Hypnosis in High-Intensity Focused Ultrasound for Thyroid Nodule Ablation

Patient: Female, 70-year-old Final Diagnosis: Thyroid nodule Symptoms: None Clinical Procedure: Hypnosis • mild sedation • non-operating room anesthesia (NORA) Specialty: Anesthesiology • Endocrinology and Metaboli OBJECTIVE: Unusual setting of medical care BACKGROUND: Current medical technologies enable physicians to treat patients outside operating rooms using minimally invasive techniques. Non-operating room anesthesia (NORA) represents a growing field of medicine, with an increasing number of cases performed over the last decade. As a result, anesthesia providers will need to enhance their understanding of the resources, medical and paramedical staff, and environment outside the operating room. Patients undergoing such procedures under light conscious sedation still experience discomfort such as pain and anxiety, thus requiring the use of pain control medication or sedative drugs. At the same time, the use of hypnosis is spreading in medical practice, particularly with minimally invasive procedures. Many studies have investigated the use of hypnosis in cases of minimally invasive procedures, showing an effective reduction of patients’ discomfort and consumption of pain control medication, thus improving patient safety. CASE REPORT: We describe the case of a woman in her 70s who underwent a thyroid nodule thermal ablation through high-intensity focused ultrasound (HIFU) performed under hypnosis in a NORA setting. The procedure was well endured; the patient experienced comfort and was satisfied with having avoided general anesthesia. Post-HIFU follow-up showed a 30% decrease of thyroid nodule volume. The patient was completely satisfied with the esthetic result. The operator did not encounter any difficulties with the awoken patient or movements during the procedure. CONCLUSIONS: Our case confirms the effective role of hypnosis in relaxation and coping with painful procedures and highlights patient satisfaction without the use of sedative drugs in the context of NORA procedures.