused by unwanted effects through an era in which rapid onset and offset of drug effect were prioritised. Today's anaesthetists have access to a library of effective drugs whose characteristics offer controllable hypnosis, analgesia and paralysis with manageable off-target effects. The availability of these agents at generic prices inhibits commercial interest and this is reflected in the limited number of current anaesthetic drug development projects. Recently, questions around neonatal neurotoxicity, delirium and postoperative cognitive dysfunction have stimulated research to characterise these phenomena and explain them in mechanistic terms. Emergent basic science from these enquiries together with exploration of possible effects of anaesthetic drug choice on patient outcomes from cancer surgery may yield new targets for drug discovery.
PMID: 29161390 [PubMed - in process]
Changes in laser-evoked potentials during hypnotic analgesia for chronic pain: a pilot study.
Ann Palliat Med. 2017 Nov 10;:
Authors: Squintani G, Brugnoli MP, Pasin E, Segatti A, Concon E, Polati E, Bonetti B, Matinella A
BACKGROUND: Hypnotic analgesia is one of the most effective nonpharmacological methods for pain control. Hypnosis and distraction of attention from pain might share similar mechanisms by which brain responses to painful stimulation could be similarly reduced in both states. There is ample evidence for the efficacy of clinical hypnosis as a psychological intervention in the treatment of acute or chronic pain. Results are conflicting, however, with some studies showing an increase, others a reduction, and others still no change in the amplitude of event-related brain potentials during hypnosis as compared to control conditions. Here we compared the effects of clinical hypnosis to simple distraction of attention during recording of laser-evoked potentials (LEPs) in patients with chronic pain.
METHODS: The dominant hand in ten patients with chronic pain was tested with LEPs during: (I) resting state; (II) clinical hypnosis, and (III) distraction of attention. Nociceptive responses elicited by LEPs were graded on a numerical rating scale (NRS), and the change in N2-P2 complex amplitude during the three experimental conditions was analyzed.
RESULTS: N2-P2 amplitudes were significantly decreased during the hypnotic state as compared to the resting state and distraction of attention.
CONCLUSIONS: Hypnosis is a modified state of consciousness that may differ from mental relaxation or distraction of attention from pain. A reduction in N2-P2 amplitude may result from the modulation of diverse brain networks, particularly the frontolimbic pathways, which could modify noxious stimuli input processing during hypnotic analgesia. Our findings indicate that several different brain mechanisms may act together in hypnosis and distraction of attention during pain processing and that clinical hypnosis may provide a useful non-invasive pain relief therapy.
PMID: 29156922 [PubMed - as supplied by publisher]
Clinical hypnosis in Palliative Care: neural correlates, clinical, psychological and spiritual therapies.
Ann Palliat Med. 2017 Oct 26;:
Authors: Brugnoli MP
PMID: 29156919 [PubMed - as supplied by publisher]
I hurt so: hypnotic interventions and palliative care for traumatic brain injury.
Ann Palliat Med. 2017 Sep 12;:
Authors: Moss D
This article presents a case study in which self-hypnosis, hypnosis-assisted psychotherapy, and palliative care strategies were provided within a multi-modal integrative treatment program for a 38-year-old woman with traumatic brain injury (TBI) secondary to motor vehicle accident. Self-hypnosis was helpful in anxiety reduction and pain management. Hypnosis-assisted psychotherapy was beneficial in de-sensitizing many post-traumatic memories, and in managing post-concussion pain, including neuropathic pain and post-traumatic migraine headaches. A variety of palliative care techniques and spiritual interventions were applied to enhance sleep, moderate cognitive deficits, and enhance quality of life.
PMID: 29156905 [PubMed - as supplied by publisher]
Clinical hypnosis, mindfulness and spirituality in palliative care.
Ann Palliat Med. 2017 Sep 28;:
Authors: Casula C
In this article, I do not intend to present the many and well-known treatments for relieving pain and distress symptoms of the physical body, damaged by terminal diseases, such as cancer, AIDS, multiple sclerosis. In this article, I'd rather focus my attention on clinical hypnosis for subjects who, freed from physical pain, thanks to palliative care, are open to receiving comfort and support for their psychological and spiritual suffering. The intent of this article is to express how clinical hypnosis can harmoniously integrate psychological and spiritual aspects so that the terminal patient can make peace with his/her past, with the people who have hurt him/her, and with the people who will suffer because of his/her death. This article will present some hypnotic suggestions inspired by universal wisdom of the Stoics, by positive psychology of Mindfulness, by laws of nature regarding changes, differences and mysteries. The basic assumption of the suggestions presented is that, if disease is an enemy to fight, death is an inevitable part of life: it cannot be avoided, or postponed or exchanged with anybody. It arrives when we have finished living. When death is preceded by an incurable disease, palliative care can offer a mantle of compassion and acceptance of what cannot be avoided. The words palliative comes from the Latin pallium-mantle. This article also presents some suggestions I have utilized several times with my patients. These suggestions have demonstrated their efficacy in alleviating patients' suffering in coping with their disease and in facing death.
PMID: 29156894 [PubMed - as supplied by publisher]
Meditational spiritual intercession and recovery from disease in palliative care: a literature review.
Ann Palliat Med. 2017 Sep 20;:
Authors: Agarwal S, Kumar V, Agarwal S, Brugnoli MP, Agarwal A
Human body is a biological, open system and maintains itself in the changing environment. Disease state is cured by many medicinal systems for healing. Esoteric healing (through introspective hypnosis, meditation and spiritual intercession) is the system where its believers regard Supreme Being as Omnipotent, Omnipresent and Omniscient. Such persons take ill health as a boon and pray through meditation that He may by His Mercy grant health or if God wishes otherwise, they happily accept it so that they keep moving ahead on their spiritual path. This study is a review of literature, where results clearly point towards better psychological and spiritual healing in patients who believe in esoteric cures. Modern science in terms of cognitive psychology or neurophysiology has begun to emphasize the role of consciousness but, that is confined only to the physical world. It is only with the advent of Param Purush Puran Dhani Soami Ji Maharaj (200 years ago) that in the religion of Saints, the ultimate consciousness or the Super Consciousness of the highest order has been revealed.
PMID: 29156893 [PubMed - as supplied by publisher]
Non-pharmacological interventions for reducing mental distress in patients undergoing dental procedures: Systematic review and meta-analysis.
J Dent. 2017 Nov 14;:
Authors: Burghardt S, Koranyi S, Magnucki G, Strauss B, Rosendahl J
OBJECTIVES: This meta-analysis investigates the efficacy of non-pharmacological interventions in adults undergoing dental procedures under regional or general anesthesia compared to standard care alone or an attention control group on the reduction of mental distress, pain, and analgesic use.
DATA SOURCES: To identify relevant papers a comprehensive literature search was carried out in MEDLINE, CENTRAL, Web of Science, and PsycINFO (last search August, 2017). Additionally, lists of references of relevant articles and previous reviews were checked. ProQuest Dissertations and Theses Full Text Database was screened to identify any unpublished material.
STUDY SELECTION: A total of 29 eligible randomized controlled trials were included, comprising a total of 2.886 patients. Included trials investigated the effects of hypnosis, enhanced information, relaxation, music, or cognitive-behavioral approaches including distraction.
RESULTS: Random effects meta-analyses revealed significant positive treatment effects on the reduction of mental distress (g=0.58, CI 95% [0.39; 0.76]). Effects on pain relief (g=0.00, CI 95% [-0.28; 0.28]) and the reduction of analgesic use (g=0.26, CI 95% [-0.22; 0.73]) were not significant. Because effects on mental distress were substantially heterogeneous, subgroup analyses were run yielding significantly larger effects for studies with low risk of bias compared to studies with high or unclear risk of selection and attrition bias. No significant differences appeared between various types of non-pharmacological interventions.
CONCLUSIONS: In summary, benefits of non-pharmacological interventions on reducing mental distress were demonstrated with largest effects being shown for hypnosis. However, further high quality trials are needed to strengthen the promising evidence.
CLINICAL SIGNIFICANCE: This systematic review and meta-analysis indicated that non-pharmacological interventions may be beneficial for reducing mental distress in patients undergoing dental procedures and could thus be considered as valuable adjunct to standard care.
PMID: 29154798 [PubMed - as supplied by publisher]
Thyroid surgery under bilateral superficial cervical block and hypnosis.
Minerva Anestesiol. 2017 Nov 17;:
Authors: Al-Nasser B, Lucas-Gourdet E
PMID: 29152937 [PubMed - as supplied by publisher]
Jumping Frenchmen, Miryachit, and Latah: Culture-Specific Hyperstartle-Plus Syndromes.
Front Neurol Neurosci. 2018;42:122-131
Authors: Lanska DJ
In the late 19th century, jumping (French Canadians in Maine, USA), miryachit (Siberia), and latah (Southeast Asia) were among a group of similar disorders described around the world, each of which manifests as an exaggerated startle response with additional late-response features that were felt by some to overlap with hysteria or tics. The later features following the exaggerated startle reaction variably include mimesis (e.g., echopraxia, echolalia) and automatic obedience. These reaction patterns tended to persist indefinitely in affected individuals. Because of their dramatic stimulus-driven behaviors, affected individuals were prone to be teased and tormented by being repeatedly and intentionally startled. Despite clinical overlap between jumping and Tourette syndrome, these entities are now recognized as distinct: in jumping, the key feature is an abnormal startle response, the abnormal reaction is always provoked, and tics are absent, whereas in Tourette syndrome, the key feature is spontaneous motor and vocal tics, although patients with Tourette syndrome may occasionally also have an exaggerated startle response. These disorders have been conceptualized from anthropological, psychodynamic, and neurobiologic perspectives, with no complete resolution to date. Attempts at treatment have been generally unsuccessful, including attempts with bromization and hypnosis, although anecdotal reports of successful deconditioning have been published. In population groups affected, these disorders are usually considered as behavioral peculiarities and not as diseases per se, and there is no apparent tendency to develop disabling mental illness or neurodegenerative disorders. The genesis of these disorders, their cultural and social components, and their interactions with the presumed underlying physiological substrate need further study. Careful descriptive and analytic epidemiological studies are also lacking for all of these disorders.
PMID: 29151096 [PubMed - in process]
Mechanisms of Cardioprotection of Halogenated Agents during Extracorporeal Circulation in Cardiac Surgery.
Curr Vasc Pharmacol. 2017 Nov 16;:
Authors: Aliaga MR, Belmonte JJE, Ramirez-Fernandez A, Navarro MR, Manas JC
The implementation of cardioprotective strategies involving pre-, intra-, and postoperative interventions is key during cardiac surgery requiring extracorporeal circulation (ECC). The primary goal of this study was to review the physiopathology of and protection strategies against myocardial damage secondary to ECC during cardiac surgery. The administration of halogenated anesthetics for cardiac anesthesia is commonplace due to their well-known cardioprotective effects and their capacity to ensure hypnosis. An optimal myocardial protection strategy requires that a comprehensive approach is adopted to cover pre-, intra-, and post-operative interventions. Pre-conditioning and post-conditioning share numerous pathways, mainly based on mitochondrial signaling, antiapoptotic pathways, and reduced inflammatory mediators. However, volatile anesthetic can also be administered during ECC, which mechanism of action during this period has been scantly investigated, and its biology is still unknown.
PMID: 29149820 [PubMed - as supplied by publisher]