Clinical hypnosis associated with local anesthesia for cardiac catheterization in paediatric population

Abstract

Hypnosis is a promising non-pharmacologic adjunct treatment for improving pain and interventional anxiety management in paediatric interventions. Its efficiency and impacts in paediatric cardiac catheterization (CC) are unknown. In a prospective monocentric study, all patients aged < 18 years who had CC under hypnosis with local anesthesia from January to December 2021 were included. Pain and anxiety were evaluated by the Analgesia Nociception Index (ANI) measured during the intervention, and the Visual Analogue Scale (VAS) assessed by the patients after the intervention. Sixteen patients were included. Median age was 10.5 years old [4–16 years], median weight was 37 kg [15–79 kg]. Catheterizations were interventional in 10 patients (62.5%), for diagnostic purposes in 6 patients (37.5%) ( Table 1 ). Hypnosis indications were general anesthesia (GA) contraindication in 4 patients (25.0%), need of accurate pressures measurements without GA interference in 2 patients (12.5%) and interventionist/patients preferences in 10 patients (62.5%). In one patient of 4 years old, the hypnotic status was not achieved. Procedures were accomplished successfully in 15 patients (93.7%) without any additional sedation even in challenging cases; large atrial septal defect closed with 39 mm Occlutech device in 16 years old patient, and catheterization in 14 years old patient with Fontan failure, elevated pulmonary vascular resistances, cyanosis (Hemodynamic Vulnerability Score = 5) with GA contraindication. In one case, pulmonary artery pressures normalized comparing to previous catheterization under local anesthesia alone leading to the cancellation of cardiac surgery on mitral stenosis. VAS score was under 5/10 in all patients. ANI remained above 50 (non-painful zone) in all but one patient. No significative decrease of the ANI was found during the intervention comparing to baseline ( P = 0.62). No complications were recorded ( Table 1 ). Paediatric CC are feasible under hypnosis even in complicated cases. Hypnosis was efficient to manage pain and stress in all cases, it ensures more reliable pressures measurements.