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

Abstract

Hypnosis is a promising non-pharmacological adjunct treatment for improving pain and interventional anxiety management in pediatric interventions. Its efficiency and impacts in pediatric cardiac catheterization (CC) are unknown. Evaluate hypnosis efficiency and impacts in pediatric cardiac catheterization. This a prospective monocentric study, all patients aged < 16 years who had CC under hypnosis with local anesthesia from January to December 2021 were included. Pain and anxiety were evaluated by the ANI (Analgesia Nociception Index) measured during the intervention, and the Visual Analogue Scale (VAS) assessed by the patients after the intervention. Sixteen patients were included, mean age was 10.5 years |range 4–16 years], mean weight was 37 kg [range 15–69 kg]. Catheterizations were interventional in 10 patients (62.5%) and for diagnostic purposes in 6 patients (37.5%). Hypnosis indications were general anesthesia (GA) contraindication in 4 patients (25.0%), the need of accurate pressures measurements without GA interference in 3 patients (18.7%) and interventions/patients preferences in 9 patients (56.3%). In one patient of 4 years old, the hypnotic status was not achieved and the procedure was aborted before the installation. CC was accomplished successfully in 15 patients (93.7%) even in complicated cases; large atrial septal defect (ASD) closed with 39 mm Occlutech device in 16 years old patient, and a large ASD 26 mm/m2 closed by 18 mm Amplazer device in 7 years old patient. Mean procedures and fluoroscopy times were 67.5 and 5.3 min, respectively. In one case, pulmonary artery pressures were normalized comparing to previous catheterization under local anesthesia alone leading to the cancellation of cardiac surgery on mitral stenosis. No additional medication was necessary in all patients. VAS score was under 5/10 in all patients. The ANI remained above 50 (non-painful zone) in all but one patient. There is no significative decrease of the ANI during the intervention comparing to the baseline (P = 0.62). One patient with language difficulties had short and transient decrease of the ANI (49) during one minute after the puncture (Table 1). Pediatric CC are feasible under hypnosis even in complicated cases. Hypnosis was efficient to manage pain and stress in all cases. It ensures more reliable pressure measurements.