After Ron Estinger's presentation on autosuggestion was over, a traveling nurse queried him outside the meeting room, seeking advice on ways to calm anxious children before medical procedures.
Using some gadgets purchased from a trick shop, Estinger created the illusion of removing the woman's nose from her face -- which then glowed red in his hand -- tossing it into the air with one hand and catching it with the other.
The nurse giggled and asked how he did it.
Estinger explained how his parlor trick illustrates the way hypnosis and autosuggestion work in medicine by redirecting the focus of the mind. According to Estinger, who spoke Friday at the American Association of Ambulatory Surgery Centers' annual meeting in Reno, Nev., the tools are effective in relieving anxiety in preoperative patients and improving intraoperative and postoperative outcomes.
"In hypnosis, we bypass the critical factor in the conscious, analytical part of the brain," Estinger said. "It will allow you to deal with your clients on a subconscious level."
Estinger, a nurse anesthetist since 1975, is a past president of the Virginia Association of Nurse Anesthetists. He spent 36 years in military service, in the Marine Corps, Army, Army Reserve and the Navy. Recently, Estinger served as director of patient services and senior nurse executive at the Naval Hospital Beaufort in North Carolina. After retiring as a captain from the Navy in 2003, he opened Health Visions, a wellness clinic in Oak Ridge, Tenn., where he incorporates hypnosis and autosuggestion into patient care.
Estinger said his interest in hypnosis began in high school, but he didn't begin taking courses until 10 years later. He was certified as a hypnotherapist in 1978 by the Academy of Clinical Hypnosis in New Orleans. He is board certified as a trainer of hypnotherapists by the National Guild of Hypnotists in Merrimac, N.H., and offers an intense, weeklong clinical-hypnosis training program that is accredited by the American Association of Nurse Anesthetists for 54 hours of continuing-education credits.
Estinger said physicians running ASCs or performing in-office surgeries would do well to invest in a supply of guided-imagery CDs to give to their patients. He said the best time for them to begin listening is about two weeks prior to their scheduled procedures, when studies show they start thinking about the surgery and their anxiety levels begin to rise. He also advised surgeons to let the patients listen to the same CDs with headphones just before and during surgery.
For many patients, the CDs' calming effect and positive suggestions will reduce the patient's need for anesthesia as well as lessen their incidence of postoperative nausea, vomiting and pain.
"It's not miracles," he said. "It's not magic. It's not voodoo. It's the way our bodies were meant to heal ourselves."
Estinger also counseled conference attendees to be mindful of speaking positively and reassuringly to and around patients, particularly when they are under anesthesia and susceptible to suggestion. A majority of anesthetized patients "eavesdrop" on clinicians in the operating room during surgery -- even while they are "out" -- and can be influenced by negative remarks. Patients are similarly susceptible to suggestion when they are awakening from anesthesia, he said.
Estinger said most physicians and nurses are familiar with the basic principles of hypnotism and autosuggestion, but he estimated only one in 10 applies the methods in his or her practice. He recommended ASC personnel take a class in clinical hypnosis, then stay in practice by routinely applying the techniques at work.
"It will make a difference, not only for your patients," he said. "You also can do stress management classes for your staff."
Lecture attendee Jeanette Boarman, a registered nurse who works in post-operative patient care at the West Shore Surgery Center in Mechanicsburg, Pa., said she will take back a number of tips from Estinger's presentation.
"The first thing I ask patients when they wake up is, 'Are you feeling any pain?'" Boarman said. "Maybe I should ask them, 'Are you comfortable?'"
Accordingly, Boarman also said she is going to recommend changing the ASC's pain-assessment scale to a patient-comfort scale.
Boarman said she believes investing in a class in clinical hypnosis would be time well spent, especially, she said, "if it means pushing less pain medication."