Management of Perioperative Anxiety by the Cardiac Coherence Technique Coupled With a Hypnosis Session

The perioperative period is recognized as an anxiety-provoking period for patients. If for some patients, this anxiety is more or less manageable, for others, it is the major concern with regard to their intervention, fearing not to wake up, to remain in a coma. Consideration of this aspect is very important for patients who require surgery. It is also a concern for caregivers involved in the care of these patients, including anesthesiologists, surgeons and operating room staff.

For many years, pharmacological premedication, including benzodiazepines, has been the gold standard in the treatment of preoperative anxiety.

This systematic prescription is controversial in populations most exposed to side effects such as the elderly, patients with heart or respiratory diseases.

Surgery also seems to influence the impact of premedication. For example, abdominal surgery and breast surgery are associated with a higher risk of agitation upon awakening.

Mental preparation, based on simple explanations by the anaesthetist, is not enough to reduce patients' anxiety.

A recent study evaluated the perioperative experience of patients receiving or not receiving premedication. It shows that benzodiazepines are associated with cognitive impairment and delayed extubation in the elderly. In addition, it seems to have little effect on patient anxiety when compared to a placebo.

In this context of anxiety, an emotional regulation tool appears particularly relevant. Cardiac coherence" (CC) is a particular state of cardiac variability. This state is correlated with many physiological and psychological variables. It is possible to promote this state through different techniques. One of its practices, "fixed frequency guided breathing", seems relevant both in its principles and in its simplicity of implementation.

This specific respiratory mode permits to rebalance the sympathetic - parasympathetic balance of the autonomic nervous system and reveals a state of calm vigilance. This simple, well-coded respiratory psychophysiological practice is widely used in many applications, such as for the most caricatural ones, the management of difficult situations where stress is a central element such as decision-making among fighter pilots on mission, in national education to improve academic learning (especially among anxious students) and also more generally in stress and anxiety management.

This technique induces a refocusing of emotions by regulating the SNA and therefore a better regulation of the hormones involved in the emotional cascade.

This practice has several advantages:

• it is psychophysiological (psychocorporeal) and widely described in the scientific literature in several indications
• it is completely free of charge and immediately accessible to the patient, regardless of time and place
• it can be used at other anxiety-inducing times (e.g., imaging or biopsy tests)
• it allows total patient autonomy, offering self-management of anxiety and independence from the presence of a third party
• it can approach a hypnotic model by focusing and absorbing what it can induce on breathing, and thus share some of its benefits
• It does not have any adverse effects. The major difficulty of this technique is the adherence and regularity of the practice. The optimal effect is dependent on regular training.

To improve this adherence, an audio tape will be put online, read in a hypnotic tone, which will aim to explain respiratory physiology, the benefits of oxygenation on cells and metabolism; this will have the effect of understanding the interest and utility of this exercise and will contribute to induce a feeling of relaxation and well-being.

This study will be a study of feasibility about a program based on the cardiac coherence technique in a context of perioperative anxiety.

Inclusion criteria

• Age ≥ 18 years old
• Surgery for breast or gynaecological cancer requiring scheduled hospitalization for up to 3 days
• Signing of informed consent before any specific procedure in the study
• Patient affiliated to a social security system

Exclusion criteria

• Patients undergoing outpatient surgery for their cancer will not be included
• Natural bradycardia (50 beats per minute)
• Patient taking β-blockers, digoxin, flecaine, isoptin, cordarone, diltiazem
• Cardiac arrhythmias
• Severe heart failure with ventricular ejection fraction < 40%
• Uncontrolled chronic pain
• Patients whose medical or psychological conditions do not allow them to complete the study or sign the consent
• Patient does not understand the French language
• Deaf and/or dumb patient
• Adult patient under guardianship or curatorship