Effects of Music on Anesthetic Consumption

It has long been known that music has positive effects on mood and anxiety and doctors have recently examined whether music played during surgery can provide a better surgical experience for patients [1]. Music during surgery is split into two groups: music medicine and music therapy [1]. Music medicine is when a patient has music played for them during surgery, typically of their own choice [1]. In contrast, music therapy is when a trained music therapist provides live or recorded music to a patient in surgery [1]. Many patients experience anxiety before surgery and this may complicate the induction of anesthesia; therefore, it is common to provide sedatives before general anesthesia [1]. However, these sedatives may cause negative side effects such as drowsiness and breathing difficulties and may interact with anesthetic drugs therefore prolonging recovery [1]. A review of 26 studies found that music listening may lower levels of preoperative anxiety by an average of 5.72 units (95% CI ‐7.27 to ‐4.17, P < 0.00001)  

[1]. Wang et al (2002) found that patients who had music medicine during surgery reported lower levels of trait anxiety than those in a control group who received no music [2]. Patients who listened to music of their choice when having surgery with spinal anesthesia required less midazolam to achieve the same reduced level of anxiety than patients who were not listening to music [3]. This meant that the patients who heard music during surgery required less sedation than those who did not hear music. 

Music not only reduces the level of patient anxiety but may also be related to the use of less invasive regional anesthetics or reduced levels of general anesthesia. A common patient complaint for wanting general anesthesia instead of regional anesthesia is that they do not want to hear the surroundings [4]. Therefore, music medicine or music therapy might help patients choose a less invasive anesthesia alternative [4]. Similarly, another study randomized 140 surgical patients into two groups: an intervention group that received music during surgery and a control group that did not listen to music during surgery [5]. This study found that patients who received the musical intervention had more stable blood pressure, less anxiety, and less intraoperative awareness during surgery than those in the control group [5]. These are all markers for possibly being able to use less general anesthetic [5]. 

However, limited studies have shown any reduction or changes in general anesthesia when listening to music [4]. A randomized controlled trial of music therapy, music medicine, and a control group found that patients who received music therapy or medicine did not differ on the amount of general anesthesia needed. However, they both reported significantly less levels of preoperative anxiety compared to the control group [6]. Another study found that patients who underwent general anesthesia with music had less drastic changes in their heart rate and blood pressure after coming out of anesthesia compared to a group who did not hear music [7]. However, Nilsson et al (2003) found that patients who heard music required less morphine after surgery than those who listened to no music [8]. Furthermore, Szmuk et al (2008) found that listening to music during surgery did not reduce the amount of anesthesia needed [9]. 

In conclusion, studies support that music medicine or therapy during surgery may reduce levels of patient anxiety, therefore, requiring less sedatives; however, it is unclear whether it would reduce the amount of general or regional anesthesia necessary for surgery. 

References: 

1. Bradt, J., Dileo, C., & Shim, M. (2013). Music Interventions for Preoperative Anxiety. Cochrane Database of Systematic Reviews, 6. doi: 10.1002/14651858.CD006908.pub2 

1. Wang, S.M., Kulkarni, L., Dolev, J., & Kain, Z.N. (2002). Music and Preoperative Anxiety: A Randomized, Controlled Study. Anesthesia and Analgesia, 94(6), 1489-94. doi: 10.1097/00000539-200206000-00021 

1. LePage, C. et al. (2001). Music Decreases Sedative Requirements During Spinal Anesthesia. Anesthesia and Analgesia, 93(11), 912-916. doi: 10.1097/00000539-200110000-00022 

1. Graff, V. (2017). Role of Music in the Perioperative Setting. American Society of Regional Anesthesia and Pain Medicine. https://www.asra.com/news/160/role-of-music-in-the-perioperative-setti 

1. Kahloul, M. et al. (2017). Effects of music therapy under general anesthesia in patients undergoing abdominal surgery. Libyan Journal of Medicine, 12(1). doi: 10.1080/19932820.2017.1260886 

1. Bradley-Palmer, J., Lane, D., Mayo, D., Schluchter, M., & Leeming, R. (2015). Effects of Music Therapy on Anesthesia Requirements and Anxiety in Women Undergoing Ambulatory Breast Surgery for Cancer Diagnosis and Treatment: A Randomized Controlled Trial. Journal of Clinical Oncology, 33(28), 3162-3168. doi: 10.1200/JCO.2014.59.6049 

1. Tsuchiya, M. et al. (2003). Relaxing intraoperative natural sound blunts haemodynamic change at the emergence from propofol general anaesthesia and increases the acceptability of anaesthesia to the patient. Acta Anaesthesiologica Scandinavica, 47(8). doi: 10.1034/j.1399-6576.2003.00160.x 

1. Nilsson, U., Rawal, N., & Unosson, M. (2003). A comparison of intra‐operative or postoperative exposure to music – a controlled trial of the effects on postoperative pain. Anaesthesia, 58(7). doi: 10.1046/j.1365-2044.2003.03189_4.x 

1. Szmuk, P. et al. (2008). Listening to Music During Anesthesia Does Not Reduce the Sevoflurane Concentration Needed to Maintain a Constant Bispectral Index. Anesthesia and Analgesia, 107(1), 77-80. doi: 10.1213/ane.0b013e3181733e16