Published: Anesthesia and Analgesia 2005 Jul; 101

Background: Assess the effect of music on the level of sedation and the BIS index during the preoperative period Methods: Observer’s Assessment of Alertness/Sedation Scales (OAAS) score and BIS values were recorded at specific time intervals.

Results: BIS values of the music group were smaller than in the control group at 30 and 40 min. BIS values were significantly decreased from baseline values at 10-50 min in the music group, whereas BIS values were decreased at 30-50 min in the control group.

Conclusion: Listening to music during midazolam pre-medication is associated with an increase in sedation level in the preoperative period as reflected by a lower BIS value.

Published: Acta Anaesthesiol Scand 2009 Jul:53

Procedure: Background: Patients awaiting surgery often suffer from fear and anxiety. Relaxing music may be an alternative treatment for anxiolytic drugs with fewer adverse effects

Conclusion: Relaxing music decreases the level of anxiety in a pre-operative setting to a greater extent than orally administered midazolam

Who: Damir Janigro, Neuroscientist, Cleveland Clinic, Cleveland, OH Published: Reported by “Time” Magazine, 10/23/2009 and Oct. 30, 2009 as part of a symposium in New York City on Music and the Brain.

Background: The medical community has long been interested in how the brain is affected by music. Historically, however, most research was linked to the cortex, the brain’s outer layer, which is associated with functions like memory, consciousness and abstract thought. In those studies, neurosurgical patients, wide awake with their cortex exposed, listened to certain sounds and music. While their neural activity was being recorded, they told researchers how those selections made them feel. Janigro wanted to perform similar studies on motor centers deep within the brain. Because music is often associated with movement — like tapping one’s feet — he theorized that music could be used to modify the activity of thalamic and subthalamic neurons, which are located in the same area where a neuronal pacemaker is implanted during deep-brain stimulation. Methods: In the studies, neurosurgical patients, wide awake with their cortex exposed, listened to certain sounds and music. While their neural activity was being recorded, they told researchers how those selections made them feel. In Janigro’s study, more than a dozen neurosurgical patients, predominantly with Parkinson’s, listened to three musical selections — rhythmic music with no discernible melody (by Gyorgi Ligeti, of Stanley Kubrick–movie fame), melodic music with undefined rhythm (by Aaron Jay Kernis, a Pulitzer Prize winner) and something in between (Ludwig van Beethoven). In the later stages of the research, to prevent familiarity from swaying the subjects’ responses, music was specifically composed for the study by students from the Cleveland Institute of Music. Results: Listening to melodic music decreased the activity of individual neurons in the deep brain, says Janigro, adding that the physical responses to the calming music ranged from patients’ closing their eyes to falling asleep. Some patients even settled into a nice round of snoring. And when lead neurosurgeon Ali Rezai needed patients to perform an action, such as lifting a limb, during the procedures, he simply removed their earphones and relayed instructions. Once the music resumed, patients returned to their snoozing

Conclusion: With the right music patients can be more relaxed in the operating room. And that relaxation may mean not only that procedures involve less medication — to control blood pressure, which increases with stress — but perhaps that patients have quicker recovery times and shorter hospital stays. Janigro anticipates that following institutional approval, music will be used during certain neurosurgical procedures at the clinic as early as 2010. He hopes other hospitals will soon follow Cleveland’s lead. “This type of surgery can be a traumatizing experience, and using music can decrease anxiety,” he notes.

Who: Delray Medical Center, Delray Beach, FL Published: Nursing in Critical Care. 2006 Sep-Oct;11(5):224-31

Background: The purpose of this study was to determine the effect of music listening on postoperative anxiety and intubation time in patients undergoing cardiovascular surgery.

Methods: The experimental group listened to music during and after surgery, while the control group received standard postoperative care. Results: Older adults undergoing cardiovascular surgery who listen to music had less anxiety and reduced intubation time than those who did not.

Who: Department of Gastroenterology, Medical College Hospital, Kozhikode 673 008, Kerala Published: Indian J Gastroenterol. 2006 Jan-Feb;25(1):3-5

Background: This was a trial to determine whether music decreases the requirement for midazolam during colonoscopy and makes the procedure more comfortable and acceptable. Music played during endoscopic procedures may alleviate anxiety and improve patient acceptance of the procedure. A prospective randomized, controlled trial was undertaken to determine whether music decreases the requirement for midazolam during colonoscopy and makes the procedure more comfortable and acceptable.

Methods: Patients undergoing elective colonoscopy between October 2003 and February 2004 were randomized to either not listen to music (Group 1; n=40) or listen to music of their choice (Group 2; n=38) during the procedure. All patients received intravenous midazolam on demand in aliquots of 2 mg each. We looked at The dose of midazolam, duration of procedure, recovery time, pain and discomfort scores and willingness to undergo a repeat procedure using the same sedation protocol were compared.

Results: Patients in Group 2: received significantly less midazolam than those in Group 1 (p=0.007). The pain score was similar in the two groups, whereas discomfort score was lower in Group 2 (p=0.001). Patients in the two groups were equally likely to be willing for a repeat procedure.

Conclusion: Listening to music during colonoscopy helps reduce the dose of sedative medications and decreases discomfort experienced during the procedure.

Who: Yale University School of Medicine, New Haven, CT Published: Anesthesia & Analgesia, 2005 May; 100 (5)

Background: Previous studies have indicated that music decreases intraoperative sedative requirements in patients undergoing surgical procedures under regional anesthesia.

Purpose: In this study we sought to determine whether this decrease in sedative requirements results from music or from eliminating operating room (OR) noise. A secondary aim of the study was to examine the relationship of response to intraoperative music and participants’ culture (i.e., American versus Lebanese). Eighty adults (36 American and 54 Lebanese) undergoing urological procedures with spinal anesthesia and patient-controlled IV propofol sedation were randomly assigned to intraoperative music, white noise, or OR noise.

Methods: Results: We also found that, regardless of group assignment, Lebanese patients used less propofol as compared with American patients and that, in both sites, patients in the music group required less propofol (P < 0.05).

Conclusion: We conclude that when controlling for ambient OR noise, intraoperative music decreases propofol requirements of both Lebanese and American patients who undergo urological surgery under spinal anesthesia .

Who: Damir Janigro, Neuroscentist, Cleveland Clinic, Cleveland, OH Published: Reported by “Time” Magazine, 10/23/2009 and Oct. 30, 2009 as part of a symposium in New York City on Music and the Brain.

Background: The medical community has long been interested in how the brain is affected by music. Historically, however, most research was linked to the cortex, the brain’s outer layer, which is associated with functions like memory, consciousness and abstract thought. In those studies, neurosurgical patients, wide awake with their cortex exposed, listened to certain sounds and music. While their neural activity was being recorded, they told researchers how those selections made them feel. Janigro wanted to perform similar studies on motor centers deep within the brain. Because music is often associated with movement — like tapping one’s feet — he theorized that music could be used to modify the activity of thalamic and subthalamic neurons, which are located in the same area where a neuronal pacemaker is implanted during deep-brain stimulation.

Methods: In the studies, neurosurgical patients, wide awake with their cortex exposed, listened to certain sounds and music. While their neural activity was being recorded, they told researchers how those selections made them feel. In Janigro’s study, more than a dozen neurosurgical patients, predominantly with Parkinson’s, listened to three musical selections — rhythmic music with no discernible melody (by Gyorgi Ligeti, of Stanley Kubrick–movie fame), melodic music with undefined rhythm (by Aaron Jay Kernis, a Pulitzer Prize winner) and something in between (Ludwig van Beethoven). In the later stages of the research, to prevent familiarity from swaying the subjects’ responses, music was specifically composed for the study by students from the Cleveland Institute of Music.

Results: Listening to melodic music decreased the activity of individual neurons in the deep brain, says Janigro, adding that the physical responses to the calming music ranged from patients’ closing their eyes to falling asleep. Some patients even settled into a nice round of snoring. And when lead neurosurgeon Ali Rezai needed patients to perform an action, such as lifting a limb, during the procedures, he simply removed their earphones and relayed instructions. Once the music resumed, patients returned to their snoozing

Conclusion: With the right music patients can be more relaxed in the operating room. And that relaxation may mean not only that procedures involve less medication — to control blood pressure, which increases with stress — but perhaps that patients have quicker recovery times and shorter hospital stays. Janigro anticipates that following institutional approval, music will be used during certain neurosurgical procedures at the clinic as early as 2010. He hopes other hospitals will soon follow Cleveland’s lead. “This type of surgery can be a traumatizing experience, and using music can decrease anxiety,” he notes.

Who: Benjamin Krevsky, a professor of medicine at the School of Medicine and Director of gastrointestinal endoscopy at Temple University Hospital; Co-investigator Kevin Skole, M.D., Published: Ilene Raymond For Temple Health Sciences PR, 2012 Background: Co-investigator Kevin Skole, M.D., who was a gastroenterology fellow at Temple, had the original idea for the study. Krevsky too was inspired when a dentist handed him ear buds to listen to music during a dental procedure.

Methods: Researchers asked 44 female and 29 male subjects to either bring music from home or choose from a selection of available CDs. Before the procedure, ear buds le to only the patient. After the patient received his or her initial dose of medication, an investigator opened a randomized envelope to see if the music selections would be played. Following the colonoscopy, the attending doctor, fellow and nurse evaluated pain, anxiety and comfort levels for each patient. A non-participating medical provider conducted a second, later interview.

Results: Results revealed that those who listened to music required less sedation (3.8 mg of midazolam vs. 4.4 mg, and 87 mcg of fentanyl vs. 93 mcg) yet reported the same comfort levels as those receiving the higher amounts. The reductions, equal to about one less dose of medication, are considered clinically significant findings.

Conclusion: “Over all, colonoscopies are very, very safe,” Krevsky said. “And while the risks of sedatives are relatively small, in general, less medication is always better.” Krevsky also notes the decreased drug dose may translate into reduced healthcare costs. Most of the participants picked gospel tunes, but the type of music didn’t appear to make a difference. “Offering music makes sense,” Krevsky said. “It has no downside, it may prove beneficial, and patients appear to be satisfied with the procedure.” All of which may add up to less anxiety and more colonoscopies.

Who: Dr. Matthew Bush, Assistant Professor of Surgery, University of Kentucky, Lexington, KY Published: Journal of the American College of Surgeons, May 2013

Background: “To minimize errors of communication, it is essential that we consider very carefully the listening environment we are promoting in the operating room.” The researchers gave an example of a possible miscommunication: A request for heparin might be heard as “Hespan,” an entirely different drug.

Methods: In conducting the study, the researchers simulated a noise environment similar to the noise levels found in an operating room. Fifteen surgeons with between one and 30 years of experience were tested on their ability to understand and repeat words under four different conditions: quiet, noise filtered through a surgical mask, background noise without music and background noise with music. The surgeons were tested while performing a specific surgical task as well as when they were not engaged in a task. [Study did not address music delivered to the patient through headphones or ear buds. Ir only considered background noise and music delivered through speakers. Such music is usually chosen by the Surgeon.]

Results: Noise interfered with the surgeon’s speech comprehension when the words spoken to them were unpredictable, the study showed. This interference with speech comprehension was worse when there was noise in the operating room. Background music also impaired the surgeons’ ability to understand what was said to them while they were performing a surgical task. Conclusion: “To minimize errors of communication, it is essential that we consider very carefully the listening environment we are promoting in the operating room.” “Our main goal is to increase awareness that operating room noise does affect communication and that we should foster the best environment in which we can communicate better,” Bush said. “This effort means that the surgical team needs to work diligently to create the safest environment possible, and that step may mean either turning the music off or down, or limiting background conversations or other things in the environment that could lead to communication errors and medical mistakes.

Who: Department Anesthesia and Intensive Care, Malmoe University Hospital, Sweden Published: Intensive Critical Care Nurse. 2009 Aug;25(4):208-13 Background: Systematic review to examine the effect of music on postoperative pain.

Methods: A search for scientific articles was conducted using online databases. Included were quantitative studies published from 1998 through 2007 that considered the effect of music interventions on postoperative pain in adult patients. After the search and appraisal of quality, 18 studies were included in the review.

Results: The results in 15 of the studies included indicated a significant positive effect of music on postoperative pain

Conclusion: The conclusion is that music can be used as an adjuvant for the relief of postoperative pain.

Who: University of Central Florida, USA Published: Pain Management Nursing 2010 March

Background: The purpose of this study was to determine if listening to music or having a quiet rest period just before and just after the first ambulation on postoperative day 1 can reduce pain and/or anxiety or affect mean arterial pressure, heart rate, oxygen saturation, and respiratory rate in patients who underwent a total arthroplasty.

Methods: Fifty-six patients having a total knee arthroplasty were randomly assigned to either a music intervention group or a quiet rest group. A visual analog scale was used to measure pain and anxiety. Physiologic measure, including blood pressure, heart rate, oxygen saturation, and respiration rate were also obtained.

Results: Statistical findings between groups indicated that the music groups decrease in pain and anxiety was not significantly different from the comparison rest group’s decrease in pain or anxiety at any measurement point. However, statistical findings within groups indicated that the sample had a significant decrease in anxiety and pain over time. The interventions pose no risks and have the benefits of improved pain reports and decreased anxiety. It potentially could be opioid sparing in some individuals, limiting the negative effects from opioids.

Conclusion: Nurses can offer music as an intervention to decrease pain and anxiety in this patient population with confidence, knowing that there is evidence to support its

Who: Gülhane Military Medical Academy, Haydarpaşa Training Hospital, İstanbul, Turkey. Published:

Background: The aim of this study was first to find out the effect of music therapy on postoperative analgesia and second to determine the duration of its effect. Methods: Seventy patients who were undergoing elective cesarean delivery were enrolled. The patients were randomly allocated into two groups as follows: In Group 1, patients listened to music through a headphone for one hour after surgery, while in Group 2, patients did not listen to any music during the same period. In the postanesthesia care unit, patients were connected to a Patient Controlled Analgesia (PCA) device. The PCA device (tramadol 3 mg/ml) was set to deliver a bolus of 20 mg, with a lockout interval of 15 min and 4-hour maximal dose of 150 mg. Postoperative pain was assessed with a visual analog scale (VAS) and consumption of tramadol was recorded at 4, 8, 12, 16, 20 and 24 hours. Results: There was a significant decrease in Group 1 with respect to PCA delivery frequency at the 4th hour postoperatively (p<0.05). Concerning the postoperative tramadol consumption, values measured at the 4th hour were significantly lower in Group 1 (p<0.05). The total amount of tramadol consumption and additional analgesic use in the postoperative 24 hours were again lower in Group 1 when compared with Group 2 (p<0.05). All VAS values were lower in Group 1 when compared with Group 2 (p<0.05)

Conclusion: We suggest that music therapy given after surgery decreases postoperative pain in the first 24 hours and the analgesic consumption during the first four hours.