Transcript Music as an Adjunct to Anesthesia:

Music as an Adjunct to Anesthesia:
A Review of the Research
Cleveland Clinic Florida Grand Rounds Presentation
Alice H. Cash, Ph.D., LCSW
April 1, 2011
Dr. Alice H. Cash, Ph.D., LCSW
[email protected]
1
Cleveland Clinic
Cleveland Clinic has been a pioneer
in the use of music during surgery
Dr. Alice H. Cash, Ph.D., LCSW
[email protected]
2
The Phenomenon of Rhythmic Entrainment
• Humans have been entraining to music
since the beginning of time
– Hand clapping
– Dancing
– Finger snapping
– Swaying back and forth
Dr. Alice H. Cash, Ph.D., LCSW
[email protected]
3
Early publications suggesting benefits of music in
surgery (1998)
• “Use of intraoperative music in awake patients decreases patientcontrolled sedative and analgesic requirements.”
• “Thus, the decrease in sedative and analgesic requirements could
be caused by elimination of ambient operating room noise and not
by the effects of music.”
Dr. Alice H. Cash, Ph.D., LCSW
[email protected]
4
The sedative and analgesic sparing effect of music.
Yale University Hospital study (1998)
• Background: To determine whether music influences intraoperative
sedative and analgesic requirements, two randomized controlled
trials were performed.
• Methods: Phase 1
Phase 2
• Results: In phase 1, patients in the music group required
significantly less propofol for sedation than patients in the
control group
Similarly, in phase 2, patients who listened to music had a
significant reduction in alfentanil requirements
• Duration of stay in the postanesthesia care unit and the rate of
adverse events was similar in both groups (P = NS).
Dr. Alice H. Cash, Ph.D., LCSW
[email protected]
5
Music as an Adjunct to Anesthesia
“The Efficacy of Music Therapy”
• Journal of Peri-anesthesia Nursing
( 2010 Aug; 25(4):226-32)
Wakim JH, Smith S, Guinn C. University of Tennessee
• Being anesthetized is anxiety provoking can cause
– An increase in blood pressure
– An increase in heart rate
– Other effects that can have a negative impact preoperatively
Dr. Alice H. Cash, Ph.D., LCSW
[email protected]
6
Music’s Effect on the Body
• Rhythmic Entrainment is one
of the most important
concepts in the fields of
music therapy and music
medicine.
Dr. Alice H. Cash, Ph.D., LCSW
[email protected]
7
Music for Surgeons and Anesthesiologists
• Today music is often
found in the operating
room
Dr. Alice H. Cash, Ph.D., LCSW
[email protected]
8
Music for the Patient
• For decades, surgeons have used
music in the operating room
• Rarely is the patient considered
when the surgeon chooses his
music.
• Ideally, the patient and the surgeon
need their own unique types of
music.
Dr. Alice H. Cash, Ph.D., LCSW
[email protected]
9
A Three-Part Playlist
• I recommend three distinct
tempos of music for the
surgical procedure.
– Pre-Surgery
– During Surgery
– Post Surgery
Dr. Alice H. Cash, Ph.D., LCSW
[email protected]
10
A Three-Part Playlist
• Pre-Surgery
– Music that is familiar to
them and makes them feel
safe and comforted is ideal.
– Relaxing
– Example: Edelweiss
Dr. Alice H. Cash, Ph.D., LCSW
[email protected]
11
A Three-Part Playlist
• Surgery:
– Slow, steady purely
instrumental music
– Tempo of the healthy,
resting heartbeat.
– Perhaps “unknown”
Ex: Baroque or classical
movements.
“Pachelbel’s Canon”
Dr. Alice H. Cash, Ph.D., LCSW
[email protected]
12
A Three-Part Playlist
• Recovery area
– Little more upbeat
– Possibly with positive,
affirming lyrics
Ex: “Morning has Broken”
“When you Wish upon a Star”
“The Rainbow Connection”
Dr. Alice H. Cash, Ph.D., LCSW
[email protected]
13
Reduction of Anxiety Before
• Studies have shown that
listening to calm, steady music
for 30-40 minutes before
surgery, can greatly decrease
the amount of anxiety
medication needed.
• Some patients state that they
are so relaxed by the music
that they do not need any
added anxiety medications
prior to being sedated.
Dr. Alice H. Cash, Ph.D., LCSW
[email protected]
14
Reduction of Anesthesia During
Procedure
• After listening to calm,
soothing music for 3040 minutes prior to
surgery, the patient
arrives in the O.R.
more calm and quiet.
Dr. Alice H. Cash, Ph.D., LCSW
[email protected]
15
Review of Recent Research
• Today, I will focus on research
studies and articles between 20012011.
• Although music has probably been
used in one form or another for
medical procedures over hundreds of
years, we are only now
understanding how to use it
intentionally.
Dr. Alice H. Cash, Ph.D., LCSW
[email protected]
16
Review of Recent Research
• Relaxing music as pre-medication
before surgery
• Acta Anaesthesiol Scand 2009 Jul:53
• Dept of Surgery, Sodertalje Hospital
Sodertalje, Sweden.
• Conclusion: Higher effectiveness and
absence of apparent adverse effects
makes pre-operative relaxing music a
useful alternative to midazolam for premedication.
Dr. Alice H. Cash, Ph.D., LCSW
[email protected]
17
Review of Recent Research
• The effect of music on preoperative sedation
and the bispectral index
Anesthesia and Analgesia 2005 Jul; 101 Harran
University, School of Medicine,
Sanliurfa, Turkey
• Conclusions: Listening to music during
midazolam pre-medication is associated with an
increase in sedation level in the preoperative
period as reflected by a lower BIS value.
Dr. Alice H. Cash, Ph.D., LCSW
[email protected]
18
Review of Recent Research
• The effect of music listening on older
adults undergoing cardiovascular surgery.
Nursing in Critical Care. 2006 SepOct;11(5):224-31. Delray Medical Center,
Delray Beach, FL
• Conclusions: Listening to music during and
after cardiovascular surgery is an effective
and safe intervention for older adults.
Dr. Alice H. Cash, Ph.D., LCSW
[email protected]
19
Review of Recent Research
• Music and ambient operating room noise
in patients undergoing spinal anesthesia
• Yale University School of Medicine, New
Haven, CT
Anesthesia & Analgesia, 2005 May; 100 (5)
• Results: Intraoperative music decreases
propofol requirements. We also found that
Lebanese patients used less propofol as
compared with American patients.
Dr. Alice H. Cash, Ph.D., LCSW
[email protected]
20
Review of Recent Research
• Clinical trial: music reduces anxiety levels
in patients attending for endoscopy
• Alimentary Pharmacology Therapy 2009 Oct,
Kent & Canterbury Hospital, Canterbury, UK.
Dr. Alice H. Cash, Ph.D., LCSW
[email protected]
21
Review of Recent Research
• Listening to music decreases need for
sedative medication during colonoscopy
• Indian Journal of Gastroenterology 2006 Jan
Feb;25(1):3-5, Medical College Hospital,
Kozhikode 673 008, Kerala
• Conclusion: Listening to music during
colonoscopy helps reduce the dose of
sedative medications and decreases
discomfort experienced
Dr. Alice H. Cash, Ph.D., LCSW
[email protected]
22
Review of Recent Research
• Music Therapy in Gastrointestinal
Endoscopic Procedures.
World Journal of Gastroenterology, 2007 Sep
7;13(33):4533
• Background: To elucidate the role of music
therapy in gastrointestinal endoscopic
procedures following the conflicting outcomes
reported in two recent studies
• Conclusions: The beneficial effects were
shown on analgesia and sedation
requirements and procedure duration times
when used as an adjunct to pharmacotherapy.
Dr. Alice H. Cash, Ph.D., LCSW
[email protected]
23
Review of Recent Research
• Patients' perception of music versus
ordinary sound in a post-anaesthesia
care unit
• Intensive and Critical Care Nursing. 2009
Aug;25(4):208-13.
Malmoe University Hospital, Sweden
• Conclusions: Promote the use of listening to
music to establish a healing environment for
patients in a post-anaesthesia care unit.
Dr. Alice H. Cash, Ph.D., LCSW
[email protected]
24
Review of Recent Research
• Music as a nursing intervention for
postoperative pain: a systematic review
• University College in Dalarna, Falun, Sweden
2009 Dec;24(6):370-83.
Dr. Alice H. Cash, Ph.D., LCSW
[email protected]
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Review of Recent Research
• The Effect of Music on postoperative pain
and anxiety
Pain Management Nursing 2010 Mar University of
Central Florida, USA
•
Background: Determine if listening to music or
having a quiet rest period just before and just after
the first ambulation on postoperative day 1 can
reduce pain and/or anxiety or affect mean arterial
pressure, heart rate, oxygen saturation, and
respiratory rate
•
Conclusions Nurses can offer music as an
intervention to decrease pain and anxiety in this
patient population with confidence,
Dr. Alice H. Cash, Ph.D., LCSW
[email protected]
26
Review of Recent Research
• Evidence That Music Listening Reduces
Patients' Anxiety
• Biological Research for Nursing. Jan 28, 2011
• Results: The music group demonstrated
significant reductions in VAS scores, patients in
the control group showed no changes;
frequency-domain parameters of HRV can be
indicators for monitoring the change
Dr. Alice H. Cash, Ph.D., LCSW
[email protected]
27
Review of Recent Research
• Effect of music therapy on postoperative
analgesia and to determine the duration of
its effect.
• Gülhane Military Medical Academy,
Haydarpaşa Training Hospital, İstanbul,
Turkey.
• Conclusion: Music therapy decreases
postoperative pain in the first 24 hours and
the analgesic consumption during the first
four hours.
Dr. Alice H. Cash, Ph.D., LCSW
[email protected]
28
Review Recent Research
• The role of music during surgery and the
effect on staff, users and patients
• Ahmadu Bello University Teaching hospital,
Zaria. African Health Science 2010
Dec;10(4):386-9.
• Conclusion: music can prevent distraction,
minimize annoyance, reduce stress and
diminish the anxiety of patients, staff and
users.
Dr. Alice H. Cash, Ph.D., LCSW
[email protected]
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Review of Recent Research
• Monitored Anesthesia Care.
Doctor’s Regional Medical Center, Corpus Christi,
TX, USA.
• Conclusion: The use of music as an anesthetic
adjunct during MAC cases can reduce the amount
of sedation required, speed recovery time, and
prevent the likelihood of converting to a general
anesthetic.
• 2010 American Society of PeriAnesthesia Nursing
Dr. Alice H. Cash, Ph.D., LCSW
[email protected]
30
Review of Recent Research
• Minimizing preoperative anxiety with music
for day surgery patients
• Journal of Clinical Nursing. 2011 Feb 20.
- a randomized clinical trial.
• Evaluate the effects of musical intervention on
preoperative anxiety and vital signs in patients
undergoing day surgery
• Relevance to clinical practice. Finding
multimodal approaches to ease discomfort and
anxiety from unfamiliar unit surroundings and
perceived risks of morbidity
Dr. Alice H. Cash, Ph.D., LCSW
[email protected]
31
Conclusion and Recommendations
• Music is a powerful and
effective adjunct to anesthesia
and carries no known risks or
downside.
And yet music for the patient,
is still rarely seen in the
operating room.
• When the music is delivered
through cordless headphones,
the patient can have his
optimal type of music and the
surgeon and O.R. staff can
have their preferred music.
Dr. Alice H. Cash, Ph.D., LCSW
[email protected]
32
Conclusion and Recommendations
• Current practices:
– Music being used now is chosen by staff for their
listening needs
– Patients sometimes report not liking the music that is
being played in OR.
– Patients sometimes report hearing comments and
conversations that are upsetting.
Dr. Alice H. Cash, Ph.D., LCSW
[email protected]
33
Conclusion and Recommendations
• Best practices
– Music through headphones, offered to each surgical
patient, starting 30-45 minutes before procedure
– Same music be continued through-out the surgery
– Either the same music or music with a slightly more
upbeat tempo and positive affect into the recovery
area until patient is awake and alert
Dr. Alice H. Cash, Ph.D., LCSW
[email protected]
34
Conclusion and Recommendations
• Safety and efficacy
– Music is a safe and risk-free adjunct to
traditional anesthesia and can assist in
keeping the patient relaxed and comfortable
while decreasing both anesthesia and
analgesia
Dr. Alice H. Cash, Ph.D., LCSW
[email protected]
35
Conclusion and Recommendations
• Is There a Place for Music in Medical School?
• Music permeates the medical literature regarding
disease therapy. However, there are only few
articles concerning music as a tool for
development of cultural competency and
interpersonal relations.
Medical Teacher. 2011;33(1):76-7.
Boston University School of Medicine, MA 02118,
USA.
Dr. Alice H. Cash, Ph.D., LCSW
[email protected]
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Music as an Adjunct to Anesthesia:
A Review of the Research
Do you have any questions?
Dr. Alice H. Cash, Ph.D., LCSW
[email protected]
37
Music as an Adjunct to Anesthesia:
A Review of the Research
Thank You for your time today!
(It’s something you don’t have a lot of….)
Dr. Alice H. Cash
[email protected]
Dr. Alice H. Cash, Ph.D., LCSW
[email protected]
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