Dr. Alice H. Cash, Ph.D., LCSW [email protected]1 Music as an Adjunct to Music as an Adjunct to Anesthesia: Anesthesia: A Review of the Research A Review of the Research Cleveland Clinic Florida Grand Rounds Presentation Alice H. Cash, Ph.D., LCSW April 1, 2011
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Dr. Alice H. Cash, Ph.D., LCSW [email protected] Music as an Adjunct to Anesthesia: A Review of the Research Cleveland Clinic Florida Grand Rounds Presentation.
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Early publications suggesting benefits of music in Early publications suggesting benefits of music in surgery (1998)surgery (1998)
• “Use of intraoperative music in awake patients decreases patient-controlled sedative and analgesic requirements.”
• “Thus, the decrease in sedative and analgesic requirements could be caused by elimination of ambient operating room noise and not by the effects of music.”
The sedative and analgesic sparing effect of music. The sedative and analgesic sparing effect of music. Yale University Hospital study (1998) Yale University Hospital study (1998)
• Background: To determine whether music influences intraoperative sedative and analgesic requirements, two randomized controlled trials were performed.
• Methods: Phase 1 Phase 2
• Results: In phase 1, patients in the music group required significantly less propofol for sedation than patients in
the control group
Similarly, in phase 2, patients who listened to music had a significant reduction in alfentanil requirements
• Duration of stay in the postanesthesia care unit and the rate of adverse events was similar in both groups (P = NS).
Music as an Adjunct to AnesthesiaMusic as an Adjunct to Anesthesia
“The Efficacy of Music Therapy”
• Journal of Peri-anesthesia Nursing( 2010 Aug; 25(4):226-32) Wakim JH, Smith S, Guinn C. University of Tennessee
• Being anesthetized is anxiety provoking can cause– An increase in blood pressure– An increase in heart rate– Other effects that can have a negative impact pre-
Reduction of Anxiety BeforeReduction of Anxiety Before
• Studies have shown that listening to calm, steady music for 30-40 minutes before surgery, can greatly decrease the amount of anxiety medication needed.
• Some patients state that they are so relaxed by the music that they do not need any added anxiety medications prior to being sedated.
Review of Recent ResearchReview of Recent Research
• Today, I will focus on research studies and articles between 2001-2011.
• Although music has probably been used in one form or another for medical procedures over hundreds of years, we are only now understanding how to use it intentionally.
Review of Recent ResearchReview of Recent Research
• Relaxing music as pre-medication before surgery
• Acta Anaesthesiol Scand 2009 Jul:53
• Dept of Surgery, Sodertalje Hospital Sodertalje, Sweden.
• Conclusion: Higher effectiveness and absence of apparent adverse effects makes pre-operative relaxing music a useful alternative to midazolam for pre-medication.
Review of Recent ResearchReview of Recent Research
• The effect of music on preoperative sedation and the bispectral index
Anesthesia and Analgesia 2005 Jul; 101 Harran University, School of Medicine,
Sanliurfa, Turkey
• Conclusions: 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.
Review of Recent ResearchReview of Recent Research
• Music and ambient operating room noise in patients undergoing spinal anesthesia
• Yale University School of Medicine, New Haven, CT
Anesthesia & Analgesia, 2005 May; 100 (5)
• Results: Intraoperative music decreases propofol requirements. We also found that Lebanese patients used less propofol as compared with American patients.
Review of Recent ResearchReview of Recent Research
• Music Therapy in Gastrointestinal Endoscopic Procedures.
World Journal of Gastroenterology, 2007 Sep 7;13(33):4533
• Background: To elucidate the role of music therapy in gastrointestinal endoscopic procedures following the conflicting outcomes reported in two recent studies
• Conclusions: The beneficial effects were shown on analgesia and sedation requirements and procedure duration times when used as an adjunct to pharmacotherapy.
Review of Recent ResearchReview of Recent Research
• The Effect of Music on postoperative pain and anxiety
Pain Management Nursing 2010 Mar University of Central Florida, USA
• Background: 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
• Conclusions Nurses can offer music as an intervention to decrease pain and anxiety in this patient population with confidence,
Review of Recent ResearchReview of Recent Research
• Evidence That Music Listening Reduces Patients' Anxiety
• Biological Research for Nursing. Jan 28, 2011
• Results: The music group demonstrated significant reductions in VAS scores, patients in the control group showed no changes; frequency-domain parameters of HRV can be indicators for monitoring the change
Review of Recent ResearchReview of Recent Research
• Monitored Anesthesia Care.
Doctor’s Regional Medical Center, Corpus Christi, TX, USA.
• Conclusion: The use of music as an anesthetic adjunct during MAC cases can reduce the amount of sedation required, speed recovery time, and prevent the likelihood of converting to a general anesthetic.
Review of Recent ResearchReview of Recent Research
• Minimizing preoperative anxiety with music for day surgery patients
• Journal of Clinical Nursing. 2011 Feb 20. - a randomized clinical trial.
• Evaluate the effects of musical intervention on preoperative anxiety and vital signs in patients undergoing day surgery
• Relevance to clinical practice. Finding multimodal approaches to ease discomfort and anxiety from unfamiliar unit surroundings and perceived risks of morbidity
Conclusion and RecommendationsConclusion and Recommendations
• Music is a powerful and effective adjunct to anesthesia and carries no known risks or downside.
And yet music for the patient, is still rarely seen in the operating room.
• When the music is delivered through cordless headphones, the patient can have his optimal type of music and the surgeon and O.R. staff can have their preferred music.
Conclusion and RecommendationsConclusion and Recommendations
• Is There a Place for Music in Medical School?
• Music permeates the medical literature regarding disease therapy. However, there are only few articles concerning music as a tool for development of cultural competency and interpersonal relations.
Medical Teacher. 2011;33(1):76-7. Boston University School of Medicine, MA 02118, USA.