RESEARCH FINDINGS USING GUIDED
IMAGERY FOR
HEART SURGERY
August, 2006
Definition
of the Problem
Cardiac surgery can best be divided into five major
classifications: cardiovascular operations, bypass
surgeries, valve repair, repair of congenital defects, and
other miscellaneous procedures.
Scope and Cost of the Problem
The American Heart Association reports that for the year
2000, there were a total of 5,939,000 in-patient cardiac
surgeries, 686,000 of which were open heart procedures.
This number includes 87,000 valve replacements, 561,000
Percutaneous Transluminal Coronary Angioplasties (PTCA’s),
1,318,000 in-patient cardiac catheterizations, 34,000
implantable defibrillator procedures; 152,000 pacemaker
procedures; 124,000 endarterectomies, and 519,000 bypass
procedures (American Heart Association,
2003).
An American Heart Association report lists the average cost
of an in-patient cardiac catheterization at $16,838 (AHA,
2003). The
cost for Bypass (CABG) surgery is approximately $27,000,
with an average stay of 5-6 days (9 days for Medicare
patients); most bypass patients are not able to return to
work for 4-6 weeks (and, in some cases, 6-12 weeks)
(Coronary Heart Disease Treatment, undated).
Mind-Body
Approaches to Coping with Surgery
Since pharmacologic sedation often increases the risk of
low blood pressure and lack of oxygen, doctors have looked
at other ways to reduce pre-surgical anxiety. Even the
outwardly simple act of listing to relaxing music can have
significant positive effect on cardiac surgery patients’
anxiety and pain (Voss, Good, et al, 2004).
Most effective have been relaxation with guided imagery
(self-hypnosis) and pre-procedure provision of information
(Ashton, Whitworth, et al, 1997; Faymonville, Fissette, et
al, 1995; Lang and Hamilton, 1994; Lang, Joyce, et al,
1996; Ludwick-Rosenthal and Neufeld,
1993).
Self-hypnosis, or relaxation
with guided imagery used before and during surgery has
resulted in shorter procedures (Lang, Benotsch, et al,
2000; Tusek, Church, et al, 1997). These techniques can
also significantly reduce post-surgical pain and the need
for post-operative pain medication (Ashton, Whitworth, et
al, 1997; Faymonville, Fissette, et al, 1995; Halpin,
Speir, et al, 2002; Lang, Benotsch, et al, 2000; Lang and
Hamilton, 2004; Lang, Joyce, et al, 1996; Manyande, Berg,
et al, 1995; Rensi, Peticca, et al, 2000; Syrjala,
Donaldson, et al, 1995; Tusek, Church, et al, 1997;
Weinstein and Au, 1991), anxiety (Hattan, King, et al.,
2002), shorten the time it for the return of normal
intestinal motility (Disbrow, Bennett & Owings, 1993;
Tusek, Church, et al, 1997), and reduce the length of
hospital stay (Bennett, 1996; Cowan, Buffington, et al,
2001; Disbrow, Bennett & Owings; Meurisse, Faymonville,
et al, 1996; Rapkin, Straubing & Holroyd, 1991; Tusek,
Church, et al.).
There is also some evidence that mind body therapies like
hypnosis and imagery can reduce blood loss (Bennett;
Bennett, Benson & Kuiken, 1986; Dreher, 1998; Enqvist,
von Konow & Bystedt, 1995; Lucas, 1975; Meurisse,
Faymonville, et al) and speed wound healing (Ginandes,
Brooks et al, 2003; Holden-Lund, 1988).
Hypnosis and guided imagery have been used effectively in
cardiac bypass to reduce length of stay, decrease use of
pain medications, and lower pharmacy costs (Ashton,
Whitworth, et al, 1997; Halpin, Speir, et al, 2002). These
techniques and similar techniques such as autogenic
training also help to alleviate anxiety (Ashton, Whitworth,
et al; Kanji, White, and Ernst, 2004). In one study, bypass patients
using these techniques were more relaxed pre-operatively
and had lower levels of post-operative depression, fatigue,
and anger (Ashton, Whitworth, et al).
Tension and pain in open heart
patients were significantly reduced in a group of patients
who used a combination of complementary therapies
consisting of guided imagery, bodywork (light
massage/gentle touch), and music (Kshettry, Carole, et al,
2006). Solid organ transplant recipients who used
mindfulness meditation experienced significant improvements
in sleep (Gross, Kreitzer, et al, 2005; Kreitzer, Gross, et
al, 2005) and anxiety (Gross, Kreitzer, et al). Use of
music prior to cardiac catheterization reduced patient
anxiety, especially in women (Hamel, 2001).
Anger can be particularly problematic for cardiac patients,
since anger has been associated with cardiac events
including heart attacks. High levels of anger are also
associated with re-narrowing of heart arteries and the need
for coronary artery bypass grafting (Appels, Bar, et al,
1997). A
simple mind-body technique like breathing therapy, similar
to the breathing technique taught in this program, has been
shown to reduce anger scores, and cut by 50% the risk of
post-PTCA cardiac events (Appels, Bar, et al). Male CABG
patients who used hypnosis experienced decreases in both
anger and depression, with the improvements being
maintained at follow-up (de Klerk, de Plessis, et al,
2004).
Acceptance of Mind-Body Approaches
In a
recent survey of middle-aged and older cardiac patients,
over 80% of those responding said that they used
Complementary and Alternative Medicine, including imagery
and relaxation techniques (Ai & Bolling, 2002).
High patient satisfaction with guided imagery tapes have
been reported by several sources, including Blue Shield of
California and Cedars Sinai Medical Center
(Los Angeles) (Bodaken, 2000; Fontana, 2000).
World-renowned cardiac surgeon Mehmet Oz and his colleagues
have stated: “Mind-body techniques and complementary care
may assist people who are undergoing surgery and those
recovering from cardiac surgery to cope with the event, the
process of recovery, and accompanying lifestyle changes.
These approaches can provide cardiac patients with
nonpharmacologic tools that may prevent further coronary
artery disease and the development of dysrhythmias”
(Whitworth, Burkhardt, and Oz, 1998).
Conclusion
A low-cost guided imagery program can help to lower
pre-surgical anxiety, reduce pain and the need for
post-operative medication, shorten procedure time and
hospital stay, and possibly reduce surgical bleeding, and
speed recovery.
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