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Jiang F, Wang T, Hu L, Chen S, Chen L, Liu X, Lu Y, Gu E, Ulloa L. Personal versus therapist perioperative music intervention: a randomized controlled trial. Int J Surg 2024; 110:4176-4184. [PMID: 38537084 PMCID: PMC11254264 DOI: 10.1097/js9.0000000000001383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 03/11/2024] [Indexed: 07/19/2024]
Abstract
INTRODUCTION Music interventions can alleviate patient anxiety and improve post-surgical satisfaction. However, it remains uncertain whether personal music preferences affect efficacy. The authors tested whether personal music intervention with patient-selected songs played ad libitum is more effective than standard therapist-designed treatment with classical music. METHODS A prospective, parallel-group, single-blinded, randomized controlled trial with 229 participants (aged 18-60 years) previously scheduled for elective surgery. Data analyses followed a modified intention-to-treat principle. The patients were randomized into three groups: Standard care without music (Control), therapist-designed classic music treatment (TT), or personal music intervention with patient-selected songs played ad libitum by the patient (PI). All patients received standard post-anaesthesia care, and music intervention was started upon arrival at the post-anaesthesia care unit. Primary outcomes were anxiety and overall satisfaction at discharge. In contrast, secondary outcomes were systolic blood pressure during music intervention, the sleep quality of the night after surgery, and the occurrence of postoperative nausea and vomiting within the first 24 h after surgery. RESULTS Compared with therapist-designed music treatment, personal intervention decreased systolic blood pressure (T 0 : 124.3±13.7, 95% CI:121-127.7; T 20min : 117.6±10.4, 95% CI:115-120.1; T 30min : 116.9±10.6, 95% CI:114.3-119.4), prevented postoperative nausea and vomiting (Control: 55.9%, TT: 64.6%, PI: 77.6%), including severe postoperative nausea (VAS score>4; Control: 44.1%; TT: 33.8%; PI: 20.9%) and severe emesis (Frequency≥3, Control: 13.2%; TT: 7.7%; PI: 4.5%). None of the treatments affected sleep quality at night after surgery (Median, Q1-Q3, Control: 3, 1-3; TT: 3, 1-4; PI: 3, 1-3.5). Personal, but not therapist, music intervention significantly prevented anxiety (Control: 36.4±5.9, 95% CI:35.0-37.9; TT: 36.2±7.1, 95% CI: 34.4-37.9; PI: 33.8±5.6, 95% CI: 32.4-35.2) and emesis (Control: 23.9%; TT: 23.4%; PI: 13.2%) and improved patient satisfaction (Median, Q1-Q3, C: 8, 6-8; TT: 8, 7-9; PI: 8, 7-9). CONCLUSIONS Personal music intervention improved postoperative systolic blood pressure, anxiety, nausea, emesis, and overall satisfaction, but not sleep quality, as compared to therapist-designed classic intervention.
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Affiliation(s)
- Fan Jiang
- Center for Perioperative Organ Protection, Department of Anesthesiology, Duke University Medical Center
- Department of Anesthesiology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Tingting Wang
- Department of Anesthesiology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Liqiong Hu
- Department of Anesthesiology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Shangui Chen
- Department of Anesthesiology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Lijian Chen
- Department of Anesthesiology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xuesheng Liu
- Department of Anesthesiology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yao Lu
- Department of Anesthesiology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Erwei Gu
- Department of Anesthesiology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Luis Ulloa
- Center for Perioperative Organ Protection, Department of Anesthesiology, Duke University Medical Center
- Center of Neuromodulation, Duke University Medical Center, Durham, NC, USA
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Maskal SM, Gentle CK, Ellis RC, Tu C, Rosen MJ, Petro CC, Miller BT, Beffa LRA, Chang JH, Messer N, Melland-Smith M, Jeekel J, Prabhu AS. Does selective intraoperative music reduce pain following abdominal wall reconstruction? A double-blind randomized controlled trial. Hernia 2024:10.1007/s10029-024-03092-y. [PMID: 38890182 DOI: 10.1007/s10029-024-03092-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 06/09/2024] [Indexed: 06/20/2024]
Abstract
PURPOSE Although intraoperative music is purported to mitigate postoperative pain after some procedures, its application has never been explored in abdominal wall reconstruction (AWR). We sought to determine whether intraoperative music would decrease early postoperative pain following AWR. METHODS We conducted a placebo-controlled, patient-, surgeon-, and assessor-blinded, randomized controlled trial at a single center between June 2022 and July 2023 including 321 adult patients undergoing open AWR with retromuscular mesh. Patients received noise-canceling headphones and were randomized 1:1 to patient-selected music or silence after induction, stratified by preoperative chronic opioid use. All patients received multimodal pain control. The primary outcome was pain (NRS-11) at 24 ± 3 h. The primary outcome was analyzed by linear regression with pre-specified covariates (chronic opioid use, hernia width, operative time, myofascial release, anxiety disorder diagnosis, and preoperative STAI-6 score). RESULTS 178 patients were randomized to music, 164 of which were analyzed. 177 were randomized to silence, 157 of which were analyzed. At 24 ± 3 h postoperatively, there was no difference in the primary outcome of NRS-11 scores (5.18 ± 2.62 vs 5.27 ± 2.46, p = 0.75). After adjusting for prespecified covariates, the difference of NRS-11 scores at 24 ± 3 h between the music and silence groups remained insignificant (p = 0.83). There was no difference in NRS-11 or STAI-6 scores at 48 ± 3 and 72 ± 3 h, intraoperative sedation, or postoperative narcotic usage. CONCLUSION For patients undergoing AWR, there was no benefit of intraoperative music over routine multimodal pain control for early postoperative pain reduction. TRIAL REGISTRATION ClinicalTrials.gov: NCT05374096.
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Affiliation(s)
- Sara M Maskal
- Cleveland Clinic Foundation, Crile Building, A100, 2049 E 100th Street, Cleveland, OH, 44195, USA.
| | - Corey K Gentle
- Cleveland Clinic Foundation, Crile Building, A100, 2049 E 100th Street, Cleveland, OH, 44195, USA
| | - Ryan C Ellis
- Cleveland Clinic Foundation, Crile Building, A100, 2049 E 100th Street, Cleveland, OH, 44195, USA
| | - Chao Tu
- Cleveland Clinic Foundation, Crile Building, A100, 2049 E 100th Street, Cleveland, OH, 44195, USA
| | - Michael J Rosen
- Cleveland Clinic Foundation, Crile Building, A100, 2049 E 100th Street, Cleveland, OH, 44195, USA
| | - Clayton C Petro
- Cleveland Clinic Foundation, Crile Building, A100, 2049 E 100th Street, Cleveland, OH, 44195, USA
| | - Benjamin T Miller
- Cleveland Clinic Foundation, Crile Building, A100, 2049 E 100th Street, Cleveland, OH, 44195, USA
| | - Lucas R A Beffa
- Cleveland Clinic Foundation, Crile Building, A100, 2049 E 100th Street, Cleveland, OH, 44195, USA
| | - Jenny H Chang
- Cleveland Clinic Foundation, Crile Building, A100, 2049 E 100th Street, Cleveland, OH, 44195, USA
| | - Nir Messer
- Cleveland Clinic Foundation, Crile Building, A100, 2049 E 100th Street, Cleveland, OH, 44195, USA
| | - Megan Melland-Smith
- Cleveland Clinic Foundation, Crile Building, A100, 2049 E 100th Street, Cleveland, OH, 44195, USA
| | - Johannes Jeekel
- Erasmus Medical Center, Erasmus University, Rotterdam, Netherlands
| | - Ajita S Prabhu
- Cleveland Clinic Foundation, Crile Building, A100, 2049 E 100th Street, Cleveland, OH, 44195, USA
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Fu VX, Lagarde SM, Favoccia CT, Heisterkamp J, van Oers AE, Coene PPLO, Koopman JSHA, van den Berg SAA, Dik WA, Jeekel J, Wijnhoven BPL. Intraoperative Music to Promote Patient Outcome (IMPROMPTU): A Double-Blind Randomized Controlled Trial. J Surg Res 2024; 296:291-301. [PMID: 38306934 DOI: 10.1016/j.jss.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 12/03/2023] [Accepted: 01/02/2024] [Indexed: 02/04/2024]
Abstract
INTRODUCTION Perioperative music can have beneficial effects on postoperative pain, anxiety, opioid requirement, and the physiological stress response to surgery. The aim was to assess the effects of intraoperative music during general anesthesia in patients undergoing surgery for esophagogastric cancer. MATERIALS AND METHODS The IMPROMPTU study was a double-blind, placebo-controlled, randomized multicenter trial. Adult patients undergoing surgery for stage II-III esophagogastric cancer were eligible. Exclusion criteria were a hearing impairment, insufficient Dutch language knowledge, corticosteroids use, or objection to hearing unknown music. Patients wore active noise-cancelling headphones intraoperatively with preselected instrumental classical music (intervention) or no music (control). Computerized randomization with centralized allocation, stratified according to surgical procedure using variable block sizes, was employed. Primary endpoint was postoperative pain on the first postoperative day. Secondary endpoints were postoperative pain during the first postoperative week, postoperative opioid requirement, intraoperative medication requirement, the stress response to surgery, postoperative complication rate, length of stay, and mortality, with follow-up lasting 30 d. RESULTS From November 2018 to September 2020, 145 patients were assessed and 83 randomized. Seventy patients (music n = 31, control n = 39) were analyzed. Median age was 70 [IQR 63-70], and 48 patients (69%) were male. Music did not reduce postoperative pain (numeric rating scale 1.8 (SD0.94) versus 2.0 (1.0), mean difference -0.28 [95% CI -0.76-0.19], P = 0.236). No statistically significant differences were seen in medication requirement, stress response, complication rate, or length of stay. CONCLUSIONS Intraoperative, preselected, classical music during esophagogastric cancer surgery did not significantly improve postoperative outcome and recovery when compared to no music using noise-cancelling headphones.
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Affiliation(s)
- Victor X Fu
- Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
| | - Sjoerd M Lagarde
- Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Christian T Favoccia
- Department of Anesthesiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Joos Heisterkamp
- Department of Surgery, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Annemarie E van Oers
- Department of Anesthesiology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | | | | | - Sjoerd A A van den Berg
- Department of Clinical Chemistry, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Willem A Dik
- Department of Immunology, Laboratory Medical Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Johannes Jeekel
- Department of Neuroscience, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Bas P L Wijnhoven
- Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Singh GP, Goyal LD, Hoovayya P, Udey B, Singh J, Choudhary A. The music playing intervention in a tertiary care institution in India: Health care workers experiences. Int J Soc Psychiatry 2024; 70:231-232. [PMID: 37092769 DOI: 10.1177/00207640231169658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Affiliation(s)
- Gurvinder Pal Singh
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), Bathinda, Punjab, India
| | - Lajya Devi Goyal
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS), Bathinda, Punjab, India
| | - Purshottam Hoovayya
- Hospital Administration, All India Institute of Medical Sciences (AIIMS), Bathinda, Punjab, India
| | - Bharat Udey
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), Bathinda, Punjab, India
| | - Jawahar Singh
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), Bathinda, Punjab, India
| | - Aarthi Choudhary
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), Bathinda, Punjab, India
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Ginsberg JP, Raghunathan K, Bassi G, Ulloa L. Review of Perioperative Music Medicine: Mechanisms of Pain and Stress Reduction Around Surgery. Front Med (Lausanne) 2022; 9:821022. [PMID: 35187004 PMCID: PMC8854756 DOI: 10.3389/fmed.2022.821022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 01/12/2022] [Indexed: 12/19/2022] Open
Abstract
Clinical-experimental considerations and an approach to understanding the autonomic basis of improved surgical outcomes using Perioperative Music Medicine (PMM) are reviewed. Combined surgical, psycho-physiological, and experimental perspectives on Music Medicine (MM) and its relationship to autonomic nervous system (ANS) function are discussed. Considerations are given to the inter-related perioperative effects of MM on ANS, pain, and underlying vagal and other neural circuits involved in emotional regulation and dysregulation. Many surgical procedures are associated with significant pain, which is routinely treated with post-operative opioid medications, which cause detrimental side effects and delay recovery. Surgical trauma shifts the sympathetic ANS to a sustained activation impairing physiological homeostasis and causing psychological stress, as well as metabolic and immune dysfunction that contribute to postoperative mortality and morbidity. In this article, we propose a plan to operationalize the study of mechanisms mediating the effects of MM in perioperative settings of orthopedic surgery. These studies will be critical for the implementation of PMM as a routine clinical practice and to determine the potential limitations of MM in specific cohorts of patients and how to improve the treatment.
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Affiliation(s)
- J. P. Ginsberg
- Departments of Applied Psychophysiology, Psychology and Statistics, Saybrook University, Pasadena, CA, United States
| | - Karthik Raghunathan
- Critical Care and Perioperative Population Health Research Unit, Department of Anesthesiology, Duke University Medical Center, Durham, NC, United States
| | - Gabriel Bassi
- Department of Anesthesiology, Center for Perioperative Organ Protection, Duke University Medical Center, Durham, NC, United States
| | - Luis Ulloa
- Department of Anesthesiology, Center for Perioperative Organ Protection, Duke University Medical Center, Durham, NC, United States
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Fu VX, Sleurink KJ, Janssen JC, Wijnhoven BPL, Jeekel J, Klimek M. Perception of auditory stimuli during general anesthesia and its effects on patient outcomes: a systematic review and meta-analysis. Can J Anaesth 2021; 68:1231-1253. [PMID: 34013463 PMCID: PMC8282577 DOI: 10.1007/s12630-021-02015-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/06/2021] [Accepted: 03/29/2021] [Indexed: 12/03/2022] Open
Abstract
PURPOSE Interest in implicit memory formation and unconscious auditory stimulus perception during general anesthesia has resurfaced as perioperative music has been reported to produce beneficial effects. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating explicit and implicit memory formation during general anesthesia and its effects on postoperative patient outcomes and recovery. SOURCE We performed a systematic literature search of Embase, Ovid Medline, and Cochrane Central from inception date until 15 October 2020. Eligible for inclusion were RCTs investigating intraoperative auditory stimulation in adult surgical patients under general anesthesia in which patients, healthcare staff, and outcome assessors were all blinded. We used random effects models for meta-analyses. This study adhered to the PRISMA guidelines and was registered in PROSPERO (CRD42020178087). PRINCIPAL FINDINGS Fifty-three (4,200 patients) of 5,859 identified articles were included. There was evidence of implicit memory formation in seven out of 17 studies (41%) when assessed using perceptual priming tasks. Mixed results were observed on postoperative behavioural and motor response after intraoperative suggestions. Intraoperative music significantly reduced postoperative pain (standardized mean difference [SMD], -0.84; 95% confidence interval [CI], -1.1 to -0.57; P < 0.001; I2 = 0; n = 226) and opioid requirements (SMD, -0.29; 95% CI, -0.57 to -0.015; P = 0.039; I2 = 36; n = 336), while positive therapeutic suggestions did not. CONCLUSION The results of this systematic review and meta-analysis show that intraoperative auditory stimuli can be perceived and processed during clinically adequate, general anesthesia irrespective of surgical procedure severity, leading to implicit memory formation without explicit awareness. Intraoperative music can exert significant beneficial effects on postoperative pain and opioid requirements. Whether the employed intraoperative anesthesia regimen is of influence is not yet clear.
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Affiliation(s)
- Victor X Fu
- Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
- Department of Neuroscience, Erasmus MC, University Medical Centre Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
| | - Karel J Sleurink
- Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
- Department of Neuroscience, Erasmus MC, University Medical Centre Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Joséphine C Janssen
- Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
- Department of Neuroscience, Erasmus MC, University Medical Centre Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Bas P L Wijnhoven
- Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Johannes Jeekel
- Department of Neuroscience, Erasmus MC, University Medical Centre Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Markus Klimek
- Department of Anesthesiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
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Mondanaro JF, Sara GA, Thachil R, Pranjić M, Rossetti A, EunHye Sim G, Canga B, Harrison IB, Loewy JV. The Effects of Clinical Music Therapy on Resiliency in Adults Undergoing Infusion: A Randomized, Controlled Trial. J Pain Symptom Manage 2021; 61:1099-1108. [PMID: 33152443 DOI: 10.1016/j.jpainsymman.2020.10.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/18/2020] [Accepted: 10/27/2020] [Indexed: 01/10/2023]
Abstract
CONTEXT Eighty-seven patients newly diagnosed with lung, breast, or gastrointestinal cancer and undergoing chemotherapy in the infusion suite of a large urban hospital in New York City. OBJECTIVE Patients were enrolled in this study of music therapy's impact on resilience in coping with the impact of symptoms inclusive of symptom clustering. METHODS Patients were randomly assigned to three arms: clinical instrumental improvisation or clinical vocal improvisation 43 subjects to instrumental improvisation or vocal improvisation and 44 subjects to control. All subjects received a Medical Music Psychotherapy Assessment including psychosocial information and music preferences, pre-/post-Resilience Scale, Hospital Anxiety and Depression Scale, Visual Analogue Scale/Faces Scale, and a pain-Color Analysis Scale. Interventions included 20-minute music therapy (MT) and two additional sessions. RESULTS Significant increases in Resilience Scale in MT groups after treatment with instrumental and vocal MT interventions equally potent-reflect average changes of 3.4 and 4.83 (P = 0.625), respectively. Although Hospital Anxiety and Depression Scale scores showed little impact of MT on perceived anxiety/depression, a strong correlation is seen between vocal intervention and lower depression scores through Visual Analogue Scale-rendered postsessions. This yielded a significant decrease in pain levels immediately after MT, with the final session showing the most significant change in pain level. Resilience in enduring procedures is a necessary component of combating potential negative illness perception. CONCLUSION Our study shows MT's facility to propel resilience in patients newly diagnosed with cancer, particularly when promoting and pairing adaptation toward coping through the expression of perceived negative effects of emotional and physiological symptoms.
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Affiliation(s)
- John F Mondanaro
- The Louis Armstrong Department of Music Therapy, Mount Sinai Beth Israel, New York, New York, USA.
| | - Gabriel A Sara
- Infusion Suite at Mount Sinai West, Division of Hematology and Oncology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Roshni Thachil
- Stanford University School of Engineering, Stanford, California, USA
| | - Marija Pranjić
- Music and Health Science Research Collaboratory, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Rossetti
- Radiation Oncology Music Therapy Program, Louis Armstrong Center for Music and Medicine, Mount Sinai Beth Israel, New York, New York, USA
| | | | | | | | - Joanne V Loewy
- The Louis Armstrong Center for Music and Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Abstract
Objective: To assess and quantify the effect of perioperative music on medication requirement, length of stay and costs in adult surgical patients. Summary Background Data: There is an increasing interest in nonpharmacological interventions to decrease opioid analgesics use, as they have significant adverse effects and opioid prescription rates have reached epidemic proportions. Previous studies have reported beneficial outcomes of perioperative music. Methods: A systematic literature search of 8 databases was performed from inception date to January 7, 2019. Randomized controlled trials investigating the effect of perioperative music on medication requirement, length of stay or costs in adult surgical patients were eligible. Meta-analysis was performed using random effect models, pooled standardized mean differences (SMD) were calculated with 95% confidence intervals (CI). This study was registered with PROSPERO (CRD42018093140) and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Results: The literature search yielded 2414 articles, 55 studies (N = 4968 patients) were included. Perioperative music significantly reduced postoperative opioid requirement (pooled SMD −0.31 [95% CI −0.45 to −0.16], P < 0.001, I2 = 44.3, N = 1398). Perioperative music also significantly reduced intraoperative propofol (pooled SMD −0.72 [95% CI −1.01 to −0.43], P < 0.00001, I2 = 61.1, N = 554) and midazolam requirement (pooled SMD −1.07 [95% CI −1.70 to −0.44], P < 0.001, I2 = 73.1, N = 184), while achieving the same sedation level. No significant reduction in length of stay (pooled SMD −0.18 [95% CI −0.43 to 0.067], P = 0.15, I2 = 56.0, N = 600) was observed. Conclusions: Perioperative music can reduce opioid and sedative medication requirement, potentially improving patient outcome and reducing medical costs as higher opioid dosage is associated with an increased risk of adverse events and chronic opioid abuse.
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Nowak H, Zech N, Asmussen S, Rahmel T, Tryba M, Oprea G, Grause L, Schork K, Moeller M, Loeser J, Gyarmati K, Mittler C, Saller T, Zagler A, Lutz K, Adamzik M, Hansen E. Effect of therapeutic suggestions during general anaesthesia on postoperative pain and opioid use: multicentre randomised controlled trial. BMJ 2020; 371:m4284. [PMID: 33303476 PMCID: PMC7726311 DOI: 10.1136/bmj.m4284] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate the effect of therapeutic suggestions played to patients through earphones during surgery on postoperative pain and opioid use. DESIGN Blinded randomised controlled study. SETTING Five tertiary care hospitals in Germany. PARTICIPANTS 385 of 400 patients consecutively recruited from January to December 2018 who were to undergo surgery for 1-3 hours under general anaesthesia. In the per protocol analysis 191 patients were included in the intervention group and 194 patients in the control group. INTERVENTION The intervention comprised an audiotape of background music and positive suggestions based on hypnotherapeutic principles, which was played repeatedly for 20 minutes followed by 10 minutes of silence to patients through earphones during general anaesthesia. Patients in the control group were assigned to a blank tape. MAIN OUTCOME MEASURES The main outcome was dose of opioid administered by patient controlled analgesia or nurse controlled analgesia within the first postoperative 24 hours, based on regular evaluation of pain intensity on a numerical rating scale (range 0-10, with higher scores representing more severe pain). RESULTS Compared with the control group, the intervention group required a significantly (P=0.002) lower opioid dose within 24 hours after surgery, with a median of 4.0 mg (interquartile range 0-8) morphine equivalents versus 5.3 (2-12), and an effect size (Cohen's d) of 0.36 (95% confidence interval 0.16 to 0.56). The number of patients who needed opioids postoperatively was significantly (P=0.001) reduced in the intervention group: 121 of 191 (63%, 95% confidence interval 45% to 70%) patients in the intervention group versus 155 of 194 (80%, 74% to 85%) in the control group. The number needed to treat to avoid postoperative opioids was 6. Pain scores were consistently and significantly lower in the intervention group within 24 hours after surgery, with an average reduction of 25%. No adverse events were reported. CONCLUSIONS Therapeutic suggestions played through earphones during general anaesthesia could provide a safe, feasible, inexpensive, and non-drug technique to reduce postoperative pain and opioid use, with the potential for more general use. Based on the finding of intraoperative perception by a considerable number of patients, surgeons and anaesthetists should be careful about background noise and conversations during surgery. TRIAL REGISTRATION German Clinical Trial Register DRKS00013800.
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Affiliation(s)
- Hartmuth Nowak
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Germany
- Contributed equally
| | - Nina Zech
- Department of Anesthesiology, University Hospital Regensburg, University of Regensburg, Regensburg, Germany
- Contributed equally
| | - Sven Asmussen
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Germany
| | - Tim Rahmel
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Germany
| | - Michael Tryba
- Clinic for Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Kassel Hospital, Kassel, Germany
- Kassel School of Medicine, Kassel, Germany
| | - Guenther Oprea
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Germany
| | - Lisa Grause
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Germany
| | - Karin Schork
- Medizinisches Proteom-Center, Ruhr University Bochum, Bochum, Germany
| | | | - Johannes Loeser
- Department of Anesthesiology and Intensive Care Medicine, University Hospital, University of Cologne, Cologne, Germany
| | - Katharina Gyarmati
- Department of Anesthesiology and Intensive Care Medicine, University Hospital, University of Cologne, Cologne, Germany
| | - Corinna Mittler
- Department of Anesthesiology and Intensive Care Medicine, University Hospital, University of Cologne, Cologne, Germany
| | - Thomas Saller
- Department of Anaesthesiology, University Hospital, LMU Munich, Munich, Germany
| | - Alexandra Zagler
- Department of Anaesthesiology, University Hospital, LMU Munich, Munich, Germany
| | - Katrin Lutz
- Department of Anesthesiology, University Hospital Regensburg, University of Regensburg, Regensburg, Germany
| | - Michael Adamzik
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Germany
| | - Ernil Hansen
- Department of Anaesthesiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93042 Regensburg, Germany
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Gökçek E, Kaydu A. The effects of music therapy in patients undergoing septorhinoplasty surgery under general anesthesia. Braz J Otorhinolaryngol 2020; 86:419-426. [PMID: 31523022 PMCID: PMC9422617 DOI: 10.1016/j.bjorl.2019.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 12/06/2018] [Accepted: 01/10/2019] [Indexed: 02/08/2023] Open
Abstract
Introduction Music has been used for several years as a relaxation method to reduce stress and anxiety. It is a painless, safe, inexpensive and practical nonpharmacologic therapeutic modality, widely used all over the world. Objectives We aimed to evaluate the effect of music therapy on intraoperative awareness, patient satisfaction, awakening pain and waking quality in patients undergoing elective septorhinoplasty under general anesthesia. Methods This randomized, controlled, prospective study was conducted with 120 patients undergoing septorhinoplasty within a 2 months period. The patients were randomly selected and divided into two groups: group music (music during surgery) and control group (without music during surgery). All patients underwent standard general anesthesia. Patients aged 18–70 years who would undergo a planned surgery under general anesthesia were included. Patients who had emergency surgery, hearing or cognitive impairment, were excluded from the study. Results A total of 120 patients were enrolled, and separated into two groups. There were no statistically significant differences between the groups in terms of demographic characteristics, anesthesia and surgery durations (p > 0.05). In the music group, sedation agitation scores were lower than those in the control group at the postoperative period (3.76 ± 1.64 vs. 5.11 ± 2.13; p < 0.001). In addition; in patients of the music group, the pain level (2.73 ± 1.28 vs. 3.61 ± 1.40) was lower (p < 0.001), requiring less analgesic drugs intake. Conclusion Music therapy, which is a nonpharmacologic intervention, is an effective method, without side effects, leading to positive effects in the awakening, hemodynamic parameters and analgesic requirements in the postoperative period. It is also effective in reducing the anxiety and intraoperative awareness episodes of surgical patients.
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Hasanah I, Mulatsih S, Haryanti F, Haikal Z. Effect of music therapy on cortisol as a stress biomarker in children undergoing IV-line insertion. J Taibah Univ Med Sci 2020; 15:238-243. [PMID: 32647520 PMCID: PMC7336003 DOI: 10.1016/j.jtumed.2020.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/11/2020] [Accepted: 03/15/2020] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE An IV-line insertion can often provoke stress that can lead to an increase in cortisol levels. Complementary medication such as music therapy is needed to overcome the increase in cortisol levels. We conducted this study to determine the effect of music therapy on salivary cortisol levels in children with leukaemia undergoing IV-line insertion. METHOD This was a pre-experimental study with a pre- and post-test design. We analysed the salivary cortisol levels in 30 children with leukaemia undergoing IV-Line insertion from January until February 2018. Music was played using earphones after the completion of the IV-line insertion procedure. The salivary cortisol levels were analysed by an enzyme-linked immunosorbent assay (ELISA) test. Changes in cortisol levels were considered clinically significant if the differences were ≥0.05 ng/ml. The Wilcoxon test was used to test the effect of music therapy on cortisol levels and a p-value of <0.05 was considered statistically significant. RESULT Levels of cortisol before and after the music therapy had a median (min-max) of 4.14 (0.25-9.89) and 3.47 (0.16-15.31), respectively. The median difference of cortisol levels was 0.67 ng/ml. This change of ≥0.05 ng/ml indicates the clinical effect of music therapy on cortisol levels. Though the music therapy did not significantly affect salivary cortisol levels (p = 0.99), this study revealed the clinical effect of music therapy in reducing cortisol levels. CONCLUSIONS This study did not indicate a statistically significant effect of music therapy on cortisol levels of children with leukaemia during an IV-line insertion. However, the study findings reflect the clinical effect of music therapy in reducing cortisol levels.
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Affiliation(s)
- Idyatul Hasanah
- Department of Nursing, Mataram Institute of Health Science, Mataram, Indonesia
| | - Sri Mulatsih
- Department of Hematology and Oncology Paediatrics, Paediatric Department, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Fitri Haryanti
- Department of Paediatric Nursing, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Zikrul Haikal
- Faculty of Medicine, Universitas Mataram, Mataram, Indonesia
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The Effects of Music on the Life Signs of Patients in the Reanimation Unit/Recovery Room After Laparoscopic Cholecystectomy. Holist Nurs Pract 2019; 33:295-302. [DOI: 10.1097/hnp.0000000000000344] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ernsten L, Hepp P, Fehm T, Schaal NK. [Perioperative music-induced analgesia : Comparison of the effect of music on pain between preoperative, intraoperative and postoperative application]. Schmerz 2019; 33:100-105. [PMID: 30411138 DOI: 10.1007/s00482-018-0338-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Despite suitable analgesia procedures and interventions only approximately 24% of inpatients with strong to very strong pain receive adequate treatment. Besides opioids, which are associated with numerous side effects and risks, non-pharmacological approaches are increasingly being used. In this context, one of the oldest known methods are music interventions; however, the state of evidence is heterogeneous and there are no explicit manuals and recommendations for the effective implementation of music interventions. OBJECTIVE This review aimed to determine the optimal time point at which perioperative music interventions can most effectively relieve pain. MATERIAL AND METHODS A PubMed search was conducted and publications investigating the effect of music during the preoperative, intraoperative and postoperative stages of various interventions were identified. RESULTS During the preoperative phase, only positive effects of music on pain relief have been reported but availability of data is sparse. During the intraoperative stage of a medical intervention the effect of music seems to be mediated by the type of anesthesia procedure and sedation depth. Only patients who can consciously perceive the music seem to profit from it. Positive alleviating effects on subjective pain perception and analgesia needs were shown in the postoperative stage. CONCLUSION Music is a non-pharmacological method to alleviate pain, which is free of side effects. Important considerations for the use of music interventions for relief of acute pain associated with surgery are discussed taking into account numerous mediating factors, which influence the efficacy of the treatment.
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Affiliation(s)
- L Ernsten
- Institut für Experimentelle Psychologie, Heinrich-Heine-Universität, Universitätsstraße 1, 40225, Düsseldorf, Deutschland
| | - P Hepp
- Landesfrauenklinik, Helios Universitätsklinikum Wuppertal, Universität Witten-Herdecke, Wuppertal, Deutschland
| | - T Fehm
- Universitätsfrauenklinik, Heinrich-Heine-Universität, Düsseldorf, Deutschland
| | - N K Schaal
- Institut für Experimentelle Psychologie, Heinrich-Heine-Universität, Universitätsstraße 1, 40225, Düsseldorf, Deutschland.
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The Effect of Perioperative Music on the Stress Response to Surgery: A Meta-analysis. J Surg Res 2019; 244:444-455. [PMID: 31326711 DOI: 10.1016/j.jss.2019.06.052] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 04/15/2019] [Accepted: 06/14/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Current perioperative patient care aims to maintain homeostasis by attenuation of the stress response to surgery, as a more vigorous stress response can have detrimental effects on postoperative recovery. This systematic review and meta-analysis aims to assess the effect of perioperative music on the physiological stress response to surgery. METHODS The Embase, Medline Ovid, Cochrane Central, Web of Science, and Google Scholar databases were searched from inception date until February 5, 2019, using a systematic literature search following the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines for randomized controlled trials investigating the effect of music before, during, and/or after surgery in adult surgical patients on the stress response to surgery. Meta-analysis was performed using a random effects model and pooled standardized mean differences were calculated with 95% confidence intervals. This study was registered in the PROSPERO database (CRD42018097060). RESULTS The literature search identified 1076 articles. Eighteen studies (1301 patients) were included in the systematic review, of which eight were included in the meta-analysis. Perioperative music attenuated the neuroendocrine cortisol stress response to surgery (pooled standardized mean difference -0.30, [95% confidence interval -0.53 to -0.07], P = 0.01, I2 = 0). CONCLUSIONS Perioperative music can attenuate the neuroendocrine stress response to surgery.
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Khan SH, Kitsis M, Golovyan D, Wang S, Chlan LL, Boustani M, Khan BA. Effects of music intervention on inflammatory markers in critically ill and post-operative patients: A systematic review of the literature. Heart Lung 2018; 47:489-496. [PMID: 30001799 DOI: 10.1016/j.hrtlng.2018.05.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 05/18/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Music listening has been shown to reduce anxiety, stress, and patient tolerance of procedures. Music may also have beneficial effects on inflammatory biomarkers in intensive care and post-operative patients, but the quality of evidence is not clear. OBJECTIVES We conducted a systematic review to evaluate the effects of music on inflammatory biomarkers in intensive care, and post-operative patients. METHODS A comprehensive search of the literature was performed. After screening 1570 references, full text review of 26 studies was performed. Fourteen studies were selected for inclusion. RESULTS Seven studies showed a significant decrease in cortisol levels, but the level of evidence was low. Three studies had low risk of methodological bias, while 11 studies had high risk of bias. CONCLUSIONS Music intervention may decrease cortisol levels, but other biomarkers remain unchanged. Given the low level of evidence, further research on music effects on inflammatory biomarkers is needed.
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Affiliation(s)
- Sikandar H Khan
- Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Indiana University School of Medicine, Indianapolis, IN.
| | - Michelle Kitsis
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Dmitriy Golovyan
- Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Sophia Wang
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN
| | - Linda L Chlan
- Department of Nursing, Nursing Research Division, Mayo Clinic, Rochester, MN
| | - Malaz Boustani
- Indiana University Center of Health Innovation and Implementation Science, Indianapolis, IN; IU Center of Aging Research, Regenstrief Institute, Indianapolis, IN; Sandra Eskenazi Center for Brain Care Innovation, Eskenazi Hospital, Indianapolis, IN; Division of Geriatrics and General Internal Medicine, Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN; Indiana Clinical and Translational Research Institute, Indiana University School of Medicine, Indianapolis, Indiana
| | - Babar A Khan
- Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Indiana University School of Medicine, Indianapolis, IN; Indiana University Center of Health Innovation and Implementation Science, Indianapolis, IN; Indiana Clinical and Translational Research Institute, Indiana University School of Medicine, Indianapolis, Indiana
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Finn S, Fancourt D. The biological impact of listening to music in clinical and nonclinical settings: A systematic review. PROGRESS IN BRAIN RESEARCH 2018; 237:173-200. [PMID: 29779734 DOI: 10.1016/bs.pbr.2018.03.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
This systematic review explored the evidence base on the impact of listening to music on biological response in both clinical and nonclinical settings. Human studies exploring the effects of listening to recorded music on biological markers were included. Studies had to involve a non-music control condition. Keyword searches were carried out of five major databases (Cochrane/Wiley, PsycINFO, PubMed, Sage, and Science Direct) and bias was assessed using the Cochrane Risk of Bias Tool for Randomized Studies (RoB 2.0). Forty-four studies assessing the biological impact of music listening were identified: 27 in clinical settings and 17 in nonclinical settings. Eighty-two percent had examined the effects of short-term listening interventions, while the remainder had looked at longitudinal interventions. Thirteen of 33 biomarkers tested were reported to change in response to listening to music. The most commonly analyzed biomarker was the stress hormone cortisol, with half of clinical studies demonstrating a stress-reducing effect of music listening. Blood glucose was also found repeatedly to reduce in response to music listening. Many of the other biomarkers analyzed are also part of biological stress pathways, which suggests that the primary way by which music listening affects us biologically is via modulations of stress response. Effects were shown irrespective of genre, self-selection of the music, or duration of listening, although a majority did use classical music. The evidence base for understanding biological responses to music is still developing, but there is support for the application of listening to music, especially within clinical settings for stress reduction.
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Affiliation(s)
- Saoirse Finn
- Centre for Performance Science, Royal College of Music, London, United Kingdom
| | - Daisy Fancourt
- Department of Behavioural Science and Health, University College London, London, United Kingdom.
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Kahloul M, Mhamdi S, Nakhli MS, Sfeyhi AN, Azzaza M, Chaouch A, Naija W. Effects of music therapy under general anesthesia in patients undergoing abdominal surgery. Libyan J Med 2018; 12:1260886. [PMID: 28452603 PMCID: PMC5328375 DOI: 10.1080/19932820.2017.1260886] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Music therapy, an innovative approach that has proven effectiveness in many medical conditions, seems beneficial also in managing surgical patients. The aim of this study is to evaluate its effects, under general anesthesia, on perioperative patient satisfaction, stress, pain, and awareness. METHODS This is a prospective, randomized, double-blind study conducted in the operating theatre of visceral surgery at Sahloul Teaching Hospital over a period of 4 months. Patients aged more than 18 undergoing a scheduled surgery under general anesthesia were included. Patients undergoing urgent surgery or presenting hearing or cognitive disorders were excluded. Before induction, patients wore headphones linked to an MP3 player. They were randomly allocated into 2 groups: Group M (with music during surgery) and group C (without music). Hemodynamic parameters, quality of arousal, pain experienced, patient's satisfaction, and awareness incidence during anesthesia were recorded. RESULTS One hundred and forty patients were included and allocated into 2 groups that were comparable in demographic characteristics, surgical intervention type and anesthesia duration. Comparison of these two groups regarding the hemodynamic profile found more stability in group M for systolic arterial blood pressure. A calm recovery was more often noted in group M (77.1% versus 44%, p < 10-3). The average Visual Analog Scale (VAS) score was lower in the intervention group (33.8 ± 13.63 versus 45.1 ± 16.2; p < 10-3). The satisfaction rate was significantly higher among the experimental group (81.4% versus 51.4%; p < 10-3). The incidence of intraoperative awareness was higher in group C (8 cases versus 3 cases) but the difference was not statistically significant. CONCLUSION Music therapy is a non-pharmacological, inexpensive, and non-invasive technique that can significantly enhance patient satisfaction and decrease patients' embarrassing experiences related to perioperative stress, pain, and awareness.
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Affiliation(s)
- Mohamed Kahloul
- a Department of Anesthesia and Intensive Care, Teaching Hospital of Sahloul , University of Medicine Ibn Jazzar , Sousse , Tunisia
| | - Salah Mhamdi
- a Department of Anesthesia and Intensive Care, Teaching Hospital of Sahloul , University of Medicine Ibn Jazzar , Sousse , Tunisia
| | - Mohamed Said Nakhli
- a Department of Anesthesia and Intensive Care, Teaching Hospital of Sahloul , University of Medicine Ibn Jazzar , Sousse , Tunisia
| | - Ahmed Nadhir Sfeyhi
- a Department of Anesthesia and Intensive Care, Teaching Hospital of Sahloul , University of Medicine Ibn Jazzar , Sousse , Tunisia
| | - Mohamed Azzaza
- b Department of Abdominal Surgery, Teaching Hospital of Sahloul , University of Medicine Ibn Jazzar , Sousse , Tunisia
| | - Ajmi Chaouch
- a Department of Anesthesia and Intensive Care, Teaching Hospital of Sahloul , University of Medicine Ibn Jazzar , Sousse , Tunisia
| | - Walid Naija
- a Department of Anesthesia and Intensive Care, Teaching Hospital of Sahloul , University of Medicine Ibn Jazzar , Sousse , Tunisia
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Doğan Bakı E, Ulu Ş, Yüksek A, Arıcan H, Sıvacı R. Does Listening to Music during Tonsillectomy Affect Sevoflurane Consumption? Med Princ Pract 2018; 27. [PMID: 29529606 PMCID: PMC6170909 DOI: 10.1159/000488319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate the effect of listening to music on the consumption of an anesthetic agent as well as postoperative recovery and pain in children undergoing elective tonsillectomy. MATERIALS AND METHODS Fifty patients were randomized into those to whom music was played during surgery (group M) and a control group to whom music was not played (group C). The depth of anesthesia was provided by entropy levels of 50 ± 5 in both groups. Demographic characteristics and hemodynamic parameters were recorded perioperatively. The duration of surgery, sevoflurane consumption, eye opening time, and extubation time were also recorded. p < 0.05 was considered statistically significant. RESULTS Surgical pleth index values measured intraoperatively were statistically lower in group M than in group C. In the postanesthesia care unit children in the music group felt less pain than those in the control group according to the Wong-Baker Faces Pain Rating Scale (p = 0.035). The heart rates of the patients in the music group were statistically lower at 30 min intraoperatively and at the end of the procedure compared to the values of the control group (p = 0.015). The consumption of sevoflurane was lower in group M than in group C but the difference was not statistically significant. The need for additional fentanyl was significantly lower in group M than in group C. CONCLUSION In this study, the children exposed to music intraoperatively needed less analgesia during surgery, and reported less pain postoperatively, but there was no difference in sevoflurane requirements.
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Affiliation(s)
- Elif Doğan Bakı
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Afyyon Kocatepe University, Afyonkarahisar, Turkey
- *Elif Doğan Baki, Anesthesiology and Reanimation Department, Faculty of Medicine, Afyon Kocatepe University, 2078th street, No. 3–4, TR-03200 Afyonkarahisar (Turkey),
| | - Şahin Ulu
- Department of Otolaryngology, Faculty of Medicine, Afyyon Kocatepe University, Afyonkarahisar, Turkey
| | - Ahmet Yüksek
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Afyyon Kocatepe University, Afyonkarahisar, Turkey
| | - Hüseyin Arıcan
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Afyyon Kocatepe University, Afyonkarahisar, Turkey
| | - Remziye Sıvacı
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Afyyon Kocatepe University, Afyonkarahisar, Turkey
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Multimodal Approaches to Analgesia in Enhanced Recovery After Surgery Pathways. Int Anesthesiol Clin 2017; 55:51-69. [DOI: 10.1097/aia.0000000000000165] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Lee JH. The Effects of Music on Pain: A Meta-Analysis. J Music Ther 2016; 53:430-477. [PMID: 27760797 DOI: 10.1093/jmt/thw012] [Citation(s) in RCA: 143] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 09/18/2016] [Accepted: 09/19/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Numerous meta-analyses have been conducted on the topic of music and pain, with the latest comprehensive study published in 2006. Since that time, more than 70 randomized controlled trials (RCTs) have been published, necessitating a new and comprehensive review. OBJECTIVE The aim of this meta-analysis was to examine published RCT studies investigating the effect of music on pain. METHODS The present study included RCTs published between 1995 and 2014. Studies were obtained by searching 12 databases and hand-searching related journals and reference lists. Main outcomes were pain intensity, emotional distress from pain, vital signs, and amount of analgesic intake. Study quality was evaluated according to the Cochrane Collaboration guidelines. RESULTS Analysis of the 97 included studies revealed that music interventions had statistically significant effects in decreasing pain on 0-10 pain scales (MD = -1.13), other pain scales (SMD = -0.39), emotional distress from pain (MD = -10.83), anesthetic use (SMD = -0.56), opioid intake (SMD = -0.24), non-opioid intake (SMD = -0.54), heart rate (MD = -4.25), systolic blood pressure (MD = -3.34), diastolic blood pressure (MD = -1.18), and respiration rate (MD = -1.46). Subgroup and moderator analyses yielded additional clinically informative outcomes. CONCLUSIONS Considering all the possible benefits, music interventions may provide an effective complementary approach for the relief of acute, procedural, and cancer/chronic pain in the medical setting.
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Effects of music on sedation depth and sedative use during pediatric dental procedures. J Clin Anesth 2016; 34:647-53. [PMID: 27687464 DOI: 10.1016/j.jclinane.2016.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 06/16/2016] [Accepted: 07/06/2016] [Indexed: 11/20/2022]
Abstract
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.
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Abstract
OBJECTIVES The aim of the study was to assess the effect of art including ambient features such as music, interior design including visual art, and architectural features on health outcomes in surgical patients. BACKGROUND Healing environments can have a positive influence on many patients, but data focusing on art in surgical patients remain scarce. METHODS We conducted a systematic search following the PRISMA guidelines from January 2000 to October 2014 on art in surgical patients. For music interventions, we pooled controlled studies measuring health outcomes (eg, pain, anxiety, blood pressure, and heart rate) in a meta-analysis. For other art forms (ambient and architectural features and interior design), we did a narrative review, also including nonsurgical patients, and looked for examples covering 3 countries. RESULTS Our search identified 1101 hits with 48 studies focusing on art in surgical patients: 47 studies on musical intervention and 1 on sunlight. The meta-analysis of these studies disclosed significant effects for music on pain after surgery, anxiety, systolic blood pressure, and heart rate, when compared with control groups without music. Effects of music were larger with self-selected music, and lower in surgical interventions performed under general anesthesia. Interior design features such as nature images and more spacious rooms, and architectural features providing more sunlight had positive effects on anxiety and postoperative pain. CONCLUSIONS Self-selected music for surgical patients is an effective and low-cost intervention to enhance well being and possibly faster recovery. Although potentially very important, the impact of environmental features and spacious architecture with wide access to sunlight remains poorly explored in surgery. Further experimental research is needed to better assess the magnitude of the impact and cost effectiveness.
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Calcaterra V, Ostuni S, Bonomelli I, Mencherini S, Brunero M, Zambaiti E, Mannarino S, Larizza D, Albertini R, Tinelli C, Pelizzo G. Music benefits on postoperative distress and pain in pediatric day care surgery. Pediatr Rep 2014; 6:5534. [PMID: 25635217 PMCID: PMC4292057 DOI: 10.4081/pr.2014.5534] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Revised: 08/01/2014] [Accepted: 08/06/2014] [Indexed: 11/23/2022] Open
Abstract
Postoperative effect of music listening has not been established in pediatric age. Response on postoperative distress and pain in pediatric day care surgery has been evaluated. Forty-two children were enrolled. Patients were randomly assigned to the music-group (music intervention during awakening period) or the non-music group (standard postoperative care). Slow and fast classical music and pauses were recorded and played via ambient speakers. Heart rate, blood pressure, oxygen saturation, glucose and cortisol levels, faces pain scale and Face, Legs, Activity, Cry, Consolability (FLACC) Pain Scale were considered as indicators of response to stress and pain experience. Music during awakening induced lower increase of systolic and diastolic blood pressure levels. The non-music group showed progressive increasing values of glycemia; in music-group the curve of glycemia presented a plateau pattern (P<0.001). Positive impact on reactions to pain was noted using the FLACC scale. Music improves cardiovascular parameters, stress-induced hyperglycemia. Amelioration on pain perception is more evident in older children. Positive effects seems to be achieved by the alternation of fast, slow rhythms and pauses even in pediatric age.
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Affiliation(s)
- Valeria Calcaterra
- Department of the Mother and Child Health, Pediatric Unit, IRCCS Policlinic San Matteo Foundation, Pavia; ; Department of Internal Medicine, University of Pavia ; Pavia, Italy
| | - Selene Ostuni
- Department of the Mother and Child Health, Pediatric Surgery Unit, IRCCS Policlinic San Matteo Foundation and University of Pavia ; Pavia, Italy
| | - Irene Bonomelli
- Department of the Mother and Child Health, Pediatric Unit, IRCCS Policlinic San Matteo Foundation, Pavia
| | | | - Marco Brunero
- Department of the Mother and Child Health, Pediatric Surgery Unit, IRCCS Policlinic San Matteo Foundation and University of Pavia ; Pavia, Italy
| | - Elisa Zambaiti
- Department of the Mother and Child Health, Pediatric Surgery Unit, IRCCS Policlinic San Matteo Foundation and University of Pavia ; Pavia, Italy
| | - Savina Mannarino
- Department of the Mother and Child Health, Pediatric Unit, IRCCS Policlinic San Matteo Foundation, Pavia
| | - Daniela Larizza
- Department of the Mother and Child Health, Pediatric Unit, IRCCS Policlinic San Matteo Foundation, Pavia; ; Department of Internal Medicine, University of Pavia ; Pavia, Italy
| | | | - Carmine Tinelli
- Biometry and Clinical Epidemiology, Scientific Direction, IRCCS Policlinic San Matteo Foundation , Pavia, Italy
| | - Gloria Pelizzo
- Department of the Mother and Child Health, Pediatric Surgery Unit, IRCCS Policlinic San Matteo Foundation and University of Pavia ; Pavia, Italy
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Fancourt D, Ockelford A, Belai A. The psychoneuroimmunological effects of music: a systematic review and a new model. Brain Behav Immun 2014; 36:15-26. [PMID: 24157429 DOI: 10.1016/j.bbi.2013.10.014] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 10/09/2013] [Accepted: 10/15/2013] [Indexed: 12/17/2022] Open
Abstract
There has been a growing interest over the past decade into the health benefits of music, in particular examining its psychological and neurological effects. Yet this is the first attempt to systematically review publications on the psychoneuroimmunology of music. Of the selected sixty-three studies published over the past 22 years, a range of effects of music on neurotransmitters, hormones, cytokines, lymphocytes, vital signs and immunoglobulins as well as psychological assessments are cataloged. Research so far points to the pivotal role of stress pathways in linking music to an immune response. However, several challenges to this research are noted: (1) there is very little discussion on the possible mechanisms by which music is achieving its neurological and immunological impact; (2) the studies tend to examine biomarkers in isolation, without taking into consideration the interaction of the biomarkers in question with other physiological or metabolic activities of the body, leading to an unclear understanding of the impact that music may be having; (3) terms are not being defined clearly enough, such as distinctions not being made between different kinds of stress and 'music' being used to encompass a broad spectrum of activities without determining which aspects of musical engagement are responsible for alterations in biomarkers. In light of this, a new model is presented which provides a framework for developing a taxonomy of musical and stress-related variables in research design, and tracing the broad pathways that are involved in its influence on the body.
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Affiliation(s)
- Daisy Fancourt
- Department of Life Sciences, Roehampton University, London, United Kingdom; Applied Music Research Centre, Roehampton University, London, United Kingdom; Centre for Performance Science, Royal College of Music, London, United Kingdom.
| | - Adam Ockelford
- Applied Music Research Centre, Roehampton University, London, United Kingdom
| | - Abi Belai
- Department of Life Sciences, Roehampton University, London, United Kingdom
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GRAVERSEN M, SOMMER T. Perioperative music may reduce pain and fatigue in patients undergoing laparoscopic cholecystectomy. Acta Anaesthesiol Scand 2013; 57:1010-6. [PMID: 23496006 DOI: 10.1111/aas.12100] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2013] [Indexed: 01/06/2023]
Abstract
BACKGROUND Acute post-operative pain is a predictor in the development of chronic pain after laparoscopic cholecystectomy. Music has been shown to reduce surgical stress. In a randomized, clinical trial, we wanted to test the hypothesis that perioperative and post-operative soft music reduces pain, nausea, fatigue and surgical stress in patients undergoing laparoscopic cholecystectomy as day surgery. METHOD The study was performed in otherwise healthy Danish patients eligible for day surgery. Ninety-three patients were included and randomized to either soft music or no music perioperatively and post-operatively. Using visual analog score pain, nausea and fatigue at baseline, 1 h, 3 h, 1 day and 7 days after surgery were recorded. C-reactive protein and cortisol were sampled before and after surgery. RESULTS Music did not lower pain 3 h after surgery, which was the main outcome. The music group had less pain day 7 (P = 0.014). Nausea was low in both groups and was not affected by music. The music group experienced less fatigue at day 1 (P = 0.042) and day 7 (P = 0.015). Cortisol levels decreased during surgery in the music group (428.5-348.0 nmol/l), while it increased in the non-music group (443.5-512.0 nmol/l); still, the difference between the two groups were only significant using general linear models as post-hoc analysis. Soft music did not affect C-reactive protein levels. CONCLUSION Soft music did not reduce pain 3 h after laparoscopic cholecystectomy. Soft music may reduce later post-operative pain and fatigue by decreasing the surgical stress response.
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Affiliation(s)
- M. GRAVERSEN
- Department of Surgery; Randers Region Hospital; Randers; Denmark
| | - T. SOMMER
- Department of Surgery; Randers Region Hospital; Randers; Denmark
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Zengin S, Kabul S, Al B, Sarcan E, Doğan M, Yildirim C. Effects of music therapy on pain and anxiety in patients undergoing port catheter placement procedure. Complement Ther Med 2013; 21:689-96. [PMID: 24280479 DOI: 10.1016/j.ctim.2013.08.017] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 07/31/2013] [Accepted: 08/23/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Patients scheduled to invasive medical procedures experience high levels of anxiety, which may lead to increased perceptions of pain and vital sign instability throughout. AIMS To examine the effect of a music intervention (MI) on stress hormones, physiologic parameters, pain, and anxiety state before and during port catheter placement procedures (PCPPs). METHODS We conducted a prospective, randomized, controlled study in 100 oncology patients, who were randomly assigned to an MI group (n=50) or a control group (n=50). The effects of music were assessed by determination of serum cortisol and adrenocorticotropic hormone (ACTH) levels, heart and respiratory rate (HR, RR) and systolic and diastolic blood pressure (SBP, DBP), on arrival in the surgical intervention room, as well as immediately prior to and immediately after the PCPP, in both groups. Furthermore, pain and anxiety levels were identified using visual analogue scale and state-trait anxiety inventory scales. RESULTS On arrival, there were no differences between the patients in terms of serum cortisol and ACTH levels, HR, RR, SBP, DBP and anxiety levels. There were significant reductions in hormone levels (p<0.05 for all), HR (p<0.001), RR (p<0.001), SBP (p<0.05) and DBP (p<0.05), immediately prior to and immediately after the PCPP in participants in the MI group compared to those in the control group. Furthermore, music led to a significant reduction in pain (p<0.05) and anxiety scores (p<0.05) in the MI group compared to control group. CONCLUSION During invasive medical procedures, MI significantly decreases stress hormone levels, physiological parameters, acute procedural pain and anxiety.
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Affiliation(s)
- Suat Zengin
- Department of Emergency, Gaziantep University, Medical School, Gaziantep, Turkey.
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Thoma MV, La Marca R, Brönnimann R, Finkel L, Ehlert U, Nater UM. The effect of music on the human stress response. PLoS One 2013; 8:e70156. [PMID: 23940541 PMCID: PMC3734071 DOI: 10.1371/journal.pone.0070156] [Citation(s) in RCA: 139] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 06/20/2013] [Indexed: 11/18/2022] Open
Abstract
Background Music listening has been suggested to beneficially impact health via stress-reducing effects. However, the existing literature presents itself with a limited number of investigations and with discrepancies in reported findings that may result from methodological shortcomings (e.g. small sample size, no valid stressor). It was the aim of the current study to address this gap in knowledge and overcome previous shortcomings by thoroughly examining music effects across endocrine, autonomic, cognitive, and emotional domains of the human stress response. Methods Sixty healthy female volunteers (mean age = 25 years) were exposed to a standardized psychosocial stress test after having been randomly assigned to one of three different conditions prior to the stress test: 1) relaxing music (‘Miserere’, Allegri) (RM), 2) sound of rippling water (SW), and 3) rest without acoustic stimulation (R). Salivary cortisol and salivary alpha-amylase (sAA), heart rate (HR), respiratory sinus arrhythmia (RSA), subjective stress perception and anxiety were repeatedly assessed in all subjects. We hypothesized that listening to RM prior to the stress test, compared to SW or R would result in a decreased stress response across all measured parameters. Results The three conditions significantly differed regarding cortisol response (p = 0.025) to the stressor, with highest concentrations in the RM and lowest in the SW condition. After the stressor, sAA (p=0.026) baseline values were reached considerably faster in the RM group than in the R group. HR and psychological measures did not significantly differ between groups. Conclusion Our findings indicate that music listening impacted the psychobiological stress system. Listening to music prior to a standardized stressor predominantly affected the autonomic nervous system (in terms of a faster recovery), and to a lesser degree the endocrine and psychological stress response. These findings may help better understanding the beneficial effects of music on the human body.
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Affiliation(s)
- Myriam V. Thoma
- Department of Psychology, Brandeis University, Waltham, Massachusetts, United States of America
- Clinical Psychology & Psychotherapy, University of Zürich, Zürich, Switzerland
| | - Roberto La Marca
- Clinical Psychology & Psychotherapy, University of Zürich, Zürich, Switzerland
| | - Rebecca Brönnimann
- Clinical Psychology & Psychotherapy, University of Zürich, Zürich, Switzerland
| | - Linda Finkel
- Clinical Psychology & Psychotherapy, University of Zürich, Zürich, Switzerland
| | - Ulrike Ehlert
- Clinical Psychology & Psychotherapy, University of Zürich, Zürich, Switzerland
| | - Urs M. Nater
- Clinical Biopsychology, University of Marburg, Marburg, Germany
- * E-mail:
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Goetz B, Benhaqi P, Müller MH, Kreis ME, Kasparek MS. Changes in beta-adrenergic neurotransmission during postoperative ileus in rat circular jejunal muscle. Neurogastroenterol Motil 2013; 25:154-e84. [PMID: 23009554 DOI: 10.1111/nmo.12020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND To explore postoperative changes in β-adrenergic neurotransmission that participate in pathophysiology of postoperative ileus. METHODS Contractile activity of circular jejunal muscle strips was studied. Groups (n = 6/group) were: naïve controls, sham controls 1 and 7 days after laparotomy, and rats 12 h, 1, 3, and 7 days after laparotomy with standardized small bowel manipulation (postoperative ileus). Dose-responses to the β-agonist isoprenaline (3 × 10(-10) - 10(-7) mol L(-1)) were studied in presence/absence of tetrodotoxin (global neural blockade; 10(-6) mol L(-1) ), N6-(1-iminoethyl)-l-lysine (inhibition of inducible nitric oxide synthesis; 10(-4) mol L(-1)), nimesulide (cyclooxygenase-2 inhibition; 10(-5) mol L(-1)), or propranolol (β-blockade; 5 × 10(-6) mol L(-1)). Histochemistry for inflammatory cells and intestinal transit were studied. KEY RESULTS Intramural inflammation and delayed transit (postoperative ileus) occurred only in ileus groups. The inhibitory potential of isoprenaline decreased in all postoperative groups including sham (P < 0.05). Tetrodotoxin enhanced isoprenaline-induced inhibition in ileus and sham groups (P < 0.05). N6-(1-iminoethyl)-l-lysine and nimesulide decreased isoprenaline-induced inhibition in ileus groups 12 h, 1, and 7 days, and in sham controls 7 days postoperatively (P < 0.05). Propranolol prevented isoprenaline effects in all groups (P < 0.05). CONCLUSIONS & INFERENCES Inhibitory effects of isoprenaline on contractile activity were decreased for 7 days postoperatively. Changes in β-adrenergic neurotransmission do not induce postoperative ileus and appear to be caused by anesthesia and laparotomy rather than bowel manipulation.
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Affiliation(s)
- B Goetz
- Walter Brendel Center of Experimental Medicine, Munich, Germany
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Matsota P, Christodoulopoulou T, Smyrnioti ME, Pandazi A, Kanellopoulos I, Koursoumi E, Karamanis P, Kostopanagiotou G. Music's use for anesthesia and analgesia. J Altern Complement Med 2012; 19:298-307. [PMID: 22989077 DOI: 10.1089/acm.2010.0235] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
This review article provides an overview of published data regarding the involvement of music in anesthesia practice. Music is an important topic for research in different fields of anesthesiology. The use of music preoperatively is aimed at reducing anxiety, stress, and fear. However, the effect of music on perception of pain intraoperatively is controversial, according to studies of both adults and children undergoing various surgical procedures under general and/or regional anesthesia. In postoperative pain management, postanesthesia care, and neonatal intensive care, music can be a complementary method for reducing pain, anxiety, and stress. Music is a mild anxiolytic, but it is relatively ineffective when a pain stimulus is severe. However, music is inexpensive, easily administered, and free of adverse effects, and as such, can serve as complementary method for treating perioperative stress and for acute and chronic pain management, even though music's effectiveness depends on each individual patient's disposition and severity of pain stimulus.
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Affiliation(s)
- Paraskevi Matsota
- 2 nd Department of Anesthesiology, University of Athens School of Medicine, Attikon University Hospital, Chaidari, Athens, Greece.
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Li Y, Dong Y. Preoperative music intervention for patients undergoing cesarean delivery. Int J Gynaecol Obstet 2012; 119:81-3. [DOI: 10.1016/j.ijgo.2012.05.017] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Revised: 05/02/2012] [Accepted: 06/21/2012] [Indexed: 11/30/2022]
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Good M, Albert JM, Arafah B, Anderson GC, Wotman S, Cong X, Lane D, Ahn S. Effects on postoperative salivary cortisol of relaxation/music and patient teaching about pain management. Biol Res Nurs 2012; 15:318-29. [PMID: 22472905 DOI: 10.1177/1099800411431301] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The physiological and psychological stress of surgery and postoperative pain can leave patients more susceptible to infection and complications. The present study was designed to determine whether two interventions, patient teaching (PT) for pain management and relaxation/music (RM), reduced cortisol levels, an indicator of stress, following abdominal surgery. Patients (18-75 years) were randomly assigned to receive PT, RM, a combination of the two, or usual care; the 205 patients with both pre- and posttest cortisol values were analyzed. A 2 × 2 factorial design was used to compare groups for PT effects and RM effects. Stress was measured by salivary cortisol before and after 20-min tests of the interventions in the morning and afternoon of postoperative Day 2. Saliva was stimulated with lemon juice and analyzed with high-sensitivity salivary cortisol enzyme immunoassay. Comparisons using analysis of covariance (ANCOVA), controlling for baseline levels, showed no PT effect or RM effect on cortisol in the morning or afternoon. Post hoc ANCOVA showed no significant effects when intervention groups were compared to the control group. Although in previous studies, RM reduced pain and music reduced cortisol on Day 1, in the present study the cortisol response to surgery was not attenuated by PT or RM on Day 2. The RM intervention can be used for pain but needs to be further tested for effects on plasma cortisol in abdominal surgery patients on their first postoperative day.
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Affiliation(s)
- Marion Good
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH 44106, USA.
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Drahota A, Ward D, Mackenzie H, Stores R, Higgins B, Gal D, Dean TP. Sensory environment on health-related outcomes of hospital patients. Cochrane Database Syst Rev 2012; 2012:CD005315. [PMID: 22419308 PMCID: PMC6464891 DOI: 10.1002/14651858.cd005315.pub2] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Hospital environments have recently received renewed interest, with considerable investments into building and renovating healthcare estates. Understanding the effectiveness of environmental interventions is important for resource utilisation and providing quality care. OBJECTIVES To assess the effect of hospital environments on adult patient health-related outcomes. SEARCH METHODS We searched: the Cochrane Central Register of Controlled Trials (last searched January 2006); MEDLINE (1902 to December 2006); EMBASE (January 1980 to February 2006); 14 other databases covering health, psychology, and the built environment; reference lists; and organisation websites. This review is currently being updated (MEDLINE last search October 2010), see Studies awaiting classification. SELECTION CRITERIA Randomised and non-randomised controlled trials, controlled before-and-after studies, and interrupted times series of environmental interventions in adult hospital patients reporting health-related outcomes. DATA COLLECTION AND ANALYSIS Two review authors independently undertook data extraction and 'Risk of bias' assessment. We contacted authors to obtain missing information. For continuous variables, we calculated a mean difference (MD) or standardized mean difference (SMD), and 95% confidence intervals (CI) for each study. For dichotomous variables, we calculated a risk ratio (RR) with 95% confidence intervals (95% CI). When appropriate, we used a random-effects model of meta-analysis. Heterogeneity was explored qualitatively and quantitatively based on risk of bias, case mix, hospital visit characteristics, and country of study. MAIN RESULTS Overall, 102 studies have been included in this review. Interventions explored were: 'positive distracters', to include aromas (two studies), audiovisual distractions (five studies), decoration (one study), and music (85 studies); interventions to reduce environmental stressors through physical changes, to include air quality (three studies), bedroom type (one study), flooring (two studies), furniture and furnishings (one study), lighting (one study), and temperature (one study); and multifaceted interventions (two studies). We did not find any studies meeting the inclusion criteria to evaluate: art, access to nature for example, through hospital gardens, atriums, flowers, and plants, ceilings, interventions to reduce hospital noise, patient controls, technologies, way-finding aids, or the provision of windows. Overall, it appears that music may improve patient-reported outcomes such as anxiety; however, the benefit for physiological outcomes, and medication consumption has less support. There are few studies to support or refute the implementation of physical changes, and except for air quality, the included studies demonstrated that physical changes to the hospital environment at least did no harm. AUTHORS' CONCLUSIONS Music may improve patient-reported outcomes in certain circumstances, so support for this relatively inexpensive intervention may be justified. For some environmental interventions, well designed research studies have yet to take place.
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Affiliation(s)
- Amy Drahota
- UK Cochrane Centre, National Institute for Health Research, Oxford, UK.
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Cervellin G, Lippi G. From music-beat to heart-beat: a journey in the complex interactions between music, brain and heart. Eur J Intern Med 2011; 22:371-4. [PMID: 21767754 DOI: 10.1016/j.ejim.2011.02.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Revised: 02/14/2011] [Accepted: 02/21/2011] [Indexed: 10/18/2022]
Abstract
Although the potential influence of music in eliciting organic reactions has been appreciated since the ancient Assyrian and Greek cultures, its relationship with body responses has been believed for long to belong to the field of magic. Growing experimental evidence now attests that some kind of music might indeed modulate several cardiac and neurological functions, as well as trigger biochemical measurable stress-reducing effects in certain individuals, mostly depending on their subjective musical education. On this basis, music has been increasingly used as a therapeutic tool in the treatment of different diseases in healthy and ill subjects over recent years (e.g., the so called "Mozart effect"), although the underlying scientific background is still poorly understood. The aim of this article is to review the current scientific evidences about the complex and multifaceted interactions between music and human biology.
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Affiliation(s)
- Gianfranco Cervellin
- U.O. Pronto Soccorso e Medicina d'Urgenza, Dipartimento di Emergenza-Urgenza, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
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Koelsch S, Fuermetz J, Sack U, Bauer K, Hohenadel M, Wiegel M, Kaisers UX, Heinke W. Effects of Music Listening on Cortisol Levels and Propofol Consumption during Spinal Anesthesia. Front Psychol 2011; 2:58. [PMID: 21716581 PMCID: PMC3110826 DOI: 10.3389/fpsyg.2011.00058] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2011] [Accepted: 03/24/2011] [Indexed: 01/01/2023] Open
Abstract
Background: This study explores effects of instrumental music on the hormonal system (as indicated by serum cortisol and adrenocorticotropic hormone), the immune system (as indicated by immunoglobulin A) and sedative drug requirements during surgery (elective total hip joint replacement under spinal anesthesia with light sedation). This is the first study investigating this issue with a double-blind design using instrumental music. Methodology/Principal Findings: Patients (n = 40) were randomly assigned either to a music group (listening to instrumental music), or to a control group (listening to a non-musical placebo stimulus). Both groups listened to the auditory stimulus about 2 h before, and during the entire intra-operative period (during the intra-operative light sedation, subjects were able to respond lethargically to verbal commands). Results indicate that, during surgery, patients of the music group had a lower propofol consumption, and lower cortisol levels, compared to the control group. Conclusion/Significance: Our data show that listening to music during surgery under regional anesthesia has effects on cortisol levels (reflecting stress-reducing effects) and reduces sedative requirements to reach light sedation.
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Affiliation(s)
- Stefan Koelsch
- Cluster of Excellence "Languages of Emotion," Freie Universität Berlin Berlin, Germany
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Kim SJ, Oh YJ, Kim KJ, Kwak YL, Na S. The Effect of Recorded Maternal Voice on Perioperative Anxiety and Emergence in Children. Anaesth Intensive Care 2010; 38:1064-9. [DOI: 10.1177/0310057x1003800617] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study was performed to test if hearing a recorded maternal voice reduces anxiety, emergence agitation and anaesthetic requirements in children. With written informed consent, children scheduled for cardiac catheterisation under intravenous ketamine anaesthesia and their mothers (n=46) were randomly assigned to either the mother-voice (MV) or control group. While the MV group (n=23) listened via headphones to a recording of their mothers’ voices during the perioperative period, the control group (n=23) wore headphones with no auditory stimulation. Ketamine requirements and haemodynamics were recorded. Anxiety of the patients and the parents were measured before and after the procedure with the modified Yale preoperative anxiety scale and Spielberger's State-Trait Anxiety Inventory, respectively. Emergence agitation was graded. The demographic and haemodynamic data were comparable, except for a longer procedure time in the MV group. Mothers’ State-Trait Anxiety Inventory was not different preoperatively between the groups. Mothers’ state and trait anxiety was lower after the procedure in the MV group compared with the preoperative values. In the control group only maternal state anxiety was diminished after the procedure. There was no significant group difference with respect to ketamine requirement (5.1±1.9 mg vs 4.9±1.6 mg, P=0.645). The anxiety score of children was lower in the MV group before the procedure (modified Yale preoperative anxiety scale score 35±12 vs 28±9, P=0.038), but there was no significant difference postoperatively. Emergence agitation was attenuated in the MV group (P=0.005).
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Affiliation(s)
- S. J. Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Assistant Professor, Department of Music Therapy, Graduate School of Social Education, Myongji University
| | - Y. J. Oh
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - K. J. Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Y.-L. Kwak
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - S. Na
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Lu Y, Liu M, Shi S, Jiang H, Yang L, Liu X, Zhang Q, Pan F. Effects of stress in early life on immune functions in rats with asthma and the effects of music therapy. J Asthma 2010; 47:526-31. [PMID: 20560827 DOI: 10.3109/02770901003801964] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Although studies have shown that psychological stress has detrimental effects on bronchial asthma, there are few objective data on whether early-life stress, as early postnatal psychosocial environment, has a long-lasting effect on adult asthma and the potential pathophysiologic mechanism. This study aims to examine the effects on immune function and hypothalamic-pituitary-adrenal (HPA) axis responses in adult asthmatic rats that experienced stress in early life and the potential ameliorative effects of music therapy on these parameters. METHODS Forty male Wistar rat pups were randomly assigned to the asthma group, the adulthood-stressed asthma group, the childhood-stressed asthma group, the music group, and the control group. Restraint stress and Mozart's Sonata K.448 were applied to ovalbumin (OVA)-induced asthmatic rats to establish psychological stress and music therapy models. The levels of serum corticosterone were examined in both childhood after stress and adulthood after OVA challenge. Immune indicators in blood, lung, and brain tissues were measured after the last OVA challenge. RESULTS Stress in both childhood and adulthood resulted in increases in leukocyte and eosinophil numbers and serum interleukin (IL)-4 levels. The adulthood-stressed group demonstrated increased corticosterone levels after challenge, whereas the childhood-stressed group showed increased corticosterone concentration in childhood but decreased level in adulthood. Central IL-1beta exhibited a similar tendency. Music group rats showed reduced serum IL-4 and corticosterone. CONCLUSIONS Stress in childhood and adulthood resulted in different HPA axis responsiveness in the exacerbation of markers of asthma. These data provide the first evidence of the long-term normalizing effects of music on asthmatic rats.
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Affiliation(s)
- Yanxia Lu
- Institute of Medical Psychology, Shandong University School of Medicine, Jinan, Shandong, P. R. China
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Ebneshahidi A, Mohseni M. The Effect of Patient-Selected Music on Early Postoperative Pain, Anxiety, and Hemodynamic Profile in Cesarean Section Surgery. J Altern Complement Med 2008; 14:827-31. [DOI: 10.1089/acm.2007.0752] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Masood Mohseni
- Department of Anesthesiology, Sadi Hospital, Isfahan, Iran
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Arai YCP, Sakakibara S, Ito A, Ohshima K, Sakakibara T, Nishi T, Hibino S, Niwa S, Kuniyoshi K. Intra-operative natural sound decreases salivary amylase activity of patients undergoing inguinal hernia repair under epidural anesthesia. Acta Anaesthesiol Scand 2008; 52:987-90. [PMID: 18477078 DOI: 10.1111/j.1399-6576.2008.01649.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The perioperative period is psychologically as well as physically stressful for patients. Although music and sound are known to reduce patients' psychological stress, a few previous studies showed an objective outcome of music. The aim of the present study was to evaluate the relaxing effect of music during epidural anesthesia, using patients' salivary amylase activity. METHODS Thirty-two American Society of Anesthesiologists (ASA) I or II patients presenting for inguinal hernia repair under epidural anesthesia were randomly assigned to listen to sounds of a soft wind and a twitter (S group) or to have no sounds (N group). Patients' salivary amylase activity was evaluated on arrival to the operating room and at wound closure. RESULTS Intra-operative music significantly decreased salivary amylase activity at wound closure in the S group and the activity at wound closure of the S group was significantly smaller than that of the N group. CONCLUSION Intra-operative natural sound significantly decreased salivary amylase activity of patients undergoing inguinal hernia repair under epidural anesthesia.
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Affiliation(s)
- Y-C P Arai
- Multidisciplinary Pain Centre, Aichi Medical University, School of Medicine, Aichi, Japan.
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Listening to Music During Anesthesia Does Not Reduce the Sevoflurane Concentration Needed to Maintain a Constant Bispectral Index. Anesth Analg 2008; 107:77-80. [DOI: 10.1213/ane.0b013e3181733e16] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Oehmke MJ, Podranski T, Mann M, Frickey N, Kuhn DFM, Hempelmann G. Perioperative concentrations of catecholamines in the cerebrospinal fluid and plasma during spinal anesthesia. Acta Anaesthesiol Scand 2008; 52:487-92. [PMID: 18339154 DOI: 10.1111/j.1399-6576.2007.01551.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Catecholamine release is a physiological response to stress. The extent to which perioperative stress provokes the central release of catecholamines, which modulate pain perception in the spinal cord, still remains unknown. The perioperative course of catecholamine concentrations in the cerebrospinal fluid (CSF) and plasma was examined. METHODS A prospective study was performed in 25 patients (ASA III, 60-84 years) undergoing elective hip joint replacement in spinal catheter anesthesia. The concentrations of dopamine, epinephrine and norepinephrine in the CSF and plasma were measured before anesthesia, immediately after surgery, and 6 and 24 h post-operatively. RESULTS In most patients, dopamine and epinephrine were not detectable in CSF. CSF-norepinephrine concentrations decreased from median [interquartile-range] 159 [124;216] pre-anesthesia to 116 [79;152] pmol/l immediately post-operatively and were slightly elevated 24 h post-operatively (180 [134;302] pmol/l) (P=0.05). Dopamine plasma concentrations were not detectable or were barely above the detection threshold. Plasma epinephrine increased from 61 [28;77] pmol/l pre-anesthesia to 112 [69;138] pmol/l 6 h post-operatively and returned to baseline 24 h post-operatively (P=0.001). Plasma norepinephrine concentrations increased intra-operatively from 298 [249;422] to 556 [423;649] pmol/l and remained elevated 24 h after surgery (P=0.009). There was no association between changes in CSF or plasma norepinephrine or epinephrine concentrations and changes in heart rate (HR) or mean arterial pressure (MAP). CONCLUSION During spinal anesthesia for elective hip joint replacement, norepinephrine concentrations were greater in plasma than in CSF. CSF dopamine and epinephrine concentrations were essentially undetectable. The changes in CSF-norepinephrine concentrations and the changes of plasma norepinephrine concentrations showed no association with each other; nor were there correlations between clinical stress parameters (HR, MAP) or visual analog scale pain, and the changes in CSF norepinephrine concentrations.
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Affiliation(s)
- M J Oehmke
- Department of Special Anaesthesia and Pain Control, Medical University of Vienna, Vienna, Austria
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Abstract
BACKGROUND Music has been used for therapeutic purposes since the beginning of cultural history. However, despite numerous descriptions of beneficial effects, the precise mechanisms by which music may improve human well-being remain unclear. METHODS We conducted a randomized study in ten critically ill patients to identify mechanisms of music-induced relaxation using a special selection of slow movements of Mozart's piano sonatas. These sonatas were analyzed for compositional elements of relaxation. We measured circulatory variables, brain electrical activity, serum levels of stress hormones and cytokines, requirements for sedative drugs, and level of sedation before and at the end of a 1-hr therapeutic session. RESULTS Compared with controls, we found that music application significantly reduced the amount of sedative drugs needed to achieve a comparable degree of sedation. Simultaneously, among those receiving the music intervention, plasma concentrations of growth hormone increased, whereas those of interleukin-6 and epinephrine decreased. The reduction in systemic stress hormone levels was associated with a significantly lower blood pressure and heart rate. CONCLUSION Based on the effects of slow movements of Mozart's piano sonatas, we propose a neurohumoral pathway by which music might exert its sedative action. This model includes an interaction of the hypothalamic-pituitary axis with the adrenal medulla via mediators of the unspecific immune system
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Abstract
Two well-recognised, but inherently reductionist, relations between medicine and music are the attempted neuro-scientific understanding of responses to music and interest in music's contributions to clinical therapy. This paper proposes a third relation whereby music is seen as an organising metaphor for clinical medicine as a practice. Both music and clinical medicine affirm human well-being, and both do this inter alia through varieties of skilful, crafted yet spontaneous mutual engagement between a 'performer' and an 'audience'. I argue that this organising metaphor offers a corrective to the reductionist influences of the first two relations, illuminates a number of medicine's important features, and reaffirms the existential as being at the core of medicine's telos.
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Affiliation(s)
- H M Evans
- Centre for Arts and Humanities in Health and Medicine, Durham University, Room 323 Dawson Building, Science Site, South Road, Durham, DH1 3LE, UK.
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Abstract
This paper is the 27th consecutive installment of the annual review of research concerning the endogenous opioid system, now spanning over 30 years of research. It summarizes papers published during 2004 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides, opioid receptors, opioid agonists and opioid antagonists. The particular topics that continue to be covered include the molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors related to behavior, and the roles of these opioid peptides and receptors in pain and analgesia; stress and social status; tolerance and dependence; learning and memory; eating and drinking; alcohol and drugs of abuse; sexual activity and hormones, pregnancy, development and endocrinology; mental illness and mood; seizures and neurologic disorders; electrical-related activity and neurophysiology; general activity and locomotion; gastrointestinal, renal and hepatic functions; cardiovascular responses; respiration and thermoregulation; and immunological responses.
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, Flushing, NY 11367, USA.
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Zhang XW, Fan Y, Manyande A, Tian YK, Yin P. Effects of music on target-controlled infusion of propofol requirements during combined spinal-epidural anaesthesia. Anaesthesia 2005; 60:990-4. [PMID: 16179044 DOI: 10.1111/j.1365-2044.2005.04299.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The sedative effects of music were evaluated using the bispectral index (BIS) during target-controlled infusion (TCI) propofol. A total of 110 women undergoing hysterectomy were randomly allocated to receive either music or no music. Propofol was administered using target-controlled infusion and the concentration adjusted gradually to achieve an observer's assessment of alertness/sedation (OAA/S) score of 3 intra-operatively. The haemodynamic and bispectral index values during the sedation phase were recorded. Interleukin-6 was evaluated before, immediately after and 1 h following intervention. The music group had a significant reduction in mean (SD) induction time of sedation: 12 (12) min vs. 18 (12) min, p < 0.01; propofol target concentration: 1.6 (0.3) microg.ml(-1) vs. 2.4 (0.4) microg.ml(-1), p < 0.0001; intra-operative amount of propofol: 171 (98) mg vs. 251 (92) mg, p < 0.0001; and significantly higher levels of satisfaction with their peri-operative care: 9.6 (0.6) compared to the control group: 8.1 (1.0), p < 0.0001. No other differences were found. The results show the influence of music on the induction time of sedation, concentration and level of propofol during surgery, and suggest sedative benefits of music.
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Affiliation(s)
- X W Zhang
- Department of Anaesthesiology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Guétin S, Ginies P, Blayac JP, Eledjam JJ. Une nouvelle technique contrôlée de musicothérapie dans la prise en charge des douleurs viscérales aiguës et chroniques. ACTA ACUST UNITED AC 2005. [DOI: 10.1007/bf03014561] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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