Pediatric Anesthesia: New Research Results

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Very interesting study done using music with pediatric surgery patients.

School-aged children’s experiences of postoperative music medicine on pain, distress, and anxiety
STEFAN NILSSON RN, MSC*†, EVA KOKINSKY MD, PhD*, ULRICA NILSSON RNA, PhD‡, BIRGITTA SIDENVALL RN, PhD† AND KARIN ENSKÄR RN, PhD†

*Department of Paediatric Anaesthesia and Intensive Care Unit, The Queen Silvia Children’s Hospital, Sahlgrenska University Hospital, Göteborg , †Department of Nursing Science, School of Health Sciences, Jönköping University, Jönköping and ‡Department of Anaesthesiology and Intensive Care and Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden

Correspondence to Stefan Nilsson, Department of Paediatric Anaesthesia and Intensive Care Unit, The Queen Silvia Children’s Hospital, Sahlgrenska University Hospital, 416 85 Göteborg, Sweden (email: stefan.r.nilsson@vgregion.se).

ABSTRACT
Aim: To test whether postoperative music listening reduces morphine consumption and influence pain, distress, and anxiety after day surgery and to describe the experience of postoperative music listening in school-aged children who had undergone day surgery.

Background: Music medicine has been proposed to reduce distress, anxiety, and pain. There has been no other study that evaluates effects of music medicine (MusiCure®) in children after minor surgery.

Methods: Numbers of participants who required analgesics, individual doses, objective pain scores (Face, Legs, Activity, Cry, Consolability

[FLACC]), vital signs, and administration of anti-emetics were documented during postoperative recovery stay. Self-reported pain (Coloured Analogue Scale [CAS]), distress (Facial Affective Scale [FAS]), and anxiety (short State-Trait Anxiety Inventory [STAI]) were recorded before and after surgery. In conjunction with the completed intervention semi-structured qualitative interviews were conducted.

Results: Data were recorded from 80 children aged 7–16. Forty participants were randomized to music medicine and another 40 participants to a control group. We found evidence that children in the music group received less morphine in the postoperative care unit, 1/40 compared to 9/40 in the control group. Children’s individual FAS scores were reduced but no other significant differences between the two groups concerning FAS, CAS, FLACC, short STAI, and vital signs were shown. Children experienced the music as ‘calming and relaxing.’

Conclusions: Music medicine reduced the requirement of morphine and decreased the distress after minor surgery but did not else influence the postoperative care.

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Music Before Surgery Proven Effective

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Yet another medical research study has come out documenting that listening to calm, relaxing music before surgery can calm the patient better than powerful midazolam. Time to order those pre-surgery headphones: www.surgicalheadphones.com.

Introduction: Patients who await surgery often suffer from fear and anxiety, which can be prevented by anxiolytic drugs. Relaxing music may be an alternative treatment with fewer adverse effects. This randomised clinical trial compared pre-operative midazolam with relaxing music.

Method: Three hundred and seventy-two patients scheduled for elective surgery were randomised to receive pre-operative prevention of anxiety by 0.05–0.1 mg/kg of midazolam orally or by relaxing music. The main outcome measure was the State Trait Anxiety Inventory (STAI X-1), which was completed by the patients just before and after the intervention.

Results: Of the 177 patients who completed the music protocol, the mean and (standard deviation) STAI-state anxiety scores were 34 (8) before and 30 (7) after the intervention. The corresponding scores for the 150 patients in the midazolam group were 36 (8) before and 34 (7) after the intervention. The decline in the STAI-state anxiety score was significantly greater in the music group compared with the midazolam group (P<0.001, 95% confidence interval range ?3.8 to ?1.8). Conclusion: Relaxing music decreases the level of anxiety in a pre-operative setting to a greater extent than orally administrated midazolam. Higher effectiveness and absence of apparent adverse effects makes pre-operative relaxing music a useful alternative to midazolam for pre-medication. Relaxing music as pre-medication before surgery: a randomised controlled trial H. BRINGMAN 1 , K. GIESECKE 2,3 , A. THÖRNE 1,3 and S. BRINGMAN 1,3 1 Department of Surgery, 2 Department of Anaesthesia, Södertälje Hospital, SE-152 86 Södertälje, Sweden and 3 Department of Clinical Science, Intervention and Technology Karolinska Institutet, Karolinska University Hospital, Huddinge, SE-141 86 Stockholm, Sweden Correspondence to Address: Sven Bringman Department of Surgery Södertälje Hospital SE-152 86 Södertälje Sweden e-mail: sven.bringman@ki.se This paper was presented as an oral presentation at the Swedish Surgical Week, Umeå, August 2008.

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Can the surgical patient hear under anesthesia?

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One of the most frequent questions I get is “can a surgical patient really hear when they are under general anesthesia?” The answer is an unequivocal “yes.” Patients awaken from surgery every day reporting that they remember conversations that they heard under anesthesia and they frequently report that they heard O.R. sounds related to drilling, hammering and sawing. The actions take place during joint replacements and other such surgeries.

One of the benefits of having soothing music through headphones during surgery is that they block these kinds of noises out, in addition to entraining the heartbeat and breathing with surgery, thus necessitating less anesthesia.

If you or someone you now is having surgery, you must go to www.surgicalserenity.com and order the surgical serenity headphones. Call or email me with any questions!

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More Info on dangers of Propofol: use ONLY as directed

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LAS VEGAS—Michael Jackson’s doctor bought a powerful anesthetic in Nevada and had it shipped to California, where it was found at the pop singer’s bedside after he died, court documents released Friday show.
Search warrant records released despite objections by Los Angeles police revealed that investigators found receipts in Dr. Conrad Murray’s Las Vegas medical office showing he purchased the sedative propofol from Applied Pharmacy Services on May 12.

The Los Angeles County coroner blamed propofol in ruling that the 50-year-old pop music icon’s June 25 death was a homicide. The coroner also cited the sedative lorazepam.

Murray, 56, a cardiologist licensed in Nevada, California and Texas, told police he used propofol along with other sedatives to help Jackson sleep.

Propofol is usually used in medical settings by anesthesia professionals to render patients unconscious for surgery. Officials say it is not meant for use as a sleep agent. However, the milky liquid drug is not regulated by state and federal authorities as a controlled substance.

Drug Enforcement Administration spokeswoman Sarah Pullen in Los Angeles said a doctor who is licensed in two states can buy propofol in one state and administer it in the other.

Murray is the focus of a Los Angeles police homicide investigation, but has not been charged with a crime.

Records show he obtained the propofol about the same time he was hired in May to accompany Jackson on a

world tour. He told police he administered 50 milligrams of the drug intravenously per night to help Jackson sleep, but was trying to use less.
In the warrant documents, investigators said Murray told them he gave propofol to Jackson in the hours before he died in a rented Los Angeles mansion.

Through a spokeswoman, Murray maintains that he didn’t prescribe or administer anything to Jackson that should have killed him.

Murray’s attorney, Edward Chernoff, issued a statement Friday saying he found no surprises in the newly released affidavit.

“The fact that Dr. Murray ordered five bottles of propofol is consistent with what he told investigators,” Chernoff said.

The affidavit showed that authorities tracing the manufacturing lot numbers of propofol bottles found in Murray’s medical bag and on Jackson’s bedside table learned that Murray bought five, 100-milliliter bottles of the drug from the Las Vegas pharmacy as part of an order costing $853.

He paid $65 extra to have it sent to him by overnight express, the document states.

Authorities said the amount of the drug purchased did not appear improper, the fact that it was moved across state lines from Nevada to California was not illegal, and because propofol is not a controlled substance it would not be tracked.

A veteran DEA investigator in Las Vegas, Jayne Tomko Griffin, said the five bottles of propofol could have provided 100 doses of 50 milligrams each.

Los Angeles police fought to keep records of the Aug. 11 search sealed. A detective argued that releasing the documents before Jan. 18 would jeopardize the investigation.

Attorneys representing The Associated Press, Los Angeles Times, TMZ Productions Inc. of Los Angeles and Stephens Media LLC, the parent company of the Las Vegas Review-Journal, argued there was no reason for the documents to remain secret.

Clark County District Judge Valerie Adair decided Thursday to unseal the records. Her order was signed Friday.

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Surgery with music now recommended at Mayo Clinic

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The Mayo Clinic in Rochester, MN is one of the most highly esteemed medical facilities in the world. Imagine how thrilled I was to find that they strong recommend the use of healing music for patients having open heart surgery.

Here is what they said:
Patients scheduled for heart surgery at Mayo Clinic in Rochester will receive a brochure on the Healing Enhancement Program when they are admitted to the hospital. The brochure lists the healing enhancement therapies that are available.

Patients and their family members are encouraged to discuss these complementary therapies with their cardiac medical team to determine which therapies may provide benefits during which treatment segments: prior to, during, or after patients’ surgical procedures.

Patients and families can select the therapies and coordinate with designated nurses to schedule the services. Therapy options include:

•Massage
•Music therapy
•Relaxation therapies
•Prayer

What they suggest specifically for music is:

Music
Music therapy is a widely accepted and easily accessible method to promote relaxation and reduce tension, stress and anxiety. Because listening to music helps patients relax and feel less tense, it helps decrease pain, improve patients’ moods and promote better sleep.

Research on the effectiveness of music therapy dates back to the 1920s, when a study reported individuals’ blood pressure dropped when listening to music. Currently, our program is conducting a research study to measure the effects of music therapy on pain, anxiety and tension.

As part of the Cardiovascular Surgery Healing Enhancement Program, rooms for cardiac surgery patients have music systems. A selection of CD music is available at each cardiac surgical unit. We encourage patients to bring their own preferred music. Selections on hand include easy listening, relaxation, classical, country, and instrumental. Contemporary music with sounds of nature, such as birds chirping and water flowing, is also available. Music systems include AM/FM radios.

Needless to say, I will be contacting them THIS WEEK about my wireless/cordless pre-loaded headphones for surgery!

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Music in the PACU: New Study from Sweden

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Music in the Post-anesthesia care unit? New study documents benefits!

Intensive Crit Care Nurs. 2009 Aug;25(4):208-13. Epub 2009 May 14.

Patients’ perception of music versus ordinary sound in a postanaesthesia care unit: a randomised crossover trial.
Fredriksson AC, Hellström L, Nilsson U.

Dep. Anesthesia and Intensive Care, Malmoe University Hospital, Sweden.

We performed an experimental single-blind crossover design study in a postanaesthesia care unit (PACU): (i) to test the hypothesis that patients will experience a higher degree of wellbeing if they listen to music compared to ordinary PACU sounds during their early postoperative care, (ii) to determine if there is a difference over time, and (iii) to evaluate the importance of the acoustic environment and whether patients prefer listening to music during their stay.

Two groups received a three-phase intervention: one group (n=23) experienced music-ordinary sound-music and the second group (n=21) experienced ordinary sound-music-ordinary sound. Each period lasted 30 min, and after each period the patients assessed their experience of the sound. The results demonstrated a significant difference (p<0.001) between groups in the proportions of patients reporting that the acoustic environment was of great importance for their wellbeing during the three-phase intervention, and most participants (n=36 versus n=8) noticed that they were exposed to different sounds during the PACU period. The results also revealed that most participants (n=32) preferred listening to music versus listening to ordinary sound (n=3) while in the PACU (p<0.001). These findings promote use of listening to music to establish a healing environment for patients in a postanaesthesia care unit

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New Research Study on Music Medicine with Children

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Paediatr Anaesth. 2009 Oct 23.

[Epub ahead of print]

School-aged children’s experiences of postoperative music medicine on pain, distress, and anxiety.
Nilsson S, Kokinsky E, Nilsson U, Sidenvall B, Enskär K.

Department of Paediatric Anaesthesia and Intensive Care Unit, The Queen Silvia Children’s Hospital, Sahlgrenska University Hospital, Göteborg.

Aim: To test whether postoperative music listening reduces morphine consumption and influence pain, distress, and anxiety after day surgery and to describe the experience of postoperative music listening in school-aged children who had undergone day surgery.

Background: Music medicine has been proposed to reduce distress, anxiety, and pain. There has been no other study that evaluates effects of music medicine (MusiCure((R))) in children after minor surgery.

Methods: Numbers of participants who required analgesics, individual doses, objective pain scores (Face, Legs, Activity, Cry, Consolability [FLACC]), vital signs, and administration of anti-emetics were documented during postoperative recovery stay. Self-reported pain (Coloured Analogue Scale [CAS]), distress (Facial Affective Scale [FAS]), and anxiety (short State-Trait Anxiety Inventory [STAI]) were recorded before and after surgery. In conjunction with the completed intervention semi-structured qualitative interviews were conducted.

Results: Data were recorded from 80 children aged 7-16. Forty participants were randomized to music medicine and another 40 participants to a control group. We found evidence that children in the music group received less morphine in the postoperative care unit, 1/40 compared to 9/40 in the control group. Children’s individual FAS scores were reduced but no other significant differences between the two groups concerning FAS, CAS, FLACC, short STAI, and vital signs were shown. Children experienced the music as ‘calming and relaxing.’

Conclusions: Music medicine reduced the requirement of morphine and decreased the distress after minor surgery but did not else influence the postoperative care.

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Surgery Headphones or Surgery Music Download

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Since I created my headphones for surgery last year, I also decided to offer just the download of the music as well. Lately, more people are choosing to download the music to put on their own MP3 players. Obviously I think this is a wonderful idea, better than having no music or taking in music that could actually energize the body and require more anesthesia to relax the body and keep it asleep. The ideal solution though is the surgery music headphones. This is because you can have the music delivered directly to the brain, through the 8th cranial nerve, and you can avoid all wires and cords. Any MP3 player in the world today has two wires that lead from the player to the headphones or earbuds. My headphones have NO wires or cords and deliver the music from a programmed chip in the headphone itself, powered by a lithium battery. In the past year, NO ONE has been prevented from taking the headphones into surgery! As a matter of fact, patients report that the doctors and nurses are fascinated by the headphones and music and eager to see them work! If you or anyone you know is having surgery, go immediately to www.surgicalheadphones.com and check these out. Thanks!

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Music and Appendectomy

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Last night I had a once in a lifetime experience. The dear man who has been my mentor in the field of music medicine for twenty years now, was in the hospital recovering from an emergency appendectomy, and I was able to deliver him a set of my surgery headphones to use during his recovery!

If it were not for Dr. Arthur Harvey, these headphones would not exist and now, he got to benefit from them! Dr. Harvey reported that the quality of music was “amazing” and as I stood there talking with his son, Dr. Harvey was smiling and singing along with the favorite hymns I had put on just for him!

Needless to say I am thrilled to be able to help the man who is responsible for my being where I am in this wonderful profession and am trusting that he will continue to recover and maybe do so faster and with less pain, thanks to the music he taught me about long ago!

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Rave Reviews come in of my Surgery Headphones

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Well I had a wonderful experience tonight at a banquet I attended. I was not expecting to know many of the people who were there, but to my delight, there was a woman MD who bought my headphones a few months ago for her knee replacement surgery! I had not heard from her and although I try to follow up with all my customers, had not gotten back to her.

During the break before the speaker she saw me and came over to me with a BIG smile on her face. She said the the headphones did great and she was so thrilled the the doctors and nurses not only allowed her to wear them all the way through her surgery, but that they were quite excited and intrigued but the whole idea and said they had been reading about them! Needless to say, i was thrilled!

Who’s next??!!

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