Music effects on preoperative anxiety: preliminary study vs midazolam

Introduction Music evokes positive emotions and feelings of wellness. This effect can potentially be used in clinical settings as a non-pharmacological intervention to reduce anxiety, fear and sedative requirement. Objective The aim of this study is to evaluate effects of preoperative music listening compared to premedication with midazolam. Methods Patients undergoing odontostomatological elective surgery in general anaesthesia were enrolled. Inclusion criteria were: normal hearing; age>18 years; ASA score from 1 to 3. Exclusion criteria were: drugs abuse; psychiatric disordered; dementia. Patients were randomly di- vided into two groups. One group received music intervention (M Group) and the other was the control group (C Group). In M Group, pa- tients listened to music using headphones for 5 minutes before induction of anaesthesia. They were instructed to close their eyes and re- lax their body. Music was selected by a music therapist according to G.I.M. techniques (Guided Imagery Music). In C Group Midazolam 0.02mg/kg i.v. was administered for premedication. Anaesthesia was the same in both groups. For each patient blood pressure, BP, and heart rate, HR, were recorded at the operating room access and before induction of anaesthesia. All patients were connected to a BIS monitor to measure the depth of sedation. BIS values were recorded before and after music intervention or midazolam administration. An Anxiety Visual Analogue Score was used to evaluate level of anxiety from 0 (no anxiety) to 10 (maximum anxiety) before and 1 hour af- ter the end of surgical procedure. Patient Global Impression of Satisfaction, PGIS were tested one hour after surgery. Stress response was assessed before and after surgery through the control of plasma PRL, GH and cortisol levels. Results We enrolled 40 patients (mean age 58±15 years); 20 pts. in M group (7men/13women) and 20 pts. in C group (8men/12women). The mean duration of procedure was the same in both groups. In both groups, BIS, BP and HR significantly decrease after the listening and the midazolam injection but there were no significant differences between the two groups. Also Anxiety VAS, collected one hour after sur- gery, decreased in both group. There were no increase of cortisol and GH serum level in both groups after surgery. PRL increase signifi- cantly after surgery in both groups without difference between two groups. M group showed more satisfaction in PGIS than C group. Discussion Patients who listened music are sedated in the same way as patients who received i.v. midazolam and it seems that preoperative music listening produced an improvement of patient satisfaction. Conclusion Music has anxiolytic effects and gives an immediate sedation during premedication, as much as midazolam. Music can be used as a com- plementary method to allow a sparing of midazolam above all in day surgery settings. It is non invasive, easy to use and free of adverse effects.