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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 17  |  Issue : 3  |  Page : 552-556

The efficacy of music therapy in lowering intraoperative sedative requirement and recall of intraoperative processes by patients under spinal anesthesia


Department of Anaesthesiology, AVBRH, Jawaharlal Nehru Medical College, Wardha, Maharashtra, India

Date of Submission30-Apr-2022
Date of Decision28-Jul-2022
Date of Acceptance04-Aug-2022
Date of Web Publication2-Nov-2022

Correspondence Address:
Dr. Monika Sharma
Department of Anaesthesiology, AVBRH, Jawaharlal Nehru Medical College, Sawangi, Meghe, Wardha, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_180_22

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  Abstract 


Background: This music therapy was found to be a potent and efficient means of strategy for the treatment of illness in all the health aspects. It modifies the normal body's flight and fight response to stress during surgeries. It is a unique approach for relieving patients, making them stress-free without any means of side effects. Methods: This prospective comparative observational study includes a total of 50 cases, randomly assigned in 2 sets of 25 each in age (20–60 years), lower abdomen, urinary complaints related to surgeries, etc. under spinal blockade. These patients were assigned randomly to Group M (music group) and Group C (nonmusic group). Midazolam was given for sedation in both the groups with the aim to achieve Observer's Assessment Sedation/Alertness Score (OAS)-3 or less and to calculate and compare midazolam (total dose) requirement. After giving spinal to the patient and achieving desired levels, the patients were given headphones and the music was set up n music group patients. Basic vitals and requirements (total sedative) during surgery were recorded and then compared between the two groups. The ability of the patient to recall intraoperative events after surgery was also calculated by 6-point questionnaire, and for assessing pain severity, the visual analog scale score method was used. Results: We have found that intraoperatively, midazolam requirement (total) was found to be very low in the patients who listened music (P < 0.01), the OAS score was better in the music group, and the systolic and diastolic blood pressure and pulse rate may be comparable in both the groups. Conversations between doctors/nurses, OT staff during surgery, and monitors sound, instruments, etc., were more significantly recalled by a group of people who do not listen to music intraoperatively. Conclusion: Our study concluded that the use of intraoperative music in patients under spinal anesthesia can be demanding therapy by reducing patient's requirement of medication, needed for sedating them and relieving pain. This helps in creating an effective, safe method for patient's overall satisfaction.

Keywords: Intraoperative sedation, midazolam, music therapy, recall of intraoperative processes, spinal anesthesia


How to cite this article:
Chandak A, Sharma M, Chandak V C, Ninave S. The efficacy of music therapy in lowering intraoperative sedative requirement and recall of intraoperative processes by patients under spinal anesthesia. J Datta Meghe Inst Med Sci Univ 2022;17:552-6

How to cite this URL:
Chandak A, Sharma M, Chandak V C, Ninave S. The efficacy of music therapy in lowering intraoperative sedative requirement and recall of intraoperative processes by patients under spinal anesthesia. J Datta Meghe Inst Med Sci Univ [serial online] 2022 [cited 2023 Feb 4];17:552-6. Available from: http://www.journaldmims.com/text.asp?2022/17/3/552/360184




  Introduction Top


This phase of perioperative period is a constant source of the fear and anxiety stress for the patient.[1] Various surgeries performed under spinal anesthesia possess a major task from anesthesia point of view, as the patient is in awake state during surgery and expose to different stimulus like visual and auditory.[2]

These anti-anxiety and sedation-causing drugs therefore given to patients frequently before and intraoperative, for relaxing them, major drawback is the compromise of function of the central nervous system and cardio-respiratory system.[3],[4]

Patients who are operated under regional anesthesia are especially in the need of sedation mostly during the operative period. The main purpose of sedation is to provide comfort, care, and hemodynamic stability to the patients. However, these adverse effects, such as respiratory depression, nausea, and vomiting, make this optimal satisfaction of the patient to be difficult to achieve.[5]

Thus, the search for producing effective patient's outcome during intraoperative period has led to the evaluation of the (music therapy, improving patient's recovery. This music therapy exerts its effects on our human mind in most efficient and positive way which could be possible. At the level of our neural system, this music role is executed, regulating deep-stressful emotions, autonomic nervous system. It calms the body and mind, acting as an energy booster. Endorphins are basically released in our body when we listen to music, thus altering the pain perception stimulus; this mechanism results in reducing sensitivity to pain and midazolam (analgesia dose) demand.

These interconnections at the level of neurons connecting the auditory mechanism and limbic system modify the response to deep emotions. This neural interconnection (hypothalamus, RAS) activation results in the release of excitatory neurotransmitters, providing relaxation and music sedation effect.[6]

Music therapy has been used during various minor procedures, in intensive care unit settings, labor rooms, etc., to reduce stress and the anxiety levels, incidence of pain complaint by the patients.

Therefore, the motive of this study was to know about patients who are undergoing surgery under spinal anesthesia, while listening music intraoperatively and really need a lower dose of sedatives intraoperative. Whether relaxing music therapy is a useful alternative to midazolam for pre-medication before surgery, and whether there is decrease in recall of intra-operative events after surgery.


  Methods Top


After getting clearance from the local ethical committee and taking patients' written inform consent, ASA status I and II, 50 patients divided into study group and the control group, undergoing elective lower abdominal surgery under spinal anesthesia, age group not less than 20 years and not more than 60 years were enrolled for the study. Patients having contraindication related to spinal blockade, with hearing impairment, or known psychiatric/memory disorder were not included in the study.

OpenEpi method was used for sample size calculation

Power (P) at 80%

Confidence interval at 95% (α = 0.05 and β = 0.90)

Twenty-five patients were required per study group, all patients received a preoperative counseling on the nature of the study and the procedure involved.

Procedure

The patients were randomly allocated on the day of the surgery, using the lottery method to Group M, who would listen to music (headphones applied) and Group C who are not interested in listening music.

Any anxiety, voluntary sedation demand by the patient, (Observer's Assessment Sedation [OAS] score), blood pressure (BP), pulse rate noted. Group C was given sedative (Midazolam) 1 mg, 1 h before shifting patient to Operation room whereas to Group M music was applied – (1 h) duration.

Operation theater room: In all the patients' IV access secured, routine monitor attached to the patient. Pulse rate, noninvasive BP, sedation level parameters noted on basis of (OAS score), at 5 min, 10 min till end of surgery.

During surgery-(total dose) midazolam, duration of surgery (total), pain/anxiety, any complaints by the patient, etc., noted. The patient was administered spinal anesthesia with bupivacaine (0.5%) (heavy), doses: −3.2–3.5ml, level achieve-T10. Then, headphones were applied to all the patients.

In Group M, according to the patient's choice music was started, and accordingly, the volume was also adjusted to consist of the classical, folk or religious/meditational category, calm and soothing music having slow beats.

Music with fast

Beats or rhythms are known to cause more excitement and anxiety, and hence, it was avoided.

In Group C, occlusive headphones were applied to eliminate ambient noise, but no music was started.

Fast or noisy beats/rhythms cause more excitement and anxiety to the patient, so it was avoided.

In Group C, music was not started; only occlusive headphones were applied to the patients to eliminate noise.

Five questions in the questionnaire were used to assess patients recalling capacity of operation theater events. For the assessment of pain in relation to sedation during surgery or any discomfort visual analog scale (VAS) scale was used.

Collection of study variables: (a) patient's data-(Age/Sex, Qualification, ASA status, interest in listening to music), (b) Complaint of anxiety (any) before/during operation, (c) request by patient for giving sedative before and during operation, (d) OAS/Alertness Score at 5 min to 10 min time interval, (e) total doses of Midazolam intraoperative, (f) VAS Scores, (g) assessment of responses by 5-point questionnaire method.

Statistical analysis

Statistical analysis was done using SPSS 25.0 version and collected data were analyzed using this version. These data in the form of mean and standard deviation or numbers and percentages (%) were interpreted. Chi-square test/Fisher's exact test was used as appropriate test for making comparison among study groups. P = 95% confidence interval P = 0.05 (level of significance), power analysis:- (α = 0.05 and β = 0.90), keeping power at 80% –25 patients in each study group are needed for assessing intraoperative midazolam doses: observer assessment sedation/alertness score (OAS score) at 30 min after arrival in operation room [Figure 1], [Figure 2], [Figure 3].
Figure 1: Postintervention data

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Figure 2: Baseline demographic data and vitals comparison

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Figure 3: Demographic data and vitals comparison

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  Ethical clearance Top


The Institutional Ethics Committee of DMIMSDU has approved the Research work proposed to be carried out at Jawaharlal Nehru Medical College, Sawangi(M), Wardha. Date : 1st August 2019 with Reference no DMIMS(DU)/IEC/2019-20/126.


  Results Top


OAS/alertness score was calculated at interval of 30 min is as shown in [Table 1], between the two groups no statistical difference was seen. Only significant difference was observed at the arrival of patient in operation room. Patients in C group-more alert as compared to the M group. When OAS score calculated at 60 and 90 min in control group were (2.9 ± 0.8, 3.1 ± 0.5) respectively, were significantly lower (P value less than 0.01). Among patients Chances of being awake or be alert at time interval of 30 min from coming in operating room found to be (30%) more overall in (M) music group and higher in those receiving only Midazolam-at 90 min was 45% and at 120 min, was 40% In both the groups Score for pain at the time of surgery was 0, For assessing any pain during surgery VAS Score in the C group was 0.4 ± 1.57 while in M group: -0.14 ± 0.4, (P > 0.01).
Table 1: Postintervention data

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On comparing recall of intraoperative processes among patients, the Music (M) group had 60% more chance of not able to recall these intra-operative processes like - talks, intraoperative when compared to the control group. Recall of machines. monitors, instruments sounds,(C) control group able to remember only few statements/words (surely yes) as compared to the Music (M) group, who were very few to recall intraoperative events.

0 = could not recall 1 = able to recall

A total of 50 patients, divided into-(Control Group [C] = 25, Music Group [M] = 25), elective cases were enrolled in this study. The effect of spinal anesthesia was achieved up to mark in all 50 patients. Patient; s variables and surgery-related data do not show any major difference in both the groups [Table 2]. Variables were comparable (P > 0.01).
Table 2: Baseline demographic data and vitals comparison

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The dose requirement of midazolam needed in the control group was higher 2.7 ± 0.52 mg as compared to the music group 0.9 ± 0.34, this difference was statistically major (P < 0.01).


  Discussion Top


Music therapy has rewarding effects in the sleep mechanisms of our body, using music during surgery is helpful for both patient and OT room.[7]

In our study, we found very less requirements of the midazolam (sedation) were needed for reaching up to mark level in the study group and this finding was similar to the findings of Caroline-Lepage et al.stdy. “Brain entrainment” Mechanism (cortical evoked response) is the proposed theory showing the effect of music as a sedative on our body and mind. Electrical waveforms are generated in our brain in response to an outside stimulus.[8]

Change in our mental state according to the moment result in the changes in our brain wave frequencies. Two different sounds which are too different from each other, does not make sense to the brain and therefore will not be having any altered effect on the brain waves.[9] Jin –Gu-Kang suggested a mechanism for effective sedation by inhibiting the transmission of noise rather than blocking music action.

In our study, operating room noises were blocked, headphones were applied in the C (Control group) patients were provided music of their choice-three types namely instrumental, folk, or spiritual.

Observer's assessment of sedation/alertness score was concluded as the best choice for a more accurate assessment of sedation level (OAS score) was found far greater than 3 (100%) in the (C) group Compared to the (M) group (76.6%), when the patient arrived in OT room.

Patients in the control group were almost 100% in awake state, it could be because of the use of constant 1 mg dose for all the patients we have selected. OAS score graph showed that effect of sedative in music group took more time to act (after 60 min). However, it was maintained for prolong duration as compared to (C) group at 60 min, 90-120 min.

The analysis of recall of intraoperative process by the 5-point questionnaire method between the 2 study groups. We observed that I. V cannula, spinal needle prick, all these procedures happened little early and complete loss of memory lacking in patients because of not appropriate sedative (drug) levels at this point of time.

Inability to recall the talks held by doctors, among staff/nurses during surgery, operating room noises by machines, monitors etc., in the music group was far better as compared to the control group. When two different number of signals are transmitted together to the ear, then it becomes difficult for the ear to differentiate between two signals-(Masking).[10],[11] Hence, even if the patients in the{ music group} during surgery is not in (deep plane of sedation), because of this “Masking” phenomenon patients who are listening to music, will not be able to remember conversations and noise arising from monitors, machines, instruments, etc.


  Conclusion Top


Our study concluded that patients hearing music through headphones during surgery under regional anesthesia need a lower dose of midazolam during surgery and also decrease in the ability to remember events during surgery. Thus, it results in an effective mode of anesthesia in patients under spinal. Hence, the provision of listening to music is an effective tool in music-loving patients, during short-duration surgeries.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Myskja A, Lindbaek M. How does music affect the human body? Tidsskr Nor Laegeforen 2000;120:1182-5.  Back to cited text no. 1
    
2.
Kari Christiansen: The History of Music Therapy. Available from: http://www.creative exchange music.com. [Last accessed on 2021 Dec 11].  Back to cited text no. 2
    
3.
Byers JF, Smyth KA. Effect of a music intervention on noise annoyance, heart rate, and blood pressure in cardiac surgery patients. Am J Crit Care 1997;6:183-91.  Back to cited text no. 3
    
4.
Good M, Stanton-Hicks M, Grass JA, Cranston Anderson G, Choi C, Schoolmeesters LJ, et al. Relief of postoperative pain with jaw relaxation, music and their combination. Pain 1999;81:163-72.  Back to cited text no. 4
    
5.
Allred KD, Byers JF, Sole ML. The effect of music on postoperative pain and anxiety. Pain Manag Nurs 2010;11:15-25.  Back to cited text no. 5
    
6.
Nilsson U, Rawal N, Uneståhl LE, Zetterberg C, Unosson M. Improved recovery after music and therapeutic suggestions during general anaesthesia: A double-blind randomised controlled trial. Acta Anaesthesiol Scand 2001;45:812-7.  Back to cited text no. 6
    
7.
Aldridge D. The music of the body: Music therapy in medical settings. Advances 1993;9:17-35.  Back to cited text no. 7
    
8.
Premendran B, Dongre H, Domkondwar U. The efficacy of music in lowering intraoperative sedation requirement and recall of intraoperative process. IOSR J Pharm 2012; 2: 569-78.  Back to cited text no. 8
    
9.
Wiley BM. Brain Entrainment:– The Science Behind Meditation Music.  Back to cited text no. 9
    
10.
Hodge B, Thompson JF. Noise pollution in the operating theatre. Lancet 1990;335:891-4.  Back to cited text no. 10
    
11.
Shankar N, Malhotra KL, Ahuja S, Tandon OP. Noise pollution: A study of noise levels in the operation theatres of a general hospital during various surgical procedures. J Indian Med Assoc 2001;99:244, 246-7.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2]



 

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