Effect of music in endoscopy procedures: systematic review and meta-analysis of randomized controlled trials

Effects of Integrated Music-Video Therapy on Pain and Anxiety During High-Dose-Rate Brachytherapy

PURPOSE

This study aimed to examine the effect of integrated music-video therapy on pain and anxiety of gynecologic cancer patients at different stages of brachytherapy.

DESIGN

This study used a single-group crossover design.

METHODS

Data on 27 patients diagnosed with gynecologic cancer and receiving brachytherapy were collected from February 2018 to January 2019. Participants' pain and anxiety levels were measured four times using a numerical rating scale (before, during, after applicator insertion, and during the radiation). In addition, vital signs were measured three times (before, after applicator insertion, and during radiation). Data were analyzed for frequency and percentage. The normality and homogeneity of the dependent variables were tested using the Kolmogorov-Smirnov and Mann-Whitney U tests, respectively.

RESULTS

Significant differences were found between the experimental and control phases in pain degree during radiation exposure (Z = -1.68, p = .046) and anxiety degree during applicator insertion (Z=-4.42, p = .000), after applicator insertion (Z = -4.85, p = .000), and during radiation exposure (Z = -5.38, p = .000). However, no significant difference was found between the changes in blood pressure, pulse, and respiration at any time point.

CONCLUSIONS

The findings suggest the need to actively employ integrated music-video therapy to reduce acute pain and anxiety in gynecologic cancer patients undergoing brachytherapy.

CLINICAL IMPLICATIONS

This study provides insights into the methodological approaches for implementing integrated music-video therapy in clinical practice, targeting the reduction of acute pain and anxiety triggered by gynecological surgeries and procedures.

British Society of Gastroenterology guidelines on sedation in gastrointestinal endoscopy

Over 2.5 million gastrointestinal endoscopic procedures are carried out in the United Kingdom (UK) every year. Procedures are carried out with local anaesthetic r with sedation. Sedation is commonly used for gastrointestinal endoscopy, but the type and amount of sedation administered is influenced by the complexity and nature of the procedure and patient factors. The elective and emergency nature of endoscopy procedures and local resources also have a significant impact on the delivery of sedation. In the UK, the vast majority of sedated procedures are carried out using benzodiazepines, with or without opiates, whereas deeper sedation using propofol or general anaesthetic requires the involvement of an anaesthetic team. Patients undergoing gastrointestinal endoscopy need to have good understanding of the options for sedation, including the option for no sedation and alternatives, balancing the intended aims of the procedure and reducing the risk of complications. These guidelines were commissioned by the British Society of Gastroenterology (BSG) Endoscopy Committee with input from major stakeholders, to provide a detailed update, incorporating recent advances in sedation for gastrointestinal endoscopy.This guideline covers aspects from pre-assessment of the elective 'well' patient to patients with significant comorbidity requiring emergency procedures. Types of sedation are discussed, procedure and room requirements and the recovery period, providing guidance to enhance safety and minimise complications. These guidelines are intended to inform practising clinicians and all staff involved in the delivery of gastrointestinal endoscopy with an expectation that this guideline will be revised in 5-years' time.

Effects of Music on Anxiety, Pain, and Comfort in Patients Undergoing Upper Endoscopy: A Randomized Clinical Trial

Although upper gastrointestinal endoscopy is an important diagnostic procedure in the detection of diseases, it can cause discomfort and anxiety in patients. This study is a randomized controlled trial conducted to determine the effects of listening to music on the anxiety, pain, and comfort levels of patients undergoing upper gastrointestinal endoscopy. The patients were randomly divided into the intervention group ( n = 40), who listened to music for 45 minutes before upper gastrointestinal endoscopy, and the control group ( n = 40), which did not receive any intervention other than routine nursing care. It was observed that the pain and anxiety levels of the patients who listened to music before the procedure decreased, and their comfort levels and ease of the procedure increased. In order to reduce the pain and anxiety of patients who will undergo upper gastrointestinal endoscopy, increase the success of the procedure, and facilitate patient-doctor cooperation, encouraging patients to listen to music while awaiting the procedure can be effective.

Three Distraction Methods for Pain Reduction During Colonoscopy: A Randomized Controlled Trial Evaluating the Effects on Pain and Anxiety

PURPOSE

The aim of this study was to compare the effects of distraction methods on pain, anxiety, and satisfaction during a colonoscopy.

DESIGN

This experimental research was conducted as a single-center, randomized, parallel-group trial.

METHODS

A total of 120 patients were recruited and randomized into 4 groups (music, stress ball, audiovisual distraction, and control). The data were collected using individual an identification form, observation form, the Visual Analog Scale, and the State-Trait Anxiety Inventory.

FINDINGS

Pain severity during colonoscopy was found to be lower in the intervention (music and audiovisual distraction) groups compared to the stress ball and control groups (P < .001).There was no statistically significant difference between the pre- and postanxiety levels in the intervention groups compared to the control group. After the colonoscopy, satisfaction levels were significantly higher in the music group compared to the audiovisual, control, and stress ball groups (P < .001).

CONCLUSIONS

Distraction methods used during colonoscopy were found to reduce pain. Although sedation is widely used during a colonoscopy procedure and is accepted as a general standard, music and VR can be used as effective alternative strategies in reducing pain for colonoscopy patients.

The effect of playing music and mother's voice to children on sedation level and requirement during pediatric magnetic resonance imaging

BACKGROUND

Magnetic resonance imaging examinations frequently cause anxiety and fear in children. The objective of this study was to investigate the effects of listening to music sound, the mother's voice, and sound isolation on the depth of sedation and need for sedatives in pediatric patients who would undergo MRI.

METHODS

Ninety pediatric patients aged 3 to 12 years who were planned for imaging in the MRI unit were randomly assigned to isolation group (Group I), musical sound group (Group II), and mother's voice group (Group III). We evaluated patients' anxiety and sedation levels via the Observer's Assessment of Alertness/Sedation (OAA/S) RESULTS: Heart rate, oxygen saturation, OAA/S, and Ramsey scores during the procedure were not significantly different among the groups (p>0.05). The mean amount of propofol and total propofol consumption was statistically lower in the mother's voice group than in the isolation and music sound groups (p<0.001). Mean propofol amount and total propofol consumption were not significantly different in isolation and music sound groups (p>0.05). No difference was found between the groups regarding the time it took for the patients' Modified Aldrete score to reach 9 (p>0.05).

CONCLUSIONS

In pediatric patients, listening to the mother's voice during MRI decreased the total sedative requirement consumed without increasing the depth of sedation.

The effect of music therapy on anxiety and pain in patients undergoing prostate biopsy: A systematic review and meta-analysis

OBJECTIVES

This study aims to explore the effect of music therapy on pain, anxiety and physiologic parameters in patients undergoing prostate biopsy.

DESIGN AND SETTING

A systematic review and meta-analysis of randomized controlled trials.

INTERVENTIONS

Five databases were systematically searched. The included studies reported randomized controlled trials comparing the effects of music therapy and non-music therapy on pain, anxiety, and physiologic parameters in patients undergoing prostate biopsy. The random-effects meta-analyses were performed for data synthesis.

MAIN OUTCOME MEASURES

The primary outcome was pain; secondary outcomes included anxiety and physiologic parameters.

RESULTS

We analyzed seven eligible studies involving 662 males undergoing prostate biopsy. We synthesized the mean difference between music and control groups in different outcomes. Compared with control groups, music therapy reduced pain (visual analog scale score, mean difference [95% CI]: -0.92 [-1.68 to -0.17], P = 0.017, low quality) and anxiety (State-Trait Anxiety Inventory equivalent scale score, mean difference [95% CI]: -4.37 [-7.72 to -1.03], P = 0.010, low quality) after the prostate biopsy. In terms of the physiological parameters, music therapy only slightly reduced heart rate, but not blood pressure and respiratory rate after the prostate biopsy.

CONCLUSIONS

Low quality of evidence showed that music therapy during prostate biopsy might reduce pain and anxiety. However, a good standard of music intervention was lacking. Cost-effective analyses are warranted to better delineate the value of music therapies for prostate biopsy.

Relieving Anxiety Through Virtual Reality Prior to Endoscopic Procedures

PURPOSE

Endoscopic procedures can cause anxiety, which can lead to more uncomfortable, difficult, and incomplete procedures, in addition to greater use of sedative medication. Here, we investigate whether exposing patients to virtual reality (VR) prior to endoscopic procedures can reduce their anxiety levels.

MATERIALS AND METHODS

Forty patients at Gangnam Severance Hospital were enrolled and divided into the VR group and the control group. Patients in the VR group were exposed to VR prior to their procedure to alleviate anxiety. The primary data outcomes were State-Trait Anxiety Inventory (STAI), pain score, satisfaction with sedation, and satisfaction with the procedure.

RESULTS

The mean STAI-state and STAI-trait did not differ significantly between the control group and the VR group. While defining a high anxiety STAI score as ≥45 in an STAI-state, the proportion of patients with high anxiety at baseline was 35% and increased to 50% prior to the procedure in the control group. However, in the VR group, the proportion of patients with high anxiety at baseline was 60% and decreased to 50% prior to the procedure. The proportion changes of patients with high anxiety in the STAI-state exhibited a significant difference between the control and VR groups (p=0.007). Furthermore, patients' satisfaction with sedation was significantly greater in the VR group compared to the control group (p=0.017).

CONCLUSION

VR exposure may relieve patients' anxiety levels prior to endoscopic procedures, but further well-designed placebo-controlled studies are needed. VR, an inexpensive, easily available, and non-invasive method, also improved the satisfaction with sedation of endoscopic procedures.

The effect of binaural beat audio on anxiety in patients undergoing fiberoptic bronchoscopy: A prospective randomized controlled trial

BACKGROUND

Fiberoptic bronchoscopy is an invasive procedure known to induce anxiety in patients. Binaural beat therapy, in which sounds of different frequencies are delivered to the 2 ears to entrain the brainwaves, has been used to reduce anxiety in some operations. This study aimed to determine the anxiolytic effects of binaural beat audio in patients undergoing fiberoptic bronchoscopy.

METHODS

Eligible subjects were randomly assigned to receive binaural beat music, plain music, or no music. They were asked to wear earphones starting approximately 15 minutes before the bronchoscopy. The level of anxiety was measured using the State-Trait Anxiety Inventory questionnaire. Blood pressure, heart rate, and sedative drug administration were also recorded.

RESULTS

One hundred and twelve subjects were randomized into binaural beat music (n = 38), plain music (n = 38), and no music (n = 36) groups. The mean change in post-bronchoscopy State-Trait Anxiety Inventory state score in the binaural beat music, plain music, and no music group was -7.26 (P < .001), -3.92 (P = .005), and -1.12 (P = .454), respectively. The mean systolic blood pressure and diastolic blood pressure significantly decreased from baseline by -9.89 (P = .002) and -5.76 (P = .005), respectively, in the binaural group. The mean heart rate increased from baseline by 3.32 (P = .035), 5.21 (P = .038), and 3.64 (P = .149) in the binaural beat music, plain music, and no music groups, respectively.

CONCLUSION

Binaural beat music appeared to reduce anxiety among patients undergoing fiberoptic bronchoscopy.Trial registration: TCTR, TCTR20200915002. Registered 14 September 2020 - Retrospectively registered.

A self-assessment tool for predicting discomfort and tolerance in Chinese patients undergoing esophagogastroduodenoscopy

Background

For patients taking esophagogastroduodenoscopy (EGD), sedation should ideally be used individually based on patients’ comfort and tolerance level. However, currently there is no valid predictive tool. We undertook this study to develop and temporally validate a self-assessment tool for predicting discomfort and tolerance in Chinese patients undergoing EGD.

Methods

We recruited 1522 patients undergoing routine diagnostic EGD without sedation. We collected candidate predictor variables before endoscopy and evaluated discomfort and tolerance with a 5-point visual analogue scale after the procedure. We developed logistic regression predictive models based on the first 2/3 of participants, and evaluated the calibration and discrimination of the models in the later 1/3 of patients.

Results

30.2% and 23.0% participants reported severe discomfort or poor tolerance to EGD respectively. The predictive factors in the model for discomfort included sex, education, expected level of discomfort, and anxiety before endoscopy. The model for tolerance included income, expected level of discomfort, and anxiety before endoscopy. In the validation population, the established models showed a moderate discriminative ability with a c-index of 0.74 for discomfort and 0.78 for tolerance. Hosmer–Lemeshow test suggested the models had fine calibration ability (discomfort: P = 0.37, tolerance: P = 0.41).

Conclusions

Equations for predicting discomfort and tolerance in Chinese patients undergoing EGD demonstrated moderate discrimination and variable calibration. Further studies are still required to validate these tools in other population.

Trial registration

Chinese Clinical Trial Registry (ChiCTR1800020236).

Effect of music intervention in colonoscopy-naïve adults: a randomised controlled trial

BACKGROUND

Previous studies have evaluated music interventions before and during a colonoscopy, but the results are contradictory and inconclusive.

AIMS

The aims of the present study were to evaluate the effect of a music intervention with MusiCure music, both before and during colonoscopy.

METHODS

The study was a two-armed, prospective, randomised, controlled trial and 337 patients undergoing colonoscopy were included. Patients were allocated to receive relaxing music (MusiCure) before and during the colonoscopy or standard care (no music). Outcome measures included pain intensity, duration of the colonoscopy, consumption of alfentanil and midazolam, vital signs, patient satisfaction and caecal intubation rates (CIR).

FINDINGS

Men in the music group had a lower middle arterial blood pressure compared with men in the no music group. The majority of patients in the music group would prefer to listen to music if they need a colonoscopy in the future. No differences were found between groups regarding pain intensity, duration of the colonoscopy, consumption of alfentanil and midazolam, vital signs, patient satisfaction and CIR.

CONCLUSION

The researchers were unable to show an effect on the primary endpoints. However, a high patient satisfaction was found in the music group and a decrease in the blood pressure during the colonoscopy, indicating a reduced stress level. Music before and during a colonoscopy may improve the patient experience.

Music Intervention for Pain Control in the Pediatric Population: A Systematic Review and Meta-Analysis

Music intervention (MI) has been applied as an effective adjunctive treatment for pain control in various clinical settings. However, no meta-analysis has yet been published on the analgesic effects of MI in infants and children. We performed a systematic review of PubMed, EMBASE, Web of Science, and Cochrane Library databases to identify randomized controlled trials (RCTs) with the keywords "pain" AND "music therapy" from inception to January 2022. Primary outcomes were pain intensity and vital signs. Standardized mean difference (SMD) values and the corresponding 95% confidence intervals (CIs) were computed using a random effect model. Subgroup analyses with age groups, types of pain, and music styles were conducted. A total of 38 RCTs involving 5601 participants met the selection criteria. MI significantly decreased the pain levels (SMD = -0.57, p < 0.001), both in the newborn group (p = 0.007) and in the infant/children group (p < 0.001). MI significantly reduced heart rate (SMD = -0.50, p < 0.001) and respiratory rate (SMD = -0.60, p = 0.002) and increased peripheral capillary oxygen saturation (SMD = 0.44, p < 0.001). In subgroup analyses of types of pain, MI had significant effects on prick pain (p = 0.003), chronic and procedural pain (p < 0.001), and postoperative pain (p = 0.018). As for music styles, significant analgesic effects were observed for classical music (p < 0.001), kids' music (p < 0.001), and pop music (p = 0.001), but not for world music (p = 0.196), special composition (p = 0.092), and multiple music combinations (p = 0.420). In conclusion, our analysis provides supportive evidence about the efficacy of MI, especially classical, kids', and pop music, in controlling prick, procedural, and postoperative pain in the pediatric population.

The Effect of Music Listening on Pain in Adults Undergoing Colonoscopy: A Systematic Review and Meta-Analysis

PURPOSE

To investigate the role of music listening in reducing pain in adults undergoing colonoscopy.

DESIGN

This is a systematic review and meta-analysis of randomized control trials (RCTs) that evaluated the effect of music in reducing pain in adults undergoing colonoscopy.

METHODS

We searched CINAHL, Embase, MEDLINE, PsycINFO, and PubMed for RCTs that reported on the effects of music listening in reducing pain in adult patients undergoing colonoscopy from database inception to March 15, 2020, when the search was completed. Studies published in English with adult participants testing the efficacy of music during colonoscopy were eligible for inclusion. Studies reporting the results of combined nonpharmacological interventions were excluded. The methodological quality of each included RCT was assessed using the Cochrane Collaboration tool for assessing the risk of bias. Two authors independently abstracted data and assessed risks of bias.

FINDINGS

Seven RCTs with a total of 622 adult participants fulfilled our inclusion criteria and were, therefore, included. A random-effects model estimated the summary effect of the 7 included studies as -1.83 ± 0.98, P = 0.06.

CONCLUSIONS

Although our meta-analysis demonstrated a small treatment effect, this effect was clinically not statistically significant. Substantial heterogeneity among the included trials limits the certainty of our findings. Additional trials investigating the effects of listening to music on pain in adults undergoing colonoscopy are needed to generate further evidence to establish the analgesic effect of music in adults undergoing colonoscopy.

Binaural beats or 432 Hz music? which method is more effective for reducing preoperative dental anxiety?

Background

The aim of this prospective clinical study was to investigate the effectiveness of binaural beats and music at a frequency of 432 Hz and compare which method is more effective for reducing preoperative dental anxiety in impacted third molar surgery.

Material and Methods

Ninety patients were randomly selected to the binaural beats group, music group and control group. Visual analog scale used to evaluate dental anxiety before the local anesthesia in the first measurement. Local anesthesia was applied to the all patients. Patients in the music group listened to 432 Hz tuned music using earphones for 10 minutes. Patients in the binaural beats group listened to binaural beats using earphones (for the right ear, 220 Hz and for the left ear 210 Hz) for 10 minutes. No special treatment was applied to the patients in control group. In the second measurement, dental anxiety was measured again in all three groups. For analysis of differences between three groups was used One way Anova and Kruskal Wallis test.

Results

Twenty seven male and 53 female patients included the study. In the first measurement, the same level of anxiety was recorded in all three groups. (p=0.811) There was a significant decrease in anxiety in both the binaural beats and music group in the second measurement. (p<0.001).

Conclusions

Binaural beats and 432 Hz tuned music are a valid non pharmacological adjuvant to reduce dental anxiety in impacted third molar surgery. They have a positive effect to reduce the dental anxiety.

Key words:Binaural beats, 432 Hz music, dental anxiety.

Evaluation of an Objective Measurement Tool for Stress Level Reduction by Individually Chosen Music During Colonoscopy-Results From the Study "ColoRelaxTone"

Background and Aims: Colonoscopy as standard procedure in endoscopy is often perceived as uncomfortable for patients. Patient's anxiety is therefore a significant issue, which often lead to avoidance of participation of relevant examinations as CRC-screening. Non-pharmacological anxiety management interventions such as music might contribute to relaxation in the phase prior and during endoscopy. Although music's anxiolytic effects have been reported previously, no objective measurement of stress level reduction has been reported yet. Focus of this study was to evaluate the objective measurement of the state of relaxation in patients undergoing colonoscopy.

Methods: Prospective study (n = 196) performed at one endoscopic high-volume center. Standard colonoscopy was performed in control group. Interventional group received additionally self-chosen music over earphones. Facial Electromyography (fEMG) activity was obtained. Clinician Satisfaction with Sedation Instrument (CSSI) and Patients Satisfaction with Sedation Instrument (PSSI) was answered by colonoscopists and patients, respectively. Overall satisfaction with music accompanied colonoscopy was obtained if applicable.

Results: Mean difference measured by fEMG via musculus zygomaticus major indicated a significantly lower stress level in the music group [7.700(±5.560) μV vs. 4.820(±3.330) μV; p = 0.001]. Clinician satisfaction was significantly higher with patients listening to music [82.69(±15.04) vs. 87.3(±15.02) pts.; p = 0.001]. Patient's satisfaction was higher but did not differ significantly.

Conclusions: We conclude that self-chosen music contributes objectively to a reduced stress level for patients and therefore subjectively perceived satisfaction for endoscopists. Therefore, music should be considered as a non-pharmacological treatment method of distress reduction especially in the beginning of endoscopic procedures.

Quality indicators in diagnostic upper gastrointestinal endoscopy

Upper gastrointestinal (UGI) endoscopy contributes a major clinical service with consistently growing demand around the world. Its utility corresponds to varying epidemiological issues throughout the globe, with cancer screening and surveillance being of the utmost priority. Despite high accuracy in neoplasia detection, UGI endoscopy remains a highly operator-dependent procedure, characterized by a substantial rate of missed pathology. Despite an overall lack of high-quality performance measures, there is an increased level of awareness about the need for quality control of this procedure, which is reflected in several guidelines and position statements published in recent years. It is widely recognized that quality assessment should go beyond mere technical aspects of the examination, and include both pre- and post-procedural factors. By this means, quality control encompasses the entire patient experience with the health care provider, from appropriate indication and physical assessment, through high-quality endoscopy service, to appropriate follow up and patient satisfaction. This article aims to review the available and emerging quality metrics for UGI endoscopy, taken mostly from Western endoscopy societies, with references to Asian recommendations where appropriate. The paper is limited solely to diagnostic UGI endoscopy and does not include performance measures for therapeutic procedures.

Role of Music in a Plastic Surgery Setting: A Systematic Review and Meta-analysis

Objective  To assess the effectiveness and harm of music to reduce anxiety and pain in a plastic surgery setting. Materials and Methods  A search strategy was conducted in the MEDLINE, CENTRAL, EMBASE, and LILACS databases. Searches were also conducted in other databases and unpublished literature. Clinical trials were included without language restrictions. The risk of bias was evaluated with the Cochrane Collaboration's tool. An analysis of random effects was conducted. The primary outcomes were anxiety and pain. The secondary outcomes were length of stay, physiological parameters, and adverse effects. The measure of the effect was the mean difference (MD) and standardized MD (SMD) with a 95% confidence interval (CI). The planned interventions were music versus no music. Results  Four articles were included in the qualitative and quantitative analysis. A total of 306 patients were found among the four studies. A low risk of bias was shown for most of the study items. The overall standardized mean difference (SMD) for anxiety -3.64 [95%CI -5.71 to -1.56 (p-value = 0.0006)] favoring music compared with no intervention, and for pain the mean difference (MD) was -12.06 [95%CI -33.47 to 9.35 (p-value = 0.2696)] showing no statistical differences. Conclusion  Playing music is a safe and free intervention that diminishes anxiety in patients who undergo plastic surgery procedures.

My approach to water-assisted colonoscopy

The goal of diagnostic colonoscopy is to achieve procedural completion while maximising effectiveness, patient acceptance and safety. In recent years, international interest in water-assisted colonoscopy (WAC) has been steadily gathering pace. A plethora of high-quality randomised controlled trials and meta-analyses now offer incontrovertible evidence into the benefits of WAC, both for the endoscopist and the patient. Despite this, uptake of WAC within the UK has been limited, with the lack of educational resources representing a significant barrier. This practical step-by-step guide is aimed at both existing practitioners and trainees, with a view to promoting familiarity with WAC and potentially for incorporation into daily practice which may ultimately have a positive effect on quality of colonoscopy and patient experience.

Associations of anxiety with discomfort and tolerance in Chinese patients undergoing esophagogastroduodenoscopy

Objectives

To evaluate the associations of pre-endoscopy anxiety with discomfort and tolerance in patients undergoing unsedated esophagogastroduodenoscopy (EGD).

Methods

This is a hospital-based cohort study of 348 patients undergoing routine, non-advanced EGD without sedation. The primary outcomes were discomfort and tolerance. The anxiety before endoscopy was evaluated with a 10-point visual analogue scale (VAS). The associations of pre-endoscopy anxiety with the outcomes were evaluated with logistic regression adjusting for potential confounders like age, sex, and body mass index.

Results

Seventy patients reported severe discomfort and 56 patients reported poor tolerance after endoscopy. The risk of severe discomfort increased with pre-endoscopy anxiety and reached a platform around 7–10 points. Compared with the participants with low pre-endoscopy anxiety, those with moderate (adjusted odds ratio [OR] 2.70, 95% confidence interval [CI] 1.17 to 6.22) and high level of anxiety (adjusted OR 6.87, 95% CI 2.16 to 21.79) were associated with a gradual increase in the risk of severe discomfort (P-trend < 0.001). The association between pre-endoscopy anxiety and tolerance was linear, with an adjusted OR of 1.67(95% CI 1.33 to 2.08) for a 1-score increase in pre-endoscopy anxiety VAS. The associations were not modified by age, sex, pharyngitis, duration of endoscopy, and diameter of the endoscope.

Conclusions

Pre-endoscopy anxiety was an independent predictor of severe discomfort and poor tolerance in Chinese patients undergoing unsedated EGD. Our findings suggested the importance of the management of anxiety to reduce adverse endoscopic experience and taking high level of anxiety as an indication for sedation.

Preparatory information reduces gastroscopy-related stress in children as confirmed by salivary cortisol

BACKGROUND/AIMS

This study aimed to determine whether the anxiety levels of pediatric patients who undergo endoscopy are reduced after receiving preparatory information about the endoscopic procedure by monitoring their salivary cortisol (s-cortisol) levels.

PATIENTS AND METHODS

A total of 184 children undergoing gastroscopy under sedoanalgesia were included in the study. All the patients received a brief explanation of the endoscopic procedure. Patients were divided into two groups; Group Unexplained did not receive any further information other than a brief explanation of the procedure, Group Explained received more detailed explanation of the procedure. To determine anxiety levels, saliva specimens were taken on the day before the procedure to examine cortisol levels before and after endoscopy. Anxiety scores before endoscopy were calculated by the modified Yale Preoperative Anxiety Scale. Patients were monitored throughout sedoanalgesia, including during the endoscopy, sedation and recovery, and total propofol dosages were recorded.

RESULTS

Eighty-nine children undergoing gastroscopy (age 11.55 ± 2.52 years; 50.5% girls) constituted Group Explained and 95 children undergoing gastroscopy (age 11.44 ± 2.66 years; 56.8% male) constituted Group Unexplained. The anxiety score, duration of sedation, endoscopy and recovery, propofol dose, pre- and post-endoscopy s-cortisol levels were significantly reduced in Group Explained.

CONCLUSIONS

We demonstrated that when endoscopic procedure is explained broadly to a child, the procedural stress is significantly less, as measured by the s-cortisol levels and the anxiety questionnaire. It is important for the attending physician to explain all aspects of examination carefully.

Level and predictors of anxiety in patients undergoing diagnostic bronchoscopy

AIMS:

Flexible bronchoscopy is a common procedure performed in pulmonary medicine, critical care, and thoracic surgery. In this study, we aimed to assess the prevalence and predictors of anxiety in patients undergoing diagnostic bronchoscopy.

METHODS:

This is a prospective study conducted at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. All patients undergoing diagnostic bronchoscopy filled the State-Trait Anxiety Inventory questionnaire before the procedure. Bronchoscopy was performed either through the mouth or the nose, based on the bronchoscopist preference. Lidocaine (1%–2%) spray was used for administering topical anesthesia. Results were collected, and statistical analysis was performed using t-test to measure statistically significant (P < 0.05).

RESULTS:

A total of 117 patients participated in this study. High anxiety score was found in 45% of the patients. Older patients significantly showed higher anxiety score than younger patients (53 years vs. 46 years, P = 0.034). Similarly, patients with higher body mass index (BMI) showed a statistically significant increase in anxiety score (28 vs. 25, P = 0.041). Premedication with pethidine significantly reduced the anxiety levels (26.9% vs. 73.1%, P = 0.031). Logistic regression demonstrated that old age and outpatient settings were significant predictors of higher anxiety scores.

CONCLUSION:

Diagnostic bronchoscopy can cause high anxiety in many patients. Prebronchoscopy anxiety assessment can help bronchoscopists to anticipate the anxiety levels of patients, and then further use it to tailor sedation requirements. Special attention should be given to older patients, patients with high BMI, and the ones undergoing bronchoscopy in outpatient settings.

The influence of various distractions prior to upper gastrointestinal endoscopy: a prospective randomized controlled study

BACKGROUND

Although many patients still have anxiety about upper gastrointestinal (GI) endoscopy, there have been few reports on the influence of distractions for a person who is going to undergo upper GI endoscopy soon. This study was a prospective randomized controlled study investigating the influence of distractions, such as auditive and visual distractions using subjective and objective assessments including autonomic nervous function prior to upper GI endoscopy.

METHODS

206 subjects who underwent upper GI endoscopy as regular health check-ups were divided randomly into 4 groups prior to upper GI endoscopy; group 1 (control group), group 2 (auditive group), group 3 (visual group), and group 4 (combination group). We measured vital signs, autonomic nervous function, profile of mood state (POMS), and the impression for upper GI endoscopy pre- and post-distraction in the 4 groups.

RESULTS

There was no significant difference in vital signs between 5 and 15 min after sitting in group 1, however, several vital signs in all distraction groups improved significantly after distraction (Pulse rate (P): p <  0.001 in group 4; blood pressure: p <  0.05 in group 2, 3, 4) and the rate of decrease in P and diastolic blood pressure was highest in group 4 (p <  0.001). Several scores of POMS and the impression for upper GI endoscopy post-distraction improved significantly compared to pre-distraction between distraction groups and the satisfaction for distraction was highest in group 4 (p <  0.01). Regarding autonomic nerve function, the low- frequency power/ high- frequency power ratio post-distraction was significantly lower than that pre-distraction in all distraction groups (p <  0.001).

CONCLUSIONS

Although auditive distraction alone and visual distraction alone were effective, a combination distraction was more effective than any other distraction by subjective and objective assessments. These distractions, which were simple and safe, may play an assistive role in the stability of physical and psychological conditions prior to upper GI endoscopy.

TRIAL REGISTRATION

This trial was registered in the University Hospital Medical Information Network (UMIN) Clinical Trials Registry as UMIN000022801 . Registered on 10 July 2016.

Standardizing music characteristics for the management of pain: A systematic review and meta-analysis of clinical trials

PURPOSE

To evaluate if music characteristics like tempo, harmony, melody, instrumentation, volume, and pitch, as defined by musical theory, are described in randomized clinical trials (RCTs) evaluating the effects of music-listening on the quantified pain perception of adults, and if these characteristics influence music's overall therapeutic effect.

METHODS

A systematic review and meta-analysis of RCTs evaluating music-listening for pain management on adults was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analyses statement. The databases Pubmed, Scopus, SCIELO, SpringerLink, Global Health Library, Cochrane, EMBASE, and LILACS were searched. Studies published between 2004 and 2017 with quantified measurements of pain were included. Quality was evaluated using the Scottish Intercollegiate Guidelines Network methodology checklist for RCT, and effect sizes were reported with standardized mean differences.

RESULTS

A total of 85 studies were included for qualitative analysis but only 56.47% described at least one music characteristic. Overall meta-analysis found a significant effect, with high heterogeneity, of music for pain management (SMD -0.59, I2 = 85%). Only instrumentation characteristics (lack of lyrics, of percussion or of nature sounds), and 60-80 bpm tempo were described sufficiently for analysis. All three instrumentation characteristics had significant effects, but only the lack of lyrics showed an acceptable heterogeneity.

CONCLUSIONS

Results show that music without lyrics is effective for the management of pain. Due to insufficient data, no ideal music characteristics for the management of pain were identified suggesting that music, as an intervention, needs standardization through an objective language such as that of music theory.

Music reduces state anxiety scores in patients undergoing pleural procedures: a randomised controlled trial

BACKGROUND

Patient anxiety is an often overlooked complication of pleural diagnostic and therapeutic procedures. Listening to music is effective in reducing patient anxiety in some endoscopy procedures but has not yet been evaluated in pleural procedures.

AIM

To evaluate the benefits of music therapy during pleural procedures on a patient's anxiety, perceived pain and satisfaction with the procedure.

METHODS

Consecutive patients undergoing therapeutic pleural procedures were randomised to music and control groups. Participants in the music group listened to self-selected music using ear-bud headphones for the duration of the procedure. State anxiety was assessed before and after the procedure using the State Trait Anxiety Inventory. Physiological parameters were also measured.

RESULTS

Sixty patients were included in the study. In the music group, a reduction in state anxiety scores were observed post-procedure (34 ± 11 vs 48 ± 13, P < 0.001), while no change was observed in the control group (40 ± 11 vs 42 ± 11, P = 0.51). Participants in the music group had reductions in heart rate (87 ± 17 vs 95 ± 15, P = 0.04), systolic (121 ± 13 vs 130 ± 16, P = 0.02) and diastolic blood pressure (72 ± 8 vs 78 ± 9, P = 0.01) post procedure compared to the pre-procedures values. A similar change was not detected in the control group: heart rate (86 ± 17 vs 85 ± 15, P = 0.73), systolic (133 ± 21 vs 134 ± 20, P = 0.83) and diastolic blood pressure (77 ± 9 vs 79 ± 10, P = 0.30). There was no difference in patient pain scores (P = 0.8), willingness to undergo the procedure again (P= 0.27), satisfaction with the performance of the pleural procedure (P = 0.20) and duration of the procedure (P = 0.68) between the music and control groups.

CONCLUSIONS

Listening to music appears to be beneficial in reducing anxiety in patients undergoing pleural procedures.

The effect of music in gynaecological office procedures on pain, anxiety and satisfaction: a randomized controlled trial

Background

Pain can interfere with office procedures in gynaecology. The aim of this study is to measure the positive effect of music in gynaecological office procedures.

Methods

A randomized controlled trial was performed between October 2014 and January 2016. Women scheduled for an office hysteroscopy or colposcopy were eligible for randomization in the music group or control group. Stratification for hysteroscopy and colposcopy took place. The primary outcome is patients’ level of pain during the procedure measured by the visual analogue scale (VAS). Secondary outcomes include patients’ level of pain after the procedure, anxiety and satisfaction of patient and doctor.

Results

No positive effect of music on patients’ perception of pain during the procedure was measured, neither for the hysteroscopy group (57 mm vs. 52 mm) nor for the colposcopy group (32 mm vs. 32 mm). Secondary outcomes were also similar for both groups.

Conclusions

This study showed no positive effect of music on patients’ level of pain, anxiety or satisfaction of patient or doctor for office hysteroscopy and colposcopy. We believe a multimodal approach has to be used to decrease patient distress in terms of pain and anxiety, with or without music.

Trial registration

Dutch Trial Register, NTR4924

The effects of music intervention on burn patients during treatment procedures: a systematic review and meta-analysis of randomized controlled trials

Background

The treatment of burn patients is very challenging because burn injuries are one of the most severe traumas that can be experienced. The effect of music therapy on burn patients has been widely reported, but the results have been inconsistent. Thus, we performed a systematic review and meta-analysis of randomized controlled trials in burn patients to determine the effect of music during treatments.

Methods

We searched a variety of electronic databases, including MEDLINE (via PubMed), EMBASE, Cochrane Library, Psychinfo, VIP Database for Chinese Technical Periodicals (VIP) and China National Knowledge Infrastructure (CNKI) for relevant trials on the basis of predetermined eligibility criteria. from their first available date through February 2016. Our search focused on two key concepts: music interventions (including music, music therapy and music medicine) and physical activity outcomes (including pain, anxiety, burn characteristics, dressing changes, wound care, debridement and rehabilitation). Two reviewers independently screened records and extracted data from all eligible studies. Statistical heterogeneity was determined using Q-test and the I² statistic. The endpoints included standardized mean differences (SMDs) and 95% confidence intervals (CIs). Publication bias was tested by Begg’s funnel plot and Egger’s test.

Results

A total of 17 studies met the inclusion criteria, for a total of 804 patients. A statistically significant difference in pain relief was demonstrated between music and non-music interventions (SMD = −1.26, 95% CI [−1.83, −0.68]), indicating that music intervention has a positive effect on pain alleviation for burn patients. The results indicated that music interventions markedly reduced anxiety in individuals compared to non-music interventions (SMD = −1.22, 95% CI [−1.75, −0.69]). Correspondingly, heart rate decreases were found after treatments that included music interventions (SMD = −0.60, 95% CI [−0.84, −0.36]).

Conclusion

In summary, a positive correlation was found between treatments including music interventions and pain alleviation, anxiety relief, and heart rate reduction in burn patients. However, additional high-quality studies with carefully considered music interventions for burn patients are still needed.

Electronic supplementary material

The online version of this article (doi:10.1186/s12906-017-1669-4) contains supplementary material, which is available to authorized users.

Music does not alter anxiety in patients with suspected lung cancer undergoing bronchoscopy: a randomised controlled trial

Background

The use of music to relieve anxiety has been examined in various studies, but the results are inconclusive.

Methods

From April to October 2015, 160 patients undergoing examination of pulmonary nodules were randomly assigned to MusiCure or no music. MusiCure was administered through earplugs to ensure blinding of the staff and was played from admission to the operating theatre to the end of the bronchoscopy. Spielberger’s State-Trait Anxiety Inventory (STAI) was administered on admission, immediately before bronchoscopy, and on discharge. Secondary outcomes were p-cortisol, physiological variables, dosage of sedatives, movements measured by Actigraph, bronchoscopy duration, number of re-examinations, and overall perception of the sounds in the operating theatre measured by Visual analogue scale.

Results

The STAI scores were similar on admission, but after a 10-min wait in the operating theatre, scores varied significantly between patients with and without music, with lower scores in the music group [median (interquartile range, IQR) 35 (18) vs. 43 (25); p=0.03]. Post hoc multiple regression revealed treatment group as insignificant when adjusting for sex and baseline anxiety. However, there was a significantly more positive perception of the sounds in the operating theatre in the music group (median (IQR) 8.2 (1.8) vs. 5.4 (6.8); p<0.0001) and fewer re-examinations in the music group (19.2% vs. 7.7%, p<0.032).

Conclusions

Ten minutes with MusiCure does not alter anxiety when adjusting for baseline anxiety and sex. The current study indicates that this field of research has many confounders.

Effects of music on sedation depth and sedative use during pediatric dental procedures

STUDY OBJECTIVE

The study aimed to investigate the effects of listening to music or providing sound isolation on the depth of sedation and need for sedatives in pediatric dental patients.

DESIGN

Prospective, randomized, and controlled study.

SETTING

Tertiary, university hospital.

PATIENTS

In total, 180 pediatric patients, American Society of Anesthesiologists physical status I and II, who were scheduled for dental procedures of tooth extraction, filling, amputation, and root treatment.

INTERVENTIONS

Patients were categorized into 3 groups: music, isolation, and control. During the procedures, the patients in the music group listened to Vivaldi's The Four Seasons violin concertos by sound-isolating headphones, whereas the patients in the isolation group wore the headphones but did not listen to music. All patients were sedated by 0.1 mg/kg midazolam and 1 mg/kg propofol. During the procedure, an additional 0.5 mg/kg propofol was administered as required.

MEASUREMENTS AND MAIN RESULTS

Bispectral index was used for quantifying the depth of sedation, and total dosage of the propofol was used for sedative requirements. The patients' heart rates, oxygen saturations, and Observer's Assessment of Alertness and Sedation Scale and bispectral index scores, which were monitored during the operation, were similar among the groups. In terms of the amount of propofol used, the groups were similar. Prolonged postoperative recovery cases were found to be significantly frequent in the control group, according to the recovery duration measurements (P = .004).

CONCLUSIONS

Listening to music or providing sound isolation during pediatric dental interventions did not alter the sedation level, amount of medication, and hemodynamic variables significantly. This result might be due to the deep sedation levels reached during the procedures. However, listening to music and providing sound isolation might have contributed in shortening the postoperative recovery duration of the patients.

The Value of Audio Devices in the Endoscopy Room (VADER) study: a randomised controlled trial

OBJECTIVE

To evaluate the effect of Star Wars music (SWM) compared with endoscopist-selected popular music (PM) on quality outcomes in colonoscopy.

DESIGN AND SETTING

A single-centre, prospective, randomised controlled trial conducted in an endoscopy suite within a quaternary-centre gastroenterology unit, Melbourne, Australia.

MAIN OUTCOME MEASURES

The primary outcome measures were procedure time, polyp detection rate (PDR) and adenoma detection rate (ADR). The secondary outcome measure was adenomas per colonoscopy (APC).

RESULTS

103 colonoscopies were analysed: 58 in the SWM group and 45 in the PM group. Bowel preparation was assessed as good or excellent in 57% of the SWM group compared with 69% of the PM group (P < 0.01). The PDR was significantly higher in the SWM group than in the PM group (60% v 35%; P = 0.006). Similarly, the ADR was significantly higher in the SWM group than in the PM group (48% v 27%; P = 0.01). The APC in the SWM group was 84% compared with 35% in the PM group (P = 0.01).

CONCLUSION

SWM compared with PM improves key quality outcomes in colonoscopy, despite poorer bowel preparation.