Usefulness of hypnosis for renal needle biopsy in children

Since Kark and Muehrcke in 1954 described the validity of renal biopsy in the prone position, using intravenous pyelography to localize the kidney [11, the number of renal biopsies increased dramatically and the renal needle biopsy was accepted as a safe, simple, and very useful procedure to use even in children [2—4]. The collaboration of the patient is fundamental in performing a needle biopsy under local anesthesia. It may be difficult to obtain cooperation with children possibly resulting in a contraindication for percutaneous biopsy with local anesthesia [5]. When these cases occur and the psychological preparation of the child fails, greater doses of sedative drugs are required and in some cases general anesthesia is necessary. To avoid the risk, albeit small, of increased doses of sedatives and/or of general anesthesia, we employed the technique of hypnosis to obtain a complete sedation and collaboration in a group of children who underwent a renal needle biopsy under local anesthesia. The results, evaluated in terms of ease, safety, and brevity of the procedure, have been compared to those obtained in a similar group of children in whom biopsy was performed without hypnosis. Methods. In the last 3 years 45 children, aged 4 to 14 years, who were referred to the Division of Nephrology in Cremona Hospital, Cremona, Italy, needed renal biopsy. Once this procedure was chosen, the children were randomly allocated to one of two groups: the hypnosis group (N 21) and the control group (N = 24). Before the biopsy was performed, children of both groups had two to three visits with the nephrologist skilled in the hypnosis technique. These visits lasted approximately 5 to 10 mm each and consisted of informal interviews that focused on gaining the confidence of the child and discovering his/her expectations of the procedure. The hypnotist was always present at the time of the biopsy, but hypnosis was performed only in the group of children selected by prior randomization. Hypnosis took place using the eye-fixing technique [6]: In brief, the child is invited to fix the hypnotist's eyes; then, the hypnotist induces monoideism in the child, that is, the mental representation of a unique (pleasant) idea. To do so, the hypnotist utilizes information obtained in the preliminary interview. For example, he may suggest the idea of the child's preferred doll. The next step is the transformation of monoideism into a trance condition (the hypnotist may suggest that the doll is tired . . . the doll is sleepy . . . the child should help the doll fall asleep). Clearly, in performing hypnosis by these procedures, no fixed rule can be used: The success, in fact, depends greatly