Patients 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, and could negatively impact their postoperative recovery.³ Pharmacologic agents, such as short-acting benzodiazepines and opioids, are commonly used to ease patients’ anxiety and pain perioperatively. However, 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.

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, 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.

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 characteristics within music that are known to be relaxing. These genres include classical, smooth jazz, and music with soothing sounds. The characteristics that are common to relaxing music are nonlyrical, tempo ranges of 60–80 beats per minute, and nonpercussive sounds without too many fluctuations in the melody. Binaural beat-infused music is another recommended style of music that is known to be soothing and relaxing.^4,25

What are binaural beats?

Binaural beats are developed when two different tones are played at the same time through both ears. The difference in the frequencies from these tones form a rhythm produced within the brain and can produce a particular electroencephalography (EEG)-associated state.²⁵ For example, if there is a tone playing at 410 Hz in the right ear and another tone playing at 400 Hz in the left ear, the difference of the two tones are 10 Hz and can simulate an alpha-wave EEG pattern, a waveform known to occur in the relaxed state. There are numerous styles of binaural beat-infused music options that can simulate the alpha, theta, and delta EEG waveforms and can be found on common music applications.

How Can You Incorporate Music Into Your Perioperative Practice?

With the advancement in technology today, an individual can easily listen to music and access a variety of musical genres. As of 2015, approximately 89% of adult users in the United States use the Internet at least occasionally, and 72% report owning a smartphone.²⁶ Of those who own smartphones, approximately 67% report listening to an online radio or music service; 87% of these individuals are 18–29 years of age, 74% are 30–49 years of age, and 41% are ≥50 years of age.²⁷ Therefore, the implementation of allowing patients to listen to music throughout the perioperative period could potentially be easier to adopt in a hospital setting by allowing patients to bring in their own media devices and headphones to listen to music. This project was implemented in 2015 at the University of Vermont Medical Center. To learn more about this project, see an interview conducted by Vermont’s WCAX TV here: http://www.wcax.com/story/30719516/using-songs-tohelp-surgery-patients-relax.

A news article from the University of Vermont Robert Larner College of Medicine is posted here: http://www.uvm.edu/medicine/?Page=n ews&storyID=21920&category=spot1.

Another alternative is to offer Wi-Fi capable media player devices with headphones during the perioperative period. This can be an option for patients who do not own smartphone devices, media players, or headphones and for institutions with strict policies that do not allow patients to bring in their personal belongings into the perioperative area.

Summary

Music is a safe, nonpharmacologic option to enhance a patient’s perioperative experience. It can be used as an adjunct to minimize or replace medications in certain points of the perioperative period. Allowing patients to listen to music via headphones throughout the perioperative setting gives them a sense of autonomy in a vulnerable period in their life and can be a simple, relatively cheap solution to incorporate in a perioperative practice.

References

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