Hypnosis is not used as often as an anesthetic agent as it is to control nonsurgical pain. On at least two occasions, the author was unable to find a local obstetrician who employed hypnosis in deliveries for pregnant women desiring such a referral (both of whom were excellent hypnotic subjects).

Probably the principal reason for this state of affairs has been the development of reasonably safe, rapidly effective chemical changes. It has been estimated that only 25% of the population are capable of developing a sufficient degree of hypnoanesthesia for its use as the sole anesthetic in relatively minor procedures, such as fracture settings, tooth extractions, the changing of burn dressings, or the removal of sutures in frightened children.

Other reasons advanced for reluctance to use hypnoanesthesia include: the amount of time, training, and skill required for a hypnotic induction; the fact that hypnosis may be contraindicted in patients with psychological problems such as psychotics, borderlines, or depressives; and the fact that hypnosis is regarded as Òquasi-scientificÓ in some professional circles

With respect to the contraindication of hypnosis and hypnoanesthia in patients with certain psychological disorders, some clarification is required. There is no absolute contraindication for hypnosis in any patient. Some patients may present a higher risk of developing adverse reactions such as spontaneous regression and aberrations, that are undesirable in a nonpsychotherapy context, and control of these require some skill on the part of the hypnotist. Hence, with these patients, hypnoanesthesia requires a hypnotist who is well trained in psychotherapy. It should not be attempted by a physician who lacks such training. It is unfortunate that physicians in general and anesthesiologists in particular, do not receive more training in psychodynamic concepts and hypnosis, for it is usually convenient to have a psychologist induce hypnoanesthia except in an emergency situation.

If initial hypnotic inductions are performed are performed in a leisurely, unhurried atmosphere and the patient is given the opportunity to develop an anesthesia and experience it tested successfully, his confidence in the adequacy of the procedure will be greater. Patients should be trained to enter a trance state either on a posthypnotic signal or by self-induction to save time in the operating room and render them independent of the presence of the particular hypnotist who trained them.

A patient so trained may be able to have a successful hypnotic delivery under the care of another obstetrician should the one who trained her in hypnosis be available at her delivery. Also, the ability to reenter hypnosis rapidly on a signal is a valuable safeguard should a patient inadvertently awaken during surgery. This contingency is quite unlikely, particularly if the hypnotist instructs the patient not to awaken until directed to and if he or she continues a steady flow of trance maintaining chatter throughout the operation. Preliminary trials of hypnosis may be presented to patients with reservations about the procedure as exercises in relaxation to prevent their fears from producing reactions that may lead to false impressions of their abilities as subjects.

The value of hypnosis may also extend to the prenatal period------It not possible to do successful hypnoanesthia, or for that matter any other hypnotic procedure, unless the therapist takes the time necessary to establish a proper rapport with the patient and the latter develops confidence in the hypnotists ability and concern for his welfare In addition to its use as an anesthetic, hypnosis can be a valuable pre-operative and postoperative adjunct to the care of surgical patients.

J. Barber and Mallin (1977) advocate the use of hypnosis during the fitting of contact lenses and emphasize the careful choice of words in the framing of suggestions. Words that denote the same thing may vary widely in their connotations and implications and thus may not be equally effective in framing suggestions.