A neurosurgeon and a hypnotist walk into an O.R.

Authors: Chloe Noteboom, student of the European Master’s in Clinical Linguistics, EMCL and Adrià Rofes, associate professor of neurolinguistics, University of Groningen.

A hypnotist and a neurosurgeon walk into an O.R…. no, there’s not a punchline coming. Hypnosis is a technique being explored as an alternative to more standard methods of sedation in awake brain surgeries.

Did you say brain surgery… while awake?!

When a patient has surgery for a slow-growing brain tumor, it is common practice for that patient to be awake for at least part of the surgery. This allows the surgical team to monitor the patient and ensure that important functions, such as motor skills and language, are not disturbed by the tumor removal . The traditional practice in awake brain surgeries is to put a patient under general anesthesia until the surgeon has exposed the cortex. At which point, patients are woken back up to perform a series of cognitive and language tests used to identify crucial areas of the brain before and during removal of the tumor. The patient is then put back under general anesthesia for the final duration of the surgery.

Where does hypnosis come into this?

Hypnosis has been used to control pain during medical procedures since the 1800’s when physician James Esdaile used hypnosis as anesthesia during complex surgeries, including tumor removal . At the time, most surgical patients died from blood loss, shock, or infection, but according to his records, most of Dr. Esdaile’s patients survived.

In the past decade, hypnosedation, using hypnosis in tandem with a local anesthetic, has increasingly been trialed by neurosurgeons around the world. In this technique, a trained anesthesiologist places the patient into a state of heightened, focused attention and decreased peripheral awareness, which makes a person highly susceptible to suggestion, immediately prior to entering the operating room .

You’re getting very sleepy…

No, it doesn’t work like you may have seen in the movies—nobody is going to tap on a teacup and instantly put you in a trance! The patient will provide the anesthesiologist with a hypnotic script, which consists of a detailed description, including information as specific as the weather, of the scenario they want to experience during their hypnosis (Pardey Bracho et al., 2022). This can be a memory or imagined. One patient chose an ABBA concert, and requested that they play ABBA’s music during the surgery (the surgical team obliged). Once the patient is hypnotized, the anesthesiologist will make suggestions intended to dull their senses, induce a positive state of mind, and even make physiological suggestions, such as reduced bleeding during the surgery. Some hypnotic instructions may be repeated throughout the process, like “trust yourself” or “enjoy the moment” . Additionally, some patients are hypnotized the evening before their surgery to calm anxiety without the use of medications, which can negatively impact the cognitive and language tests done mid-surgery (Pardey Bracho et al., 2022).

Who would agree to that?

Well, maybe surprisingly, a lot of people! In one survey, as many as 67% of adults said that they would be willing to try incorporating hypnosis as part of their medical care . Younger people were more willing to try medical hypnosis than the older adults surveyed. Naturally, some people are still skeptical about hypnosedation. Familiarity with relaxation techniques similar to hypnosis, such as meditation and yoga, can reduce that skepticism. Additionally, patients who experienced surgery under hypnosis said that they became less hesitant about it after receiving more information about the process.

What’s the point?

The modern hypnosedation technique was developed with the goal of improving patient experience during surgery, as well as enhancing their quality-of-life post-surgery . The experience of being woken up in the operating room, lying on a table while bright lights shine on you, surrounded by people, can be jarring for patients. Since hypnotized patients are awake, just in a state of focused attention, the hope is that they won’t experience the heightened stress levels sometimes associated with the ‘awake’ phase of awake brain surgery. One study even found that hypnotized patients’ stress levels decreased as the surgery progressed . There is also evidence that patients with higher anxiety levels benefit even more from hypnosis than patients who are less distressed before the procedure . Additionally, from a psychological perspective, much of the anxiety experienced after being diagnosed with a brain tumor stems from a loss of control, and hypnosis can help return some of the power back to the patient (Pardey Bracho et al., 2022). It’s not possible to hypnotize someone against their will, which means that patients play an active role in their pain management and care.

Hypnosis offers many advantages over other sedation techniques, including increased patient safety and reduced reliance on opioids, which are a highly addictive class of painkillers (Walter et al., 2025). Another advantage of hypnosedation is that it can be used on patients who could not otherwise be put under general anesthesia, such as the elderly, the obese, or those that suffer from severe gastrointestinal reflux (Bakole et al., 2023). It also allows patients to return to full consciousness immediately for the ‘awake’ portion of the surgery, including older patients, who typically take longer to wake up from anesthesia (Zemmoura et al., 2016). Waking up faster means being able to complete the cognitive and language tests without being groggy and an overall shorter surgery, which decreases the odds of certain negative outcomes, like brain infection. Waking up more quickly also increases a patient’s capacity to respond to natural physiological cues, like thirst; when a patient is able to drink water soon after surgery, post-operative nausea and vomiting are decreased significantly. In fact, the risk of nausea and vomiting after surgery is cut in half with hypnosedation, which is comparable to the effect of anti-nausea medication .

But, does it hurt?

Hypnosis may not reduce the actual pain associated with surgery, but it can improve the patient’s perception of the pain (Lahoud et al., 2026). This is supported by evidence showing that hypnosedation actually reduces brain activity in areas associated with pain perception . So, while the hypnotized patients reported higher average pain scores than the patients who experienced more standard sedation techniques, both groups had similar overall comfort scores (Cossu et al., 2024). The hypnotized patients were also more satisfied with their anesthetic management.

So, hypnosedation has been shown to reduce not only patients’ perceived physical discomfort, but also their psychological distress related to surgery (Walter et al., 2025). Anecdotally, patients who have undergone surgery while hypnotized reflected on it as a positive experience, calling it “delightful, relaxing, and pleasant” (Lind et al., 2021). One surgeon who performed a hypnosis-assisted surgery noted that his patient “never once complained about the pain” and remained relaxed for all five hours of their surgery .

Overall, current research suggests that hypnosedation is a safe alternative to traditional anesthetic methods and should continue to be explored further. So, if you ever see a neurosurgeon and a hypnotist walk into the O.R. just take a deep breath, relax, and know that everything will be just fine.

References

1. Sacko, O., Lauwers-Cances, V., Brauge, D., Sesay, M., Brenner, A. & Roux, F. (2011). Awake Craniotomy vs Surgery Under General Anesthesia for Resection of Supratentorial Lesions. Neurosurgery, 68 (5), 1192-1199. DOI: 10.1227/NEU.0b013e31820c02a3.
2. Evans, F. J. (2001). Hypnosis: An Introduction. In The use of hypnosis in surgery and anesthesiology: psychological preparation of the surgical patient (pp. 3-30). Springfield, III.: Charles C. Thomas.
3. Pardey Bracho, G. F., Collomb, K., & Topouzkhanian, A. (2022). Patient’s Acting on their Own Care: Medical Hypnosis for Perioperative Management in The Awake Craniotomy. Technical Report and Clinical Cases. OBM Integrative and Complementary Medicine, 7(3), 1-21. DOI: 10.21926/obm.icm.2203030
4. Bankole, N. D. A., Kanmounye, U. S., Ouahabi, A. E., & Zemmoura, I. (2023). Asleep-awake-asleep versus hypnosis for low-grade glioma surgery: long term follow-up outcome. Neurochirurgie, 69, 1-9. DOI: 10.1016/j.neuchi.2023.101494
5. Lind, S. B., Jacobsen, H. B., Solbakken, O. A., & Reme, S. E. (2021) Clinical Hypnosis in Medical Care: A Mixed-Method Feasibility Study. Integrative Cancer Therapies, 20(1), 1-11. DOI: 10.1177/15347354211058678
6. Zemmoura, I., Fournier, E., El-Hage, W., Jolly, V., Destrieux, C., & Velut, S. (2016). Hypnosis for Awake Surgery of Low-grade Gliomas: Description of the Method and Psychological Assessment. Neurosurgery, 78(1), 53-61. DOI: 10.1227/NEU.000000000000099
7. Cossu, G., Vandenbulcke, A., Zaccarini, S., Gaudet, J. G., Hottinger, A. F., Rimorini, N., Potie, A., Beaud, V., Guerra-Lopez, U., Daniel, R. T., Berna, C., & Messerer, M. (2024). Hypnosis-Assisted Awake Craniotomy for Eloquent Brain Tumors: Advantages and Pitfalls. Cancers, 16, 1784-1798. DOI: 10.3390/cancers16091784
8. Walter, N., Torres Leyva, M., Hinterberger, T., Rupp, M., Loew, T., Lambert-Delgado, A., & Cobián Mena, A. E. (2025). Hypnosis as a non-pharmacological intervention for invasive medical procedures – A systematic review and meta-analytic update. Journal of Psychosomatic Research, 192, 1-10. DOI: 10.1016/j.jpsychores.2025.112117
9. Lahoud, M. J., Gurary, S. T., & Elia, N. (2026). Hypnosis for anaesthetists: a systematic review and meta-analyses. Anaesthesia, 81, 103-115. DOI: 10.1111/anae.70013
10. Rainville, P., Duncan, G. H., Price, D. D., Carrier, B., & Bushnell, M. C. (1997) Pain Affect Encoded in Human Anterior Cingulate But Not Somatosensory Cortex. Science, 277(5328), 968-971. DOI: 10.1126/science.277.5328.968
11. Seigel-Itzkovich, J. (2025). In Israeli first, Galilee Medical Center performs deep brain surgery under hypnosis. The Jerusalem Post. https://www.jpost.com/science/article-868234

The post A neurosurgeon and a hypnotist walk into an O.R. appeared first on Mapping Ignorance.