OBJECTIVES The diagnosis of oral cancer causes anxiety and fear to the patient undergoing to the surgery under general anesthesia, and could affect negatively the peri-operative period rising blood pressure and heart rate. Music therapy (MT) is a therapeutic approach that uses sounds and music’s features to treat sickness and suffering caused by physical and/or psychic diseases. Further-more, receptive methods of MT are useful in the surgical setting. The aim of this study is to com-pare the effects of preoperative receptive MT to premedication by midazolam, during oral oncologic surgery procedures in general anesthesia. MATERIALS AND METHODS 25 patients, at least 18 years old, affected by stage I or II (both clinically and instrumentally N0) micro-invasive oral cancer, without auditory deficit, negative clinical history for drug abuse, psychiatric disorders or dementia, and American Society of Anesthesiologists (ASA) risk between 1 and 3, were enrolled. Pre-operative assessment was performed through standard blood tests, electrocardiogram, panoramic radiogram, high definition intra-oral ultrasonography (to measure tumor depth in millimeters), magnetic resonance imaging and anesthesiological visit. Before general anesthesia, patients were randomized between two groups: Music Group, which received preoperative receptive MT according to modified guided imagery and music technique, by a qualified music therapist; Control Group, which received pre-medication by intravenous midaz-olam 0.2 mg/kg. General anesthesia was associated to local anesthesia by carbo-caine, a short onset molecule, and bupivacaine, a long offset molecule, in order to reduce the dose of neuro-depressant drug. Depth of sedation (measured with a scale ranging from 0 to 100 reported by bi-spectral index-BIS monitor), level of satisfaction with surgical experience (Patient Global Impression of Satisfaction score), level of anxiety (Anxiety-Vi-sual Analogic Scale, A-VAS score) and vital parameters (heart rate and blood pressure) were compared between groups. RESULTS 12 patients had tongue cancer, 11 cheeks cancer and 2 lips carcino-ma. Groups did not differ in sex, mean age, ASA risk, duration of surgery, pre-operative A-VAS score, depth of sedation, heart rate and blood pressure (measured both when patient entered in operative room and before in-ducing general anesthesia), but pre-operative receptive MT provided more satisfaction with surgical experience than premedication by midazolam: 72.27% of Music Group referred the maxi-mum satisfaction, against the 14.28% of Control Group (p = 0.015%). CONCLUSIONS Receptive MT, provided by a qualified music therapist, is a non-in-vasive method, free from adverse effects, safe in day surgery, which can improve assistance in onco-logical patient, and it’s desirable that it becomes the gold standard treatment for these patients. CLINICAL SIGNIFICANCE MT provides a valid not-pharma-cologic tool to reduce anxiety in patients that undergo surgical excision of oral cancer in general anesthesia, in order to cure people and their diseases.
Preoperative receptive music therapy in oral oncologic surgery: Preliminary study
Dell'Olio F.;Sorrentino I.;Capodiferro S.;Puntillo F.;Brienza N.;Favia G.
2020-01-01
Abstract
OBJECTIVES The diagnosis of oral cancer causes anxiety and fear to the patient undergoing to the surgery under general anesthesia, and could affect negatively the peri-operative period rising blood pressure and heart rate. Music therapy (MT) is a therapeutic approach that uses sounds and music’s features to treat sickness and suffering caused by physical and/or psychic diseases. Further-more, receptive methods of MT are useful in the surgical setting. The aim of this study is to com-pare the effects of preoperative receptive MT to premedication by midazolam, during oral oncologic surgery procedures in general anesthesia. MATERIALS AND METHODS 25 patients, at least 18 years old, affected by stage I or II (both clinically and instrumentally N0) micro-invasive oral cancer, without auditory deficit, negative clinical history for drug abuse, psychiatric disorders or dementia, and American Society of Anesthesiologists (ASA) risk between 1 and 3, were enrolled. Pre-operative assessment was performed through standard blood tests, electrocardiogram, panoramic radiogram, high definition intra-oral ultrasonography (to measure tumor depth in millimeters), magnetic resonance imaging and anesthesiological visit. Before general anesthesia, patients were randomized between two groups: Music Group, which received preoperative receptive MT according to modified guided imagery and music technique, by a qualified music therapist; Control Group, which received pre-medication by intravenous midaz-olam 0.2 mg/kg. General anesthesia was associated to local anesthesia by carbo-caine, a short onset molecule, and bupivacaine, a long offset molecule, in order to reduce the dose of neuro-depressant drug. Depth of sedation (measured with a scale ranging from 0 to 100 reported by bi-spectral index-BIS monitor), level of satisfaction with surgical experience (Patient Global Impression of Satisfaction score), level of anxiety (Anxiety-Vi-sual Analogic Scale, A-VAS score) and vital parameters (heart rate and blood pressure) were compared between groups. RESULTS 12 patients had tongue cancer, 11 cheeks cancer and 2 lips carcino-ma. Groups did not differ in sex, mean age, ASA risk, duration of surgery, pre-operative A-VAS score, depth of sedation, heart rate and blood pressure (measured both when patient entered in operative room and before in-ducing general anesthesia), but pre-operative receptive MT provided more satisfaction with surgical experience than premedication by midazolam: 72.27% of Music Group referred the maxi-mum satisfaction, against the 14.28% of Control Group (p = 0.015%). CONCLUSIONS Receptive MT, provided by a qualified music therapist, is a non-in-vasive method, free from adverse effects, safe in day surgery, which can improve assistance in onco-logical patient, and it’s desirable that it becomes the gold standard treatment for these patients. CLINICAL SIGNIFICANCE MT provides a valid not-pharma-cologic tool to reduce anxiety in patients that undergo surgical excision of oral cancer in general anesthesia, in order to cure people and their diseases.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
