American Society of Regional Anesthesia and Pain Medicine May 2017 - 27
Role of Music in the Perioperative Setting
P
atients often feel anxious
during their planned
surgical procedure and
anesthetic with apprehensions
about their overall outcome
and postoperative pain
control.1,2 These feelings
can adversely affect their
perioperative experience,
elevate their stress markers,
cause various fluctuations
in their hemodynamics,
Veena Graff, MD, MS
and could negatively
Department of Anesthesiology
impact their postoperative
and Critical Care
recovery.3 Pharmacologic
University of Pennsylvania Perelman
agents, such as short-acting
School of Medicine
benzodiazepines and opioids,
University of Pennsylvania Health System
are commonly used to ease
Philadelphia, Pennsylvania
patients' anxiety and pain
perioperatively. However,
Section Editor: Melanie Donnelly, MD
patients can have significant
side effects, which may limit the use of these medications and, in
some instances, prevent their use. Therefore, music can be a very
desirable nonpharmacologic alternative that is relatively cheap,
with virtually no side effects.
MUSIC MEDICINE VERSUS MUSIC THERAPY
There is a distinction between two terms that are commonly
misused: "music medicine" and "music therapy." Music medicine
is defined as the passive listening to prerecorded music that may
be offered by medical personnel.
Headphones are commonly used when
listening to music, and it may involve
patient choice when selecting the type
of music. In contrast, music therapy
involves the "clinical and evidencebased use of music interventions
to accomplish individualized goals
within a therapeutic relationship by a
credentialed professional who has completed an approved music
therapy program."4,5 Therefore, when referring to patients listening
to music via headphones in the perioperative period, music
medicine is the correct terminology to be used. It is also important
to clarify that when referring to music medicine in the perioperative
setting, this does not refer to music being played out loud in the
operating room theater.
numerous studies have been conducted to show that passively
listening to music via headphones can be beneficial throughout
each phase of the perioperative setting.
In the preoperative setting, it can be used either as an adjuvant or
replace anxiolytics.3,6-8 This can be especially beneficial in patients
who may be very sensitive to intravenous anxiolytics and for
patients who do not report a significant amount of anxiety.
In the intraoperative setting, it can be highly desirable while
undergoing conscious sedation and/or regional anesthesia
by reducing a patient's overall medication consumption for
sedation and/or analgesia and improving a patient's comfort and
satisfaction.9-14 For example, a common reason that patients may
refuse regional anesthetics is simply because they do not want to
"hear" their surroundings.15,16 Therefore, the anesthesia provider
may administer deep sedation in conjunction with the regional
anesthetic or the patient may refuse regional anesthetics entirely,
which is listed as one of the absolute contraindications. As a result,
these decisions may unfortunately lead to unnecessary use of deep
sedation or general anesthetics when regional anesthetics are
suitable or safer to conduct. In scenarios like this, a simple solution
to minimize a patient's fear of hearing their surroundings would
be to place a pair of headphones and allow the patient to listen to
music during the intraoperative setting.
During general anesthesia, limited studies have shown any
reduction or changes in inhalational or IV anesthetics when
listening to music.17-20 Both explicit and implicit memory of auditory
stimuli is highly unlikely especially when minimum alveolar
concentration levels exceed 0.5,
which could explain why the
anesthetic depth may not change.
However, auditory signals are quite
resistant to both intravenous and
inhalational anesthetics; therefore,
there is a potential that auditory
stimuli can alter the neurocognitive
responses to surgery.20
Nevertheless, music can still be beneficial during the induction and
emergence periods by keeping the patient relaxed and preventing
him or her from listening to ambient noise and conversations that
may be recalled due to these lighter states of anesthetic periods.
"Music can be a very desirable
nonpharmacologic alternative
that is relatively cheap, with
virtually no side effects."
WHAT ROLE CAN MUSIC PLAY IN THE PERIOPERATIVE SETTING?
Music is a safe, noninvasive adjuvant that can positively
complement the overall perioperative experience for a patient
during one of the most important, sometimes life-changing,
stressful periods in his or her life. In the last few decades,
Finally, listening to music in the postoperative period can
reduce acute medication consumption, help relax patients, and
improve overall satisfaction. It can be beneficial in the immediate
postoperative period and in subsequent days (Figure 1).21-24
WHAT TYPE OF MUSIC SHOULD PATIENTS LISTEN TO?
Patients can choose their musical preference when music medicine
is involved. However, there are certain genres of music and
American Society of Regional Anesthesia and Pain Medicine
2017
27
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