Inhalation aromatherapy during radiotherapy: results of a placebo-controlled double-blind randomized trial. Effects of music therapy on physiological and psychological outcomes for patients undergoing cardiac surgery. Preventing falls on an elderly care rehabilitation ward. Bacteriological observations in a mechanically ventilated experimental ward and in two open-plan wards. The effect of music listening on older adults undergoing cardiovascular surgery. Music versus distraction for procedural pain and anxiety in patients with cancer. The effect of an auditory distraction on anxiety in ambulatory surgical patients experiencing regional anesthesia. Effects of music therapy on women's physiologic measures, anxiety, and satisfaction during cesarean delivery. A music intervention to reduce anxiety before vascular angiography procedures. Stress reduction through music in patients undergoing cerebral angiography. Listening to music decreases need for sedative medication during colonoscopy: a randomized, controlled trial. Nasal acquisition of Staphylococcus aureus in partly divided wards. The effect of sunlight on postoperative analgesic medication use: a prospective study of patients undergoing spinal surgery. Music does not reduce alfentanil requirement during patient-controlled analgesia (PCA) use in extracorporeal shock wave lithotripsy for renal stones. Effects of music on patients undergoing a C-clamp procedure after percutaneous coronary interventions. Distraction therapy with nature sights and sounds reduces pain during flexible bronchoscopy: a complementary approach to routine analgesia. The use of music to reduce anxiety for patients undergoing colposcopy: a randomized trial. Impact of portable air filtration units on exposure of haematology-oncology patients to airborne Aspergillus fumigatus spores under field conditions. Psychophysiologic responses of mechanically ventilated patients to music: a pilot study. Music as an adjunct to antiemetic therapy. Relaxing intraoperative natural sound blunts haemodynamic change at the emergence from propofol general anaesthesia and increases the acceptability of anaesthesia to the patient. Effect of music on vital signs and postoperative pain. The effect of self-selected music during colonoscopy on anxiety, heart rate, and blood pressure. The effects of music on cardiac patients on bed rest. Effect of music therapy in the postanesthesia care unit: a nursing intervention. The effect of humorous and musical distraction on preoperative anxiety. The effect of humorous distraction on preoperative anxiety. A pilot study. Relaxation techniques for reducing pain and anxiety during screening mammography. Music for postoperative pain and anxiety. Analgesia following music and therapeutic suggestions in the PACU in ambulatory surgery; a randomized controlled trial. Lavender oil as a treatment for agitated behaviour in severe dementia: a placebo controlled study. [Reduction of preoperative anxiety. A study comparing music, Thalamonal and no premedication]. [The effect of music therapy on anxiety level in hospitalized asthmatic patients]. Music and ambient operating room noise in patients undergoing spinal anesthesia. Effects of music in patients who had chronic cancer pain. Epidural versus general anesthesia, ambient operating room temperature, and patient age as predictors of inadvertent hypothermia. ["Walkman music" during epidural anesthesia]. Effect of music therapy on state anxiety in patients undergoing flexible sigmoidoscopy. Taped therapeutic suggestions and taped music as adjuncts in the care of coronary-artery-bypass patients. Using massage and music therapy to improve postoperative outcomes. Normalization of hypertensive responses during ambulatory surgical stress by perioperative music. Music during bronchoscopic examination: the physiological effects. A randomized trial. Burn pain and anxiety: the use of music relaxation during rehabilitation. Effect of environmental surroundings on outpatients' mood and perception of psychiatrists. Effects of patient-controlled music therapy during coronary angiography on procedural pain and anxiety distress syndrome. The effect of music on the neurohormonal stress response to surgery under general anesthesia. The effect of music on preoperative sedation and the bispectral index. Stress reduction through listening to Indian classical music during gastroscopy. Comparative randomized study of protected environment plus oral antibiotics versus oral antibiotics alone in neutropenic patients. Effects of music on patient anxiety in coronary care units. Music reduces stress and anxiety of patients in the surgical holding area. The effect of a vinyl floor surface and a carpeted floor surface upon walking in elderly hospital in-patients. Effect of music on state anxiety scores in patients undergoing fiberoptic bronchoscopy. A music intervention to reduce anxiety prior to gastrointestinal procedures. A randomized, controlled trial of the use of music during laceration repair. Audio and visual stimulation reduces patient discomfort during screening flexible sigmoidoscopy. The effect of nursing interventions utilizing music therapy or sensory information on Chinese patients' anxiety prior to cardiac catheterization: a pilot study. Music decreases sedative requirements during spinal anesthesia. Effects of relaxing music on cardiac autonomic balance and anxiety after acute myocardial infarction. Music reduces sensation and distress of labor pain. Reclining chairs reduce pain from gurneys in older emergency department patients: a randomized controlled trial. Music and its effect on the physiological responses and anxiety levels of patients receiving mechanical ventilation: a pilot study. Music as a therapeutic intervention for anxiety in patients receiving radiation therapy. Relaxation music decreases the dose of patient-controlled sedation during colonoscopy: a prospective randomized controlled trial. Music: an intervention for pain during chest tube removal after open heart surgery. Effects of a single music therapy intervention on anxiety, discomfort, satisfaction, and compliance with screening guidelines in outpatients undergoing flexible sigmoidoscopy. Improved recovery after music and therapeutic suggestions during general anaesthesia: a double-blind randomised controlled trial. The sedative and analgesic sparing effect of music. Music increases satisfaction in elderly outpatients undergoing cataract surgery. Improved procedure of colonoscopy under accompanying music therapy. Hemispheric-synchronisation during anaesthesia: a double-blind randomised trial using audiotapes for intra-operative nociception control. Sedative music reduces anxiety and pain during chair rest after open-heart surgery. The effect of music in the postanesthesia care unit on pain levels in women who have had abdominal hysterectomies. Effects of music on target-controlled infusion of propofol requirements during combined spinal-epidural anaesthesia. Effects of different interior decorations in the seclusion area of a psychiatric acute ward. Anxiety during the performance of colonoscopies: modification using music therapy. Relaxation response in femoral angiography. The effect of music on preoperative anxiety in day surgery. Stress reduction and analgesia in patients exposed to calming music postoperatively: a randomized controlled trial. Can visual distraction decrease the dose of patient-controlled sedation required during colonoscopy? A prospective randomized controlled trial. A prospective, randomised, controlled study examining binaural beat audio and pre-operative anxiety in patients undergoing general anaesthesia for day case surgery. Physiologic responses of coronary care patients to selected music.
To determine whether the inhalation of aromatherapy during radiotherapy reduces anxiety.
                Three hundred thirteen patients undergoing radiotherapy were randomly assigned to receive either carrier oil with fractionated oils, carrier oil only, or pure essential oils of lavender, bergamot, and cedarwood administered by inhalation concurrently with radiation treatment. Patients underwent assessment by the Hospital Anxiety and Depression Scale (HADS) and the Somatic and Psychological Health Report (SPHERE) at baseline and at treatment completion.
                There were no significant differences in HADS depression or SPHERE scores between the randomly assigned groups. However, HADS anxiety scores were significantly lower at treatment completion in the carrier oil only group compared with either of the fragrant arms (P =.04).
                Aromatherapy, as administered in this study, is not beneficial. Cardiac surgery is a common interventional procedure for ischemic and valvular heart disease. Cardiac surgery is accompanied by postoperative pain and anxiety. The use of music therapy has been shown to reduce pain, anxiety, and physiological parameters in patients having surgical procedures.
                To compare the effects of music therapy versus a quiet, uninterrupted rest period on pain intensity, anxiety, physiological parameters, and opioid consumption after cardiac surgery.
                An experimental design was used. A total sample of 86 patients (69.8% males) were randomized to 1 of 2 groups; 50 patients received 20 minutes of music (intervention), whereas 36 patients had 20 minutes of rest in bed (control). Anxiety, pain, physiologic parameters, and opioid consumption were measured before and after the 20-minute period.
                A significant reduction in anxiety (P < or = .001) and pain (P = .009) was demonstrated in the group that received music compared with the control group, but no difference was observed in systolic blood pressure (P = .17), diastolic blood pressure (P = .11), or heart rate (P = .76). There was no reduction in opioid usage in the 2 groups.
                Patients recovering from cardiac surgery may benefit from music therapy. Comparison of two flooring types--carpet and vinyl--in the bed areas, and two modes of physiotherapy--conventional therapy and additional leg strengthening exercises--in avoiding falls.
                Randomized 2 x 2 controlled trial.
                Elderly care rehabilitation ward in a community hospital.
                Fifty-four consecutive patients referred for rehabilitation.
                The incidence of falls, and the change in strength.
                There were 10 falls on carpet, and only a single fall on vinyl floor covering (relative risk 8.3, 95% confidence interval 0.95-73, p = 0.05). There were four falls in those receiving additional exercise, and seven falls in those receiving only conventional physiotherapy (relative risk 0.21, 95% confidence interval 0.04-1.2, p = 0.12). Fifty-nine per cent of patients were able to complete strength measurements on admission and discharge. In these, handgrip strength improved more in those given additional exercise than conventional physiotherapy (2.1 kg versus -0.3 kg, p < 0.05).
                There is no evidence to support either intervention in preventing falls on a rehabilitation ward, but within this low-powered study, there was a strong trend towards vinyl being superior. nan The purpose of this study was to determine the effect of music listening on postoperative anxiety and intubation time in patients undergoing cardiovascular surgery. Coronary artery disease and valvular heart disease affect approximately 15 million Americans and 5 million persons in the U.K. annually, with the majority of these patients being older adults. The anxiety experienced before, during and after surgery increases cardiovascular workload, thereby prolonging recovery time. Music listening as a nursing intervention has shown an ability to reduce anxiety. The study used a randomized control trial design. Sixty adults older than 65 years were randomly assigned to the control and the experimental groups. The experimental group listened to music during and after surgery, while the control group received standard postoperative care. The Spielberger State Trait Anxiety Inventory was administered to both groups before surgery and 3 days postoperatively. The mean of the differences between scores was compared using analysis of variance. Differences in mean intubation time were measured in both groups. Older adults who listened to music had lower scores on the state anxiety test (F = 5.57, p = .022) and had significantly fewer minutes of postoperative intubation (F = 5.45, p = .031) after cardiovascular surgery. Older adults undergoing cardiovascular surgery who listen to music had less anxiety and reduced intubation time than those who did not. To test the hypotheses that the effects of a music intervention are greater than those of simple distraction and that either intervention is better at controlling procedural pain and anxiety than treatment as usual.
                Randomized, controlled experiment.
                A midwestern comprehensive cancer center.
                60 people with cancer having noxious medical procedures such as tissue biopsy or port placement or removal; 58 provided usable data.
                Participants completed measures of pain and anxiety before and after their medical procedures and provided a rating of perceived control over pain and anxiety after the procedure.
                Procedural pain, state anxiety, and perceived control over pain and anxiety.
                Contrary to hypotheses, outcomes achieved with music did not differ from those achieved with simple distraction. Moreover, outcomes achieved under treatment as usual were not significantly different from those obtained with music or distraction interventions. Some patients found that the interventions were bothersome and reported that they wanted to attend to the activities of the surgeon and the medical procedure itself.
                The effects of music, distraction, and treatment as usual are equivocal. In addition, patients have individual preferences for use of distraction during painful or anxiety-provoking procedures.
                Patients having noxious medical procedures should be asked about their desire to be distracted before and during the procedure and offered a strategy that is consistent with their preferences. nan The purpose of the study was to investigate the effects of music therapy on women's physiologic measures, level of anxiety, and satisfaction during cesarean delivery. Sixty-four women who were planning to have a cesarean delivery were randomly divided into an experimental and a control group. The experimental group received routine care and music therapy, whereas the control group received routine care only. Our results indicated that compared to the control group the experimental group had significantly lower anxiety and a higher level of satisfaction regarding the cesarean experience. No significant differences were found between the two groups in any of the physiological indexes. This controlled study provides evidence that music therapy can reduce anxiety and create a more satisfying experience for women undergoing cesarean delivery. Patients scheduled for vascular angiography are often anxious and frightened. High levels of anxiety may result in more difficult and painful procedures. Past research has reported mixed results for anxiety reduction techniques in other procedures settings, such as education, cognitive-behavioral skills, coping and relaxation skills, combinations of techniques, and music. Music as an intervention for pre-procedural anxiety prior to vascular angiography has not been studied. A randomized controlled trial of 170 patients was undertaken to determine whether 15 minutes of self-selected music reduced pre-procedure anxiety. The State Trait Anxiety Inventory was used to measure patients' anxiety. One-hundred sixty-six men and 4 women comprised the sample with an average age of 66.8 years (SD 9.95, range 37 to 85 years). Patients who listened to music (n=89) reduced their anxiety score from 38.57 (SD 10.46) to 35.2 (SD 9.7), while those who did not listen to music (n=81) reduced their anxiety score from 36.23 (SD 10.54) to 35.1 (SD 10.59); the difference between the groups was statistically significant (t=1.95, df 161, p=0.05). Pulse achieved a statistically significant reduction in the music group (t=2.45, df 167, p=0.02). Music is a noninvasive nursing intervention that patients enjoy and reduces their anxiety and their pulse rate. Further research should address using music to reduce anxiety in other interventional vascular angiography settings with equal numbers of men and women and comparing self-selected versus investigator-selected music. We studied the influence of music on stress reaction of patients during cerebral angiography. We randomised 30 patients to a music or a control group. We measured stress hormones, blood pressure, heart rate and psychological parameters. Patients examined without music showed rising levels of cortisol in plasma, indicating high stress levels, while cortisol in patients examined with music remained stable. Systolic blood pressure was significantly lower listening to music. Patients with a high level of fear did appear to benefit particularly from the music. Music played during endoscopic procedures may alleviate anxiety and improve patient acceptance of the procedure. A prospective randomized, controlled trial was undertaken to determine whether music decreases the requirement for midazolam during colonoscopy and makes the procedure more comfortable and acceptable.
                Patients undergoing elective colonoscopy between October 2003 and February 2004 were randomized to either not listen to music (Group 1; n=40) or listen to music of their choice (Group 2; n=38) during the procedure. All patients received intravenous midazolam on demand in aliquots of 2 mg each. The dose of midazolam, duration of procedure, recovery time, pain and discomfort scores and willingness to undergo a repeat procedure using the same sedation protocol were compared.
                Patients in Group 2 received significantly less midazolam than those in Group 1 (p=0.007). The pain score was similar in the two groups, whereas discomfort score was lower in Group 2 (p=0.001). Patients in the two groups were equally likely to be willing for a repeat procedure.
                Listening to music during colonoscopy helps reduce the dose of sedative medications and decreases discomfort experienced during the procedure. The spread of coagulase-positive staphylococci has been studied in a modern hospital in which most of the patients were nursed in 4-bed rooms separated from a common corridor only by low dividing walls. Acquisition of new nasal strains from patients in other bedrooms was nearly as easy as from patients in the neighbouring beds. There was no indication that subdivision of this type hindered the spread of nasal strains as compared with open wards of the ;Nightingale' pattern. Exposure to natural sunlight has been associated with improvement in mood, reduced mortality among patients with cancer, and reduced length of hospitalization for patients who have experienced myocardial infarction. Our aim was to evaluate whether the amount of sunlight in a hospital room modifies a patient's psychosocial health, the quantity of analgesic medication used, and the pain medication cost.
                A prospective study of pain medication use was conducted in 89 patients undergoing elective cervical and lumbar spinal surgery where they were housed on either the "bright" or "dim" side of the same hospital unit. Analgesic medication was converted to standard morphine equivalents for interpatient comparison. The intensity of sunlight in each hospital room was measured daily and psychologic questionnaires were administered on the day after surgery and at discharge.
                Patients staying on the bright side of the hospital unit were exposed to 46% higher-intensity sunlight on average (p = .005). Patients exposed to an increased intensity of sunlight experienced less perceived stress (p = .035), marginally less pain (p = .058), took 22% less analgesic medication per hour (p = .047), and had 21% less pain medication costs (p = .047). Age quartile was the only other variable found to be a predictor of analgesic use, with a significant negative correlation (p <.001). However, patients housed on the bright side of the hospital consistently used less analgesic medications in all age quartiles.
                The exposure postoperatively of patients who have undergone spinal surgery to increased amounts of natural sunlight during their hospital recovery period may result in decreased stress, pain, analgesic medication use, and pain medication costs. To evaluate the impact of music on opioid requirements and pain levels during renal lithotripsy using alfentanil patient-controlled analgesia (PCA), we conducted a prospective, blinded, randomized controlled trial. Patients undergoing lithotripsy were instructed in PCA use and asked to rate their anxiety and select their preferred type of music. They were then premedicated with morphine and ketorolac and randomly allocated into two groups. Group 1 (n = 97) had music started 10 min before the procedure and maintained until 10 min after its conclusion. Group 2 (n = 96) had music begun at the conclusion of lithotripsy and continued for 10 min. Pain intensity, alfentanil requirement, side effects, quality of analgesia, patient satisfaction, and acceptance of the technique were evaluated. Demographics, alfentanil requirement, pain levels, side effects, quality of analgesia, and patient satisfaction were similar in both groups. The addition of music did not provide any benefit. This result raises the possibility that some nonpharmacologic therapies have minimal impact in settings where the painful stimulus is moderate to severe and adequate pharmacotherapy is available. This paper reports a study to determine the effect of music on physiological parameters and level of pain in patients undergoing application of a C-clamp after percutaneous coronary interventions.
                Most percutaneous coronary interventions are performed through the femoral artery. In order to stop bleeding and achieve homeostasis, a C-clamp is used after percutaneous coronary interventions. However, the experience is painful for patients and they inevitably suffer discomfort. Pain may lead to stress responses and may affect the physical and mental health of patients. One potential beneficial practice is having the patient listen to relaxing music, which might have the effect of reducing situational discomfort and pain.
                A randomized controlled study was conducted during the period September 2004 to March 2005. Forty-three people (20 experimental and 23 control) were recruited from the intensive care units of two acute care hospitals in Hong Kong. Physiological and psychological variables were collected at baseline and at 15, 30 and 45 minutes.
                In the music group, there were statistically significant reductions (P=0.001) in heart rate, respiratory rate, and oxygen saturation than the control participants at 45 minutes. In the music group, statistically significant reductions (P=0.001) in systolic blood pressure, heart rate, respiratory rate and oxygen saturation were found at the four time points, but not in the control group. No statistically significant differences were found at baseline comparison of the two groups, but statistically significant differences in pain scores were found at 45 minutes for participants in the music group compared with the control group (P=0.003). Participants in the control group showed statistically significant increases in pain at 45 minutes compared with baseline (P<0.001).
                The benefits of preventing physiological reactions to pain were demonstrated. Music is a simple, safe and effective method of reducing potentially harmful physiological and psychological responses arising from pain. To determine whether distraction therapy with nature sights and sounds during flexible bronchoscopy (FB) reduces pain and anxiety.
                Randomized controlled trial.
                Teaching hospital in Baltimore, MD.
                Consecutive adult patients (n = 80) undergoing FB with conscious sedation.
                Nature scene murals were placed at the bedside, and patients were provided a tape of nature sounds to listen to before, during, and after the procedure. Patients assigned to the control group were not offered either the nature scene or the sounds. Measurements and results: The primary outcomes were patient ratings of pain control (a 5-point scale ranging from poor to excellent) and anxiety. In a multivariate ordinal logistic regression model, the odds of better pain control were greater in the intervention patients than in the control patients (odds ratio [OR], 4.76; 95% confidence interval [CI], 1.35 to 16.7), after adjustment for age, gender, race, education, health status, and dose of narcotic medication. Older patients and patients with better health status reported significantly less pain. There was no difference in patient-reported anxiety between the two groups (OR, 0.87; 95% CI, 0.39 to 1.96).
                Distraction therapy with nature sights and sounds significantly reduces pain in patients undergoing FB. Although the precise mechanism of this beneficial effect requires further investigation, clinicians should consider this nonintrusive strategy in addition to standard analgesic medications in patients undergoing painful, invasive procedures. The goal of this work was to investigate the impact of music on women's anxiety and perceived pain during colposcopy examination.
                This was a prospective randomized study. Two hundred and twenty women referred for colposcopy for the first time were recruited. They were randomized to either the music or no-music group. Before colposcopy examination, each subject completed a Chinese version of the state anxiety questionnaire (STAI) and assessed the anticipated pain for colposcopy with a visual analog scale (VAS). Slow-rhythm music was played during colposcopy examination in the music group. Subjects in the no-music group were examined in the same setting without music. After colposcopy, each subject completed the STAI form again and assessed their pain during examination by the VAS.
                Women in the music group experienced significantly less pain (mean VAS 3.32 [95% CI 2.86-3.78] vs 5.03 [4.54-5.52], P<0.001) and lower anxiety (mean STAI 39.36 [95% CI 37.33-41.39] vs 44.16 [41.82-46.49], P = 0.002) during colposcopy examination than women in the no-music group. On linear regression analysis, the factors significantly affecting anxiety during colposcopy were anxiety score at enrollment, pain score during colposcopy, and whether or not the women had listened to music during the colposcopy examination. The factors significantly affecting the pain scores were whether the women had listened to music during the procedure and the final anxiety scores.
                Music is a simple, inexpensive, and easily used strategy to minimize anxiety and pain during colposcopy examination. We undertook a one-year study to investigate the impact of the NSA model 7100A/B portable air filtration unit on exposure of haematology-oncology patients to airborne Aspergillus fumigatus spores under field conditions. Weekly measurements for airborne A. fumigatus were conducted in indoor and outdoor air, and surveillance for invasive aspergillosis was based on a combination of ward liaison, targeted chart review and consultation with the medical staff. The mean indoor A. fumigatus counts (8.1 cfu/m3; range, <0.8 to 42 cfu/m3) reflected the fungal load of outdoor air (9.4 cfu/m3; range, <0.8 to 50 cfu/m3), and were reduced by only about one third in rooms with portable air filtration units (5.3 cfu/m3; range, <0.8 to 41 cfu/m3). During the study period, a total of five cases (incidence density, 0.8 per 1000 patient-days) of invasive aspergillosis (one proven case, four suspected cases; case fatality rate 40%) were recorded. None of these five patients was allocated to a room with portable air filtration unit, however, the difference between incidence densities in rooms with and without portable air filtration units was non-significant (Fisher's exact test, P=0.33). Due to the noise level and thermal discomfort, patient compliance with the air filtration units was poor. We conclude that under field conditions this air filtration unit cannot be recommended for prevention of invasive aspergillosis in neutropenic haematology-oncology patients. Although mechanically ventilated patients experience numerous stressors, they have not been included in music therapy stress reduction and relaxation studies.
                To examine selected psychophysiologic responses of mechanically ventilated patients to music.
                A two-group experimental design with pretest, posttest, and repeated measures was used. Twenty mechanically ventilated patients were randomized to a music-listening group or a nonmusic (headphones only) group. Physiologic dependent measures--heart rate and rhythm, respiratory rate, systolic and diastolic blood pressure, oxygen saturation, and airway pressure--were collected at timed intervals. Psychologic data were collected before and after intervention using the Profile of Mood States.
                Using repeated measures analysis of variance, results for heart rate and respiratory rate over time and over time between groups were significant. Between-group differences were significant for respiratory rate. Significant differences were found via t test for the music group's Profile of Mood States scores. No adverse cardiovascular responses were noted for either group.
                Data indicated that music listening decreased heart rate, respiratory rate, and Profile of Mood States scores, indicating relaxation and mood improvement. To test whether use of music as a diversional intervention during high-dose chemotherapy administration would affect perception of nausea and episodes of vomiting.
                39 patients undergoing bone marrow transplant. A total of 33 patients were included in the data analysis, with 17 in the control group and 16 in the music intervention group.
                Patients were assigned randomly to a control group (usual antiemetic protocol) or the experimental group (usual antiemetic group plus music intervention during the 48 hours of high-dose cyclophosphamide administered as part of the preparative regimen).
                Use of a music intervention, perception of nausea, and instances of vomiting.
                Significant differences were found between group scores on a visual analog scale for nausea and number of episodes of vomiting, demonstrating that the experimental group experienced less nausea and fewer instances of vomiting.
                This study found that music is an effective adjunct to a pharmacologic antiemetic regimen for lessening nausea and vomiting, and this study merits further investigation through a larger multi-institutional effort.
                Using music as a diversional adjunct intervention to antiemetic therapy is helpful in decreasing nausea and vomiting. The intervention can be initiated independently by nurses and individualized for each patient, leading to greater patient comfort and compliance with high-dose chemotherapy. It is known that auditory input, such as comforting music or sound, blunts the human response to surgical stress in conscious patients under regional anaesthesia. As auditory perception has been demonstrated to remain active under general anaesthesia, playing comforting sounds to patients under general anaesthesia might also modulate the response of these patients to surgical stress.
                Fifty-nine patients scheduled for laparoscopic cholecystectomy were anaesthetized with propofol general anaesthesia in combination with epidural anaesthesia. Natural sounds, chosen preoperatively by each patient as being comforting, were played to 29 patients using headphones during surgery (S group) and the remainder of the patients (n = 30) were fitted with dummy open-type headphones (N group). We compared the haemodynamic change during anaesthesia and the acceptability of anaesthetic practice between the two groups in a randomized double-blind design.
                There were no differences in haemodynamics between the S and N groups during surgery. During the emergence from anaesthesia, the mean blood pressure and heart rate gradually increased; both parameters were significantly higher in the N group than in the S group. Postoperatively, patients in the S group perceived the experience of anaesthesia as significantly more acceptable than did those in the N group.
                These findings indicate that allowing patients comforting background sounds during general anaesthesia may blunt haemodynamic changes upon emergence from general anaesthesia and increase the acceptability of the experience of anaesthesia. Pharmacological methods to improve postoperative pain are well documented, but an increasing interest in nonpharmacological methods has stimulated research in this field. Traditional and pharmacological interventions to relieve perioperative anxiety and pain are being challenged by an increasing demand for more holistic approaches. This study tested the hypothesis that listening to music preoperatively and postoperatively would affect patients' experience of pain, nausea, and well-being and have an impact on their vital signs. The authors conclude that a period of peaceful rest before and after surgery reduces patient anxiety. The purpose of this study was to examine the effects of music therapy on self-reported and physiological signs of anxiety among ambulatory patients undergoing colonoscopy. Thirty-two patients were randomly assigned to either an experimental group who listened to music during the colonoscopy or a standard procedure no music control group. Before and after the procedure, subjects completed the State Anxiety Inventory. Physiological signs of anxiety, including heart rate and blood pressure, were monitored at four time points during the procedure. Repeated measures analysis of variance indicated a significant group by time interaction on the physiological signs of anxiety. Post hoc analysis indicated that heart rate and systolic and diastolic blood pressure significantly decreased among the music intervention group during the procedure while remaining unchanged in the control group. No significant effect of the treatment was observed on the State Anxiety Inventory, although a trend indicated that the music intervention decreased state anxiety. Finally, the group who received the music intervention required less physician-administered sedation during the procedure than did the control group. These findings indicate that music therapy has the potential to reduce physiological indicators of anxiety and the need for sedation among individuals undergoing a colonoscopy.
                Copyright 2002, Elsevier Science (USA). All rights reserved. Hospitalizations that require invasive cardiac procedures or support with an intra-aortic balloon pump can be unsettling. This study was undertaken to measure the effect of a music intervention on physiologic and psychological responses of patients on bed rest due to procedural sheaths or an intra-aortic balloon pump. A randomized, two-group, pretest/post-test design was utilized to measure the effect of a 30-minute music intervention on heart rate, blood pressure, respiratory rate, skin temperature, pain perception, and mood states. One hundred forty subjects participated, 65 in the control group and 75 in the treatment group. There were no significant differences between the groups in demographic, clinical, or baseline variables, except for respiratory rate. After the music intervention, there were reductions in blood pressure, respiratory rate, and psychological distress, as measured by the Profile of Mood States (p < 0.05). Music appeared to affect selected physiologic responses and reduce psychological distress in patients on bed rest. This study examined the effect of music on pain, hemodynamic variables, and respiration in the PACU, and the impact of music on patients' recall of their PACU experience. Sixty patients scheduled for thyroid, parathyroid, or breast surgery under general anesthesia were studied. Patients were randomly assigned into three groups: group 1, control, not wearing headphones; group 2, wearing headphones but hearing no music; and group 3, wearing headphones and listening to music. A visual analogue pain scale was used to rate patients' perception of pain. There was no difference in pain level, morphine requirement, hemodynamics, respiration, or length of stay in the PACU among the 3 groups, yet the music group was able to wait significantly longer before requiring analgesia on the nursing unit. Patients who listened to music perceived their PACU experience as significantly more pleasant than the patients in the other two groups as recalled both 1 day and 1 month later. This study investigated the effect of humorous and musical distraction on preoperative anxiety among 46 patients scheduled for same day, elective, nondiagnostic surgery. Preoperative anxiety was measured with a horizontal visual analog scale after treatment group subjects listened to either a humorous audiotape or a tranquil music audiotape for 20 minutes and control group subjects received no intervention. Results show no significant difference between the group anxiety means. This study provides no evidence that humor or music decreases preoperative anxiety, but it also shows no evidence that perioperative nurses should avoid using humor or music as nursing interventions. nan The purpose of this study was to determine whether listening to a relaxation audiotape before and during mammography decreases subjective reports of pain and anxiety.
                Listening to a relaxation or music audiotape before and during mammography does not reduce subjective reports of anxiety or pain. Women undergoing screening mammography report minimal levels of distress. nan This study was designed to determine whether music (M), or music in combination with therapeutic suggestions (M/TS) could improve the postoperative recovery in the immediate postoperative in daycare surgery.
                One-hundred and eighty-two unpremedicated patients who underwent varicose vein or open inguinal hernia repair surgery under general anaesthesia were randomly assigned to (a). listening to music (b). music in combination with therapeutic suggestions or (c). blank tape in the immediate postoperative period. The surgical technique, anaesthesia and postoperative analgesia were standardized. Analgesia, the total requirement of morphine, nausea, fatigue, well-being, anxiety, headache, urinary problems, heart rate and oxygen saturation were studied as outcome variables.
                Pain intensity (VAS) was significantly lower (P = 0.002) in the M (2.1), and the M/TS (1.9) group compared with the control group (2.9) and a higher oxygen saturation in M (99.2%) and M/TS (99.2%) group compared with the control (98.0%), P < 0.001, were found. No differences were noted in the other outcome variables.
                This controlled study has demonstrated that music with or without therapeutic suggestions in the early postoperative period has a beneficial effect on patients' experience of analgesia. Although statistically significant, the improvement in analgesia is modest in this group of patients with low overall pain levels. To determine whether aromatherapy with lavender oil is effective in the treatment of agitated behaviour in patients with severe dementia.
                A placebo controlled trial with blinded observer rater.
                A long-stay psychogeriatric ward.
                Fifteen patients meeting ICD-10 diagnostic criteria for severe dementia and suffering from agitated behaviour defined as a minimum score of three points on the Pittsburgh Agitation Scale (PAS).
                A 2% lavender oil aromatherapy stream was administered on the ward for a two hour period alternated with placebo (water) every other day for a total of ten treatment sessions.
                For each subject 10 total PAS scores were obtained. Five during treatment and five during placebo periods.
                Nine patients (60%) showed an improvement, five (33%) showed no change and one patient (7%) showed a worsening of agitated behaviour during aromatherapy compared with placebo. A comparison of the group median PAS scores during aromatherapy showed a significant improvement in agitated behaviour during aromatherapy compared with placebo (median PAS scores 3 c.f. 4; Wilcoxon Signed-Ranks test p = 0.016 (one-tailed)).
                Lavender oil administered in an aroma stream shows modest efficacy in the treatment of agitated behaviour in patients with severe dementia.
                Copyright 2002 John Wiley & Sons, Ltd. Ninety ASA I-II patients scheduled for a pre-planned surgical operation were randomly assigned to three groups: the first of these received no premedication, the second received 1-2 ml Thalamonal i.m., and the third were offered music from a walkman via earphones. Excluded from the study were patients under 15 and over 65 years of age, patients suffering from malignant diseases, those expecting operations of uncertain outcome, and patients whose mother tongue was not German. All 90 patients were cared for by the same investigator. She obtained informed consent on the eve of the scheduled operation and chose the music that was to be offered preceding the operation according to the patient's wishes. Each patient's history was evaluated, including the grade of anxiety and his or her attitude towards music. Of course, a physical examination was also conducted. Ninety minutes prior to the operation, psychometric tests (STAI-G-X2, STAI-G-X1, ESA-S, and BF-S) were performed. Thereafter, either music was offered or else 1-2 ml Thalamonal was injected, according to the random assignment: group 1 received neither. Fifteen minutes before entering the operating room, the tests expressing anxiety with regard to the situation were repeated as was the physical examination, and the investigator once again assessed the level of anxiety of the patients. On the evening of the day of surgery, all patients were asked to give an evaluation of the preoperative period. Trait-anxiety, as measured by the STAI-G-X2-Test, was comparable in all groups.(ABSTRACT TRUNCATED AT 250 WORDS) The role of music therapy as a supportive treatment is not well defined. The music therapy cannot be estimated as the isolated method it is often only the part of the complex therapy. The aim of this study was to evaluate the influence of music therapy on anxiety level in hospitalized asthmatic patients. The patient group was consisted of 36 patients with bronchial asthma (23 women and 13 men). In all patients we evaluated the level of anxiety (attribute and state) according to Spielberger and intensity of dyspnoe according to Borg scale at the first day of examination and after 10 days of rehabilitation program. Moreover we performed spirometry. The respiratory rehabilitation program included: exercise of breath control, correction of respiratory pattern, training of diaphragm and additional respiratory muscles. The duration of music therapy lasted 15 min. After 10 days rehabilitation with or without music therapy we found the reduction of anxiety (state) (p<0.0001). However we did not observe the difference between two studied groups with or without music therapy in diminishing of anxiety (p = 0.55). In conclusion, we believe that the music therapy can play important role in treatment of somatic disease but our study did not confirm its additive positive meaning in patients with bronchial asthma. Previous studies have indicated that music decreases intraoperative sedative requirements in patients undergoing surgical procedures under regional anesthesia. In this study we sought to determine whether this decrease in sedative requirements results from music or from eliminating operating room (OR) noise. A secondary aim of the study was to examine the relationship of response to intraoperative music and participants' culture (i.e., American versus Lebanese). Eighty adults (36 American and 54 Lebanese) undergoing urological procedures with spinal anesthesia and patient-controlled IV propofol sedation were randomly assigned to intraoperative music, white noise, or OR noise. We found that, controlling for ambient OR noise, intraoperative music decreases propofol requirements (0.004 +/- 0.002 mg . kg(-1) . min(-1) versus 0.014 +/- 0.004 mg . kg(-1) . min(-1) versus 0.012 +/- 0.002 mg . kg(-1) . min(-1); P = 0.026). We also found that, regardless of group assignment, Lebanese patients used less propofol as compared with American patients (0.005 +/- 0.001 mg . kg(-1) . min(-1) versus 0.017 +/- 0.003 mg . kg(-1) . min(-1); P = 0.001) and that, in both sites, patients in the music group required less propofol (P < 0.05). We conclude that when controlling for ambient OR noise, intraoperative music decreases propofol requirements of both Lebanese and American patients who undergo urological surgery under spinal anesthesia. nan To elucidate the multifactorial nature of perioperative changes in body temperature, the influence of several clinical variables, including anesthetic technique, ambient operating room temperature, and age, were evaluated. Perioperative oral sublingual temperatures were measured in 97 patients undergoing lower extremity vascular surgery randomized to receive either general (GA) or epidural (EA) anesthesia. Surgery and anesthesia were performed in operating rooms (OR) with a relatively warm mean ambient temperature (24.5 +/- 0.4 degrees C) (GA, n = 30; EA, n = 33) or relatively cold mean ambient temperature (21.3 +/- 0.3 degrees C) (GA, n = 21; EA, n = 13). Patients were 35-94 yr old, with a mean age of 64.5 +/- 1.1 yr. A regression analysis was performed to determine the variables that correlated with intraoperative decrease in temperature and postoperative rewarming rate. The major correlates of greater intraoperative decrease in temperature were 1) GA (P = 0.003); 2) cold ambient OR temperature (P = 0.07); and 3) advancing patient age (P = 0.03). There was significant interaction between ambient OR temperature and type of anesthesia (P = 0.03): there was a greater intraoperative decrease in temperature with GA compared to EA in a cold OR but a similar decrease with GA and EA in a warm OR. The data also suggest an interaction between type of anesthesia and patient age (P = 0.06), showing a greater decrease in temperature with GA compared to EA in the younger patients, but a similar decrease between GA and EA in older patients.(ABSTRACT TRUNCATED AT 250 WORDS) The sedating effect and influence of walkman music on 120 patients, that were randomly divided into a music and non-music group, who had received epidural anesthesia were investigated. It was found that significantly fewer patients in the music group felt anxious during surgery (P = 0.049). Meanwhile, heart rate and mean arterial pressure of the non-music group remained at a higher level, resulting in higher heart loading. Furthermore, patients listening to music had a significantly smaller need of sedatives (P = 0.001). With the purpose of reducing the consumption of sedatives, and offering a better anesthetic environment, we recommend the use of music during regional anesthesia. Patient anxiety related to flexible sigmoidoscopy can negatively affect acceptability and compliance with screening protocol, complicate and prolong procedure time, and potentially result in prematurely aborted procedures. Music has been recognized through research as a safe, inexpensive, and effective nonpharmaceutical anxiolitic agent.
                An experimental study was performed on 50 adults scheduled for outpatient sigmoidoscopy. The control group received standard sigmoidoscopy protocol. Subjects in the experimental group received the standard protocol with the addition of listening to music throughout the procedure. State-Trait Anxiety Inventory (STAI) measurements were performed on all subjects before and postsigmoidoscopy. Physiologic recordings of heart rate and mean arterial pressure were recorded before and during the procedure.
                Patients who listened to self-selected music tapes during the procedure had significantly decreased STAI scores (P < 0.002), heart rates (P < 0.03), and mean arterial pressures (P < 0.001) in comparison to the control subjects.
                The results of the study indicate that music is an effective anxiolitic adjunct to flexible sigmoidoscopy. A randomized, single-blinded, placebo-controlled trial examined the benefits of taped therapeutic suggestions and taped music in coronary-artery-bypass patients. Sixty-six patients listened to either suggestion tapes or music tapes, intraoperatively and postoperatively; 29 patients listened to blank tapes intraoperatively and listened to no tapes postoperatively. Half the patients who listened to a tape found it helpful. There were no significant differences between groups in length of SICU or postoperative hospital stay, narcotic usage, nurse ratings of anxiety and progress, depression, activities of daily living, or cardiac symptoms. There were no significant differences in these same outcomes between the patients who were helped by the tapes and the patients not helped. These results suggest that if taped therapeutic suggestions have a measurable effect upon cardiac surgery patients, demonstrating this effect will require more detailed patient evaluations to identify subgroups of patients responsive to this type of intervention. An experimental pilot study was conducted to investigate the effects of preoperative massage and music therapy on patients' preoperative, intraoperative, and postoperative experiences. Participants were assigned randomly to one of four groups--a group that received massage with music therapy, a group that received massage only, a group that received music therapy only, or a control group. Hemodynamics, serum cortisol and prolactin levels, and anxiety were measured preoperatively and postoperatively. Postoperative anxiety levels were significantly lower and postoperative prolactin levels were significantly higher for all groups. The purpose of this study was to determine whether cognitive appraisals of stress level and hypertensive responses to ambulatory ophthalmic surgery can be ameliorated by patient-selected music.
                We studied 40 elderly individuals requiring ophthalmic surgery, 20 in an experimental group (mean age, 74 years) and 20 in a control group (mean age, 77 years). All patients had an established resting blood pressure <140/90 mm Hg. In the experimental group self-selected music was provided by headphones throughout the preoperative, surgical, and postoperative periods. In the control group patients had neither headphones nor music. All patients received similar (weight-determined) doses of alfentanil and midazolam during surgery. Heart rate, blood pressure, and patient-reported stress and coping levels were the dependent variables.
                In both groups, blood pressure values were normal (approximately 129/82 mm Hg) during screening examinations 1 week before surgery. On the day of surgery both groups displayed increased preoperative blood pressures (approximately 159/92 mm Hg) associated with increases in heart rate (by approximately 17 beats/min). Intraoperative blood pressures in the experimental group returned quickly to screening baseline values, whereas the control group experienced persistent elevations in intraoperative blood pressure similar to preoperative levels. Over the course of the surgical experience, patients with music reported significant reductions in perceived stress and increases in coping abilities (p < .001), whereas those without music did not.
                The perceived stress of ambulatory surgery in geriatric patients is associated with a clinical hypertensive response that is ameliorated by self-selected perioperative music, which also decreases perceived stress and increases patients' sense of personal control and well-being. Patients scheduled for bronchoscopic procedures are often anxious and frightened. Reduction in the state of anxiety during an invasive procedure may prevent some possible complications. Music has been proposed as a safe nonpharmacological antianxiety intervention.
                We followed up physiological indicators of anxiety (blood pressure, heart rate) during bronchoscopic examination to determine the effect of music on the level of anxiety.
                Two hundred adult patients were included in the study. Blood pressure, heart rate, procedures performed during bronchoscopy and duration of examination were monitored. Patients' overall feelings during the procedure were rated from 0 (without unpleasant feelings) to 10 (unbearable). All patients used the Visual Analogue Scale (VAS).
                Two hundred adult patients referred for bronchoscopy were included in the study: 93 patients received music during the procedure and 107 served as control. There were no significant differences between the two groups in terms of age, sex, indications for bronchoscopy, procedures performed during bronchoscopy, duration of the examination and patients' subjective perception of the procedure. The mean hart rate, systolic and diastolic blood pressures were significantly lower in the music group compared to the control group.
                Our findings suggest that the application of music reduces anxiety during bronchoscopic examination as physiological indicators of anxiety, the mean heart rate, systolic and diastolic blood pressures, were significantly lower in the music group.
                Copyright 2006 S. Karger AG, Basel. Pain and anxiety are well-documented problems during the rehabilitation of patients with burns. This study examined the effect of music on anxiety and pain during range of motion. Eleven subjects with partial-thickness or deeper burns were randomly assigned to a control group (without music intervention) or experimental group (with music intervention). Vital signs, pain, and anxiety were recorded before and after treatments. There was no difference in pretest and posttest anxiety across the groups; however, there was a difference in anxiety between the groups. Conversely, there was a difference in pretest and posttest pain across the groups but no difference in pain between the groups. Results showed no significant reduction in anxiety and pain during therapy with music relaxation. Limitations included nonhomogenous groups, small sample size, potentially unrepresentative sample, variation in exercise protocol, and small musical selection. Further research is recommended. nan nan Several pharmacological interventions reduce perioperative stress hormone release during surgery under general anesthesia. Listening to music and therapeutic suggestions were also studied, but mostly in awake patients, and these have a positive effect on postoperative recovery and the need for analgesia. In this study, we evaluated the effect of listening to music under general anesthesia on the neurohormonal response to surgical stress as measured by epinephrine, norepinephrine, cortisol, and adrenocorticotropic hormone (ACTH) blood levels. Thirty female patients scheduled for abdominal gynecological procedures were enrolled and randomly divided into two groups: group NM (no music) and group M (music). In group M, music was played from after the induction of anesthesia until the end of surgery. In the NM group, the patients wore the headphones but no music was played. We established three sample times for hormonal dosage during the procedure and one in the recovery room. Hemodynamic data were recorded at all times, and postoperative consumption of morphine in the first 24 h was noted. There was no group difference at any sample time or in the postoperative period in terms of mean arterial blood pressure, heart rate, isoflurane end-tidal concentration, time of the day at which the surgery was performed, bispectral index (BIS) value, doses of fentanyl, or consumption of postoperative morphine. There was no difference between the two groups with regard to plasmatic levels of norepinephrine, epinephrine, cortisol, or ACTH at any sample time, although the blood level of these hormones significantly increased in each group with surgical stimulation. In conclusion, we could not demonstrate a significant effect of intraoperative music on surgical stress when used under general anesthesia.
                Listening to music under general anesthesia did not reduce perioperative stress hormone release or opioid consumption in patients undergoing gynecological surgery. We assessed the effect of music on the level of sedation and the electroencephalograph bispectral index (BIS) during the preoperative period. Fifty-four ASA physical status I-II patients, scheduled for elective septo-rhinoplastic surgery, were included in the study. Subjects were assigned to receive either music (music group; n = 28) or no music (control group; n = 26) during the preoperative period. Sedative premedication was provided with midazolam 0.08 mg/kg IM. Observer's Assessment of Alertness/Sedation Scales (OAAS) scores and BIS values were recorded at specific time intervals. In the control group, there were more patients with an OAAS score of 1 than in the music group at 30 min after midazolam injection. In addition, there were more patients with an OAAS score of 2 in the control group than in the music group at 30-50 min. However, there were significantly more patients with an OAAS score of 3 in the music group than in the control group at 20-50 min. BIS values of the music group were also smaller than the control group at 30 and 40 min. BIS values were significantly decreased from baseline values at 10-50 min in the music group, whereas BIS values decreased at 30-50 min in the control group. In conclusion, listening to music during midazolam premedication is associated with an increase in sedation level in the preoperative period as reflected by a lower BIS value. The purpose of this study was to examine the effects of music on elevated state of anxiety as many patients become stressed and anxious during diagnostic procedures. The study was conducted on 104 consecutive patients undergoing GI endoscopy for various reasons. Patients were randomly assigned to two groups regardless of sex, age and underlying disease. One group of 54 patients were made to listen to a recorded Indian classical instrumental music before and during the procedure, while the other group of 50 patients did not. Blood pressure, heart rate and respiratory rate were recorded at the beginning of consultation and end of procedure. Perception of procedure using a three point attitude scale was assessed. Our results indicate that the background Indian classical music is efficacious in reducing psychological distress during a gastroscopic examination. We suggest that music could be applied to other medical situations as well, which tend to generate undue psychological stress and anxiety. Music, as a familiar personal and culture medium, can be used to ease anxiety, to act as distractor, to increase discomfort and pain threshold. A series of 24 patients with severe neutropenia, most of whom had acute myeloblastic leukemia, were treated in an isolation unit with oral nonabsorbable antibiotics and were compared to 21 similar patients receiving oral antibiotics alone. The frequency of bacterial infections was lower in the patients receiving both isolation and oral antibiotics compared to the patients who received only oral antibiotics. The responses to chemotherapy in terms of remission rates were identical for the two groups. In this experimental study we examined the effects of listening to relaxation-type music on self-reported anxiety and on selected physiologic indices of relaxation in patients with suspected myocardial infarction. Seventy-five patients were randomly assigned to one of two experimental groups, one listening to music and the other to "white noise," or to a control group. The State Anxiety Inventory was administered before and after each testing session, and blood pressure, heart rate, and digital skin temperature were measured at baseline and at 10-minute intervals for the 30-minute session. There was no significant difference among the three groups for state anxiety scores or physiologic parameters. Because no differences were found, analyses were conducted of the groups combined. Significant improvement in all of the physiologic parameters was found to have occurred. This finding reinforces the need for nurses to plan care that allows for uninterrupted rest for patients in the coronary care unit. Many patients in the Surgical Holding Area become stressed and anxious. In a hospital setting music reduces patients' anxiety. This study determined that music can reduce the anxiety and stress of patients in the Surgical Holding Area. In this study, one group of subjects listed to music while a second group did not. Subjects who listened to music while in the Surgical Holding Area had significantly less stress and anxiety than did those who did not listen to music. Both groups spent similar lengths of time in the Surgical Holding Area. The results strongly suggest that if music were available to all patients in the Surgical Holding Area, most would select this option, and they would experience less anxiety. Fifty-eight elderly hospital patients walked along a 10-m length of carpeted corridor and a 10-m length of vinyl-tiled corridor. Gait speed and step length were significantly greater on the carpeted than on the vinyl surface. To study the effect of music on state anxiety levels in patients undergoing flexible fiberoptic bronchoscopy (FFB).
                Randomized clinical trial using pretests, posttests, and two groups.
                Pulmonary special-procedures unit of a tertiary-care referral center.
                Sixty adult patients: 30 patients received music during bronchoscopy and 30 control subjects received no music.
                The study population had baseline state anxiety levels similar to those previously reported in surgical patients (42.6 +/- 13 vs 42.7 +/- 14; p value, not significant [NS]) and higher than those reported in normal working adults (42.6 +/- 13 vs 34.4 +/- 10; p < 0.001). Experimental and control groups were similar in patient and procedure-related characteristics and baseline pre-FFB state and trait anxiety scores. Although trait anxiety scores decreased significantly after the procedure (pooled post-FFB scores of 32.6 +/- 10 vs pre-FFB scores of 35.5 +/- 11; p < 0.001), no reductions were noted in state anxiety (pooled post-FFB scores of 42.8 +/- 13 vs pre-FFB scores of 42.6 +/- 13; p value, NS). More importantly, playing music through headphones during FFB did not result in a statistically or clinically significant reduction in either state or trait anxiety when compared to control subjects.
                Relaxation music administered through headphones to patients during flexible bronchoscopy does not decrease procedure-related state anxiety. Patients scheduled for gastrointestinal procedures such as colonoscopy or esophagogastroduodenoscopy are often anxious and frightened. High levels of anxiety may result in more difficult and painful procedures. Past research has reported education, coping skills, relaxation techniques, and combinations of these including music, have decreased anxiety in patients across many settings. Self-selected music therapy for preprocedural anxiety has not been studied. A randomized controlled trial of 198 patients was undertaken to determine whether 15 minutes of self-selected music reduced preprocedure anxiety. The State Trait Anxiety Inventory was used to measure patients' anxiety. One-hundred ninety-three men and 5 women comprised the sample with an average age of 61 (SD 10.5). Patients who listened to music (n = 100) reduced their anxiety score from 36.7 (SD 9.1) to 32.3 (SD 10.4), while those who did not listen to music (n = 98) reduced their anxiety score from 36.1 (SD 8.3) to 34.6 (SD 11.5). These differences were statistically significant (F = 7.5, p =.007) after controlling for trait anxiety. There were no significant vital sign changes premusic and postmusic. Music is a noninvasive nursing intervention that can significantly reduce patients' anxiety prior to gastrointestinal procedures. Further research should address using music to reduce anxiety in other procedure areas and testing effectiveness of self-selected versus investigator-selected music in reducing anxiety. To determine whether music significantly reduces the pain and anxiety associated with laceration repair in the emergency department.
                Adult patients presenting to the ED at an urban teaching hospital for laceration repair. Exclusion criteria included patients less than 18 years old, having received analgesics, with suspected alcohol or substance intoxication, and in whom laceration repair was complicated by treatment of a more serious medical condition.
                This was a randomized, controlled trial. After giving informed consent, patients were randomly assigned to receive standard laceration repair without music (control) or standard laceration repair with music. Patients assigned to the music group chose an audio tape from 50 available styles and artists. Patients received the music through a headset, and they controlled the volume. Intradermal lidocaine was used in all patients. Data were collected on heart rate, blood pressure, and respirations just before and immediately after wound repair. Psychological variables included the state subscale of the Spielberger State Trait Anxiety Inventory (STAI), a visual analog pain scale rating, and a brief questionnaire. STAI and pain scale ratings were analyzed with Wilcoxon's rank-sum test with an alpha error of .05.
                Thirty-eight patients (19 per group) completed the protocol. Pain scores were significantly (P less than .05) lower in the music group (mean, 2.09) than in controls (mean, 3.31). Anxiety after the procedure was reduced in both groups, but STAI reduction scores were not significantly different between groups (music, 17.7; control, 18.5). Seventeen of 19 patients (89%) rated music "very beneficial," and 100% said they would use music again.
                Music provides a safe, inexpensive, and effective adjunct for the management of pain in the ED but does not significantly affect anxiety. Despite current recommendations calling for regular screening flexible sigmoidoscopies over the age of 50, only a small percentage of the population have regular examinations. Improving patient tolerance of flexible sigmoidoscopies could therefore increase patient compliance with these recommended guidelines. The aim of this study was to determine whether audio and visual stimulation reduces discomfort during flexible sigmoidoscopy and whether the effects of the stimulation are secondary to distraction.
                A total of 37 patients undergoing routine screening flexible sigmoidoscopy were randomized to receive no intervention, audio stimulation alone, or audio and visual stimulation. Patient discomfort ratings and affect states were measured prior to and immediately following flexible sigmoidoscopy using a visual analogue scale and the Stress Symptom Ratings (SSR) ratings.
                Patients receiving audio and visual intervention had lower abdominal discomfort ratings (7.1 +/- 1.4) than patients receiving audio stimulation (9.5 +/- 1.3) or no intervention (10.8 +/- 1.6) (p < 0.05). Patients receiving audio and visual intervention also had higher arousal (7.3 +/- 0.4) and attention (9.2 +/- 0.2) ratings than patients receiving no intervention (6.1 +/- 0.4 and 6.2 +/- 0.7, respectively) (p < 0.05). Anxiety and anger ratings, on the other hand, were significantly lower in patients receiving audio and visual intervention (2.5 +/- 0.4, 1.4 +/- 0.3, respectively) than patients receiving no intervention (4.4 +/- 0.6, 3.6 +/- 0.7).
                Audio and visual stimulation reduces abdominal discomfort associated with flexible sigmoidoscopy. This effect appears to be due to distraction. Unrelieved anxiety can produce an increase in sympathetic nervous system activity leading to an increase in cardiac workload. Nursing interventions using music therapy or sensory information among patients with coronary artery disease has resulted in anxiety reduction, though results in Chinese subjects has not previously been published.
                To determine the effects of using nursing interventions of music therapy or sensory information, on reducing anxiety and uncertainty, and improving negative mood among Chinese subjects immediately prior to cardiac catheterization.
                An experimental three-group repeated measures design for this pilot study was used. Forty-five hospitalized adults (15/group) undergoing cardiac catheterization were randomly assigned to either (1) a music therapy intervention, (2) a sensory information intervention or (3) treatment as usual (control). Anxiety, uncertainty and mood state were measured using self-reported questionnaires and physiological measures were made at baseline, post-intervention to determine their effect and post-cardiac catheterization to determine whether these interventions had any long-lasting effect.
                The control group was found to be significantly older (P=0.001) than the two experimental groups. Older age was associated with lower anxiety scores (r=-0.31, P=0.04 at baseline; r=-0.30, P=0.04 post-intervention; r=-0.22, P=0.15 post-cardiac catheterization). After controlling for age, the use of music therapy or sensory information did not significantly reduce anxiety, improve mood state, reduce uncertainty, decrease heart or respiratory rate among subjects undergoing cardiac catheterization.
                The non-significant result may have been affected by the small sample, and the social and cultural expectations regarding the public display of emotions among Chinese populations. Ambulatory surgery can create significant anxiety. This prospective study measured whether music can influence anxiety and perioperative sedative requirements in outpatients undergoing surgery with spinal anesthesia. We also evaluated the correlation between two anxiety measures, the State-Trait Anxiety Inventory test (STAI) and the 0- to 10-cm visual analog scale (VAS 0-10), with 0 meaning complete relaxation and 10 the worst feeling of anxiety possible. Fifty unpremedicated patients were randomly assigned to listen to music of their choice via headset during the perioperative period (Group I) or to have no music (Group II). All participants used patient-controlled IV midazolam sedation and underwent repeated evaluations of their anxiety level with the STAI and the VAS 0-10. Midazolam requirements during surgery (Group I, 0.6 +/- 0.7 versus Group II, 1.3 +/- 1.1 mg; P < 0.05) and for the whole perioperative period (Group I, 1.2 +/- 1.3 versus Group II, 2.5 +/- 2.0 mg; P < 0.05) were smaller in patients listening to music. Anxiety levels, measured with STAI or VAS 0-10, were similar in both groups. The Spearman's coefficient values between STAI and VAS 0-10 ranged from 0.532 to 0.687. We conclude that patients listening to music require less midazolam to achieve a similar degree of relaxation as controls and that measures of anxiety obtained from the STAI and the VAS 0-10 are positively, but only moderately, correlated.
                It is possible to decrease sedative requirements during surgery under spinal anesthesia by allowing patients to listen to music to reduce their anxiety. Acute myocardial infarction places additional demands on an already compromised myocardium. Relaxing music can induce a relaxation response, thereby reversing the deleterious effects of the stress response.
                To compare the effects of relaxing music; quiet, uninterrupted rest; and "treatment as usual" on anxiety levels and physiological indicators of cardiac autonomic function.
                A 3-group repeated measures experimental design was used. Forty-five patients, 15 per group, with acute myocardial infarction were assigned randomly to 20 minutes of (1) music in a quiet, restful environment (experimental group); (2) quiet, restful environment without music (attention); or (3) treatment as usual (control). Anxiety levels and physiological indicators were measured.
                Immediately after the intervention, reductions in heart rate, respiratory rate, and myocardial oxygen demand were significantly greater in the experimental group than in the control group. The reductions in heart rate and respiratory rate remained significantly greater 1 hour later. Changes in heart rate, respiratory rate, and myocardial oxygen demand in the attention group did not differ significantly from changes in the other 2 groups. The 3 groups did not differ with respect to systolic blood pressure. Increases in high-frequency heart rate variability were significantly greater in the experimental and attention groups than in the control group immediately after the intervention. State anxiety was reduced in the experimental group only; the reduction was significant immediately and 1 hour after the intervention.
                Patients recovering from acute myocardial infarction may benefit from music therapy in a quiet, restful environment. Labor pain is often severe, and analgesic medication may not be indicated. In this randomized controlled trial we examined the effects of music on sensation and distress of pain in Thai primiparous women during the active phase of labor. The gate control theory of pain was the theoretical framework for this study. Randomization with a computerized minimization program was used to assign women to a music group (n = 55) or a control group (n = 55). Women in the intervention group listened to soft music without lyrics for 3 hours starting early in the active phase of labor. Dual visual analog scales were used to measure sensation and distress of pain before starting the study and at three hourly posttests. While controlling for pretest scores, one-way repeated measures analysis of covariance indicated that those in the music group had significantly less sensation and distress of pain than did the control group (F (1, 107) = 18.69, p <.001, effect size =.15, and F (1, 107) = 14.87, p <.001, effect size =.12), respectively. Sensation and distress significantly increased across the 3 hours in both groups (p <.001), except for distress in the music group during the first hour. Distress was significantly lower than sensation in both groups (p <.05). In this controlled study, music--a mild to moderate strength intervention--consistently provided significant relief of severe pain across 3 hours of labor and delayed the increase of affective pain for 1 hour. Nurses can provide soft music to laboring women for greater pain relief during the active phase when contractions are strong and women suffer. Pain related to the gurney is a frequent complaint of older emergency department (ED) patients. The authors hypothesized that these patients may have less pain and higher satisfaction if allowed to sit in a reclining hospital chair.
                A single-blind, randomized controlled trial was performed. Patients 65 years old or older who were able to sit upright, transfer, and engage in normal conversation were eligible. Severely ill or cognitively impaired patients were excluded. Patients were randomized to either remain on the gurney or transfer to the chair after initial evaluation. Patients reported pain at arrival (t0), at one hour (t1), and at two hours (t2) using a 0-10 pain scale, and satisfaction at study completion on a 0-10 scale. The primary outcome was a decrease in pain between t0 and t1 or no pain at both t0 and t1. This outcome was analyzed using a 95% confidence interval for the difference between proportions; exclusion of zero was considered significant.
                Sixty-six patients in each group were enrolled. There was no difference in demographics between groups, but the chair patients were more likely to have pain at t0 than the gurney patients. More chair patients than gurney patients had a successful primary outcome (97% vs. 76%, 21% difference, 95% CI=10% to 32%). The mean satisfaction score was higher in the chair group than in the gurney group (8.1 vs. 6.0, 2.1 difference, 95% CI=1.4% to 2.8%).
                The simple modification of allowing older ED patients to sit in reclining chairs resulted in less pain and higher satisfaction. The aim of this study was to investigate the effects of music on the anxiety of patients on mechanical ventilation, as assessed by objective parameters and a subjective validated anxiety scale.
                Mechanical ventilation, although sometimes lifesaving, is often associated with levels of anxiety requiring sedatives, which has inevitable implications on costs and complications.
                A randomized controlled trial design.
                A total of 64 subjects was randomly assigned to undergo either 30 minutes of music intervention or a rest period. The subjects were asked to answer the Chinese State Trait Anxiety Inventory scale before and after the study period and physiological indices and resting behaviours were recorded before and after the study period in both groups. The subjects' satisfaction with music was also obtained after music intervention.
                The findings indicate that patients on mechanical ventilation that listened to a single 30-minute session of music appeared to show greater relaxation as manifested by a decrease in physiological indices and an increase in comfortable resting behaviours.
                Music can provide an effective method of reducing potentially harmful physiological responses arising from anxiety in mechanically ventilated patients.
                As indicated by the results of this study, music therapy can act as a simple and safe nursing intervention to allay anxiety and promote patient comfort. Interest and comments on music therapy provided as a relaxation technique should be elicited from both nurses and patients. To determine whether music moderates the level of anxiety that patients experience during radiation therapy.
                Experimental, longitudinal, random assignment to music or no music therapy.
                Urban radiation oncology center in a Department of Veterans Affairs hospital in the southeastern United States.
                Forty-two men (19 in the experimental group, 23 in the control group) aged 39-80 years (74% white, 12% African American, 12% Hispanic, and 2% other) receiving definitive external beam radiation therapy for pelvic or abdominal malignancies.
                Patients in the experimental group listened to music of their choice provided via audiotapes and headphones before and during their simulation and daily treatments for the duration of the planned course of therapy. The control group received standard care. The State-Trait Anxiety Inventory was administered initially to participants in both groups at the time of evaluation (time 1), post-simulation (time 2), at the end of the first week (time 3), at the end of the third week (time 4), and at the end of the fifth week or end of radiation therapy (time 5).
                State anxiety.
                No significant difference existed between the two groups to suggest that music moderated the level of anxiety during radiotherapy. However, post-hoc analyses identified changes and trends in state anxiety scores, suggesting a possible benefit of music therapy during radiotherapy.
                Despite a lack of group differences, early intervention with music therapy for patients with high levels of anxiety may be beneficial.
                Nurses and other clinicians may administer state anxiety scales at the initial visit or prior to pretreatment radiation planning (simulation). Individuals who have high state anxiety scores may receive nursing interventions tailored to reduce anxiety during simulation and the early part of radiotherapy. A prospective randomized controlled trial was performed to test the hypotheses that music decreases the dose of sedative medication required for colonoscopy and that the combination of music and patient-controlled sedation improves patient acceptance of colonoscopy.
                One hundred sixty-five patients scheduled to undergo elective colonoscopy were randomized to receive 1 of 3 different modes of sedation: Group 1, a combination of music and patient-controlled sedation with a mixture of propofol and alfentanil; Group 2, patient-controlled sedation alone; Group 3, music alone with diazemuls and meperidine administered intravenously if requested by the patient. Each bolus of patient-controlled sedation delivered 4.8 mg propofol and 12 microg alfentenil. Music was provided by means of a portable compact disc machine with headphones. Outcome measures assessed immediately after colonoscopy and 24 hours later included dose of patient-controlled sedation used, complications, recovery time, pain score, satisfaction score, and willingness to repeat the procedure with the same mode of sedation.
                The mean (SD) dose of propofol used in Group 1 was significantly less than Group 2 (0.84 mg/kg [0.69 mg/kg] vs. 1.15 mg/kg [0.83 mg/kg]; p = 0.02, t test). The mean (SD) satisfaction score was higher in Group 1 (7.8 [2.1]) compared with Group 2 (6.8 [2.3]) and Group 3 (7.4 [2.3]) (p = 0.05, 1-way analysis of variance). The majority of patients in Group 1 were willing to repeat the same mode of sedation when queried immediately after colonoscopy (87%) and 24 hours later (75%), which was significantly different from the corresponding results in the other 2 groups; p = 0.04 and p < 0.01 respectively, chi-square test.
                Music can decrease the dose of sedative medication required for colonoscopy. The combination of music and patient-controlled sedation was the best-accepted mode of sedation among 3 groups. Pain associated with chest tube removal is a major problem for patients who undergo open heart surgery. Because this pain is short-lived, timing the administration of pharmacological agents for pain relief is difficult and is therefore done inconsistently.
                To examine the effect of music as an intervention for pain relief during chest tube removal after open heart surgery.
                In an experimental design, 156 subjects (mean age, 66 years; 69% men) were randomly assigned to 1 of 3 groups: control, white noise, or music. All subjects preselected the type of music they preferred hearing. Ten minutes before the chest tube was removed, the patient's heart rate and blood pressure were measured, the patient rated pain intensity by using a numeric rating scale, and the prerecorded audiotape of music was begun. The patients rated their pain again immediately after chest tube removal and 15 minutes later. Physiological variables were assessed every 5 minutes until 15 minutes after the chest tubes were removed.
                Self-reported pain intensity, physiological responses, and narcotic intake after chest tube removal did not differ significantly among the 3 groups.
                Although the findings were not statistically significant, most subjects enjoyed listening to the music, and therefore the use of music as an adjuvant to other therapies may be an appropriate nursing intervention. Screening flexible sigmoidoscopy (FS) is an effective tool for the detection of colon cancer. Nonetheless, persons are reluctant to undergo FS for a variety of reasons such as anxiety, discomfort, and the possibility of abnormal findings. Nurses caring for FS patients can implement interventions to allay anxiety and promote comfort in an effort to enhance satisfaction and future compliance. Music therapy is one nonpharmacologic intervention that has been shown to be effective in allaying anxiety, reducing discomfort, and promoting satisfaction in other patient populations. A two-group pretest, posttest experimental design with repeated measures study recruited 64 subjects undergoing FS from one Midwestern tertiary care center. Subjects were randomly assigned to a control condition of usual procedural care or to an experimental condition of music therapy during the examination. State and trait anxieties were measured at pretest. State anxiety, discomfort, satisfaction, and perceived compliance with future screening were measured after the procedure. Subjects in the music group reported less anxiety and discomfort than subjects in the control group. There were no differences on satisfaction ratings or perceived compliance with screening guidelines. Nurses caring for patients undergoing screening FS can offer music therapy as one nonpharmacologic intervention to ameliorate anxiety and reduce discomfort. This study was designed to determine whether music or music in combination with therapeutic suggestions in the intra-operative period under general anaesthesia could improve the recovery of hysterectomy patients.
                In a double-blind randomised clinical investigation, 90 patients who underwent hysterectomy under general anaesthesia were intra-operatively exposed to music, music in combination with therapeutic suggestion or operation room sounds. The anaesthesia was standardised. Postoperative analgesia was provided by a patient-controlled analgesia (PCA). The pain scores were recorded by means of a visual analogue scale. Nausea, emesis, bowel function, fatigue, well-being and duration of hospital stay were studied as outcome variables.
                On the day of surgery, patients exposed to music in combination with therapeutic suggestions required less rescue analgesic compared with the controls. Patients in the music group experienced more effective analgesia the first day after surgery and could be mobilised earlier after the operation. At discharge from the hospital patients in the music and music combined with therapeutic suggestion group were less fatigued compared to the controls. No differences were noted in nausea, emesis, bowel function, well-being or length of hospital stay between the groups.
                This double-blind study has demonstrated that intra-operative music and music in combination with therapeutic suggestions may have some beneficial effects on postoperative recovery after hysterectomy. Further controlled studies are necessary to confirm our results. To determine whether music influences intraoperative sedative and analgesic requirements, two randomized controlled trials were performed.
                In phase 1, 35 adults undergoing urologic procedures with spinal anesthesia and patient-controlled intravenous propofol sedation were randomly assigned to hear favorable intraoperative music via headset or to have no music. In phase 2, 43 adults undergoing lithotripsy treatment of renal or ureteral calculi and receiving patient-controlled intravenous opioid analgesia were randomly assigned to either a music or no-music group. The effect of music on sedatives and analgesics requirements, recovery room duration, and adverse outcomes was assessed.
                In phase 1, patients in the music group required significantly less propofol for sedation than patients in the control group (0 [0-150] mg vs. 90 [0-240] mg, median[range]; P < 0.001). These findings persisted after adjusting for duration of surgery (0.3+/-0.1 mg/min vs. 1.6+/-0.4 mg/min; P < 0.001). Similarly, in phase 2, patients who listened to music had a significant reduction in alfentanil requirements (1,600 [0-4,250] microg vs. 3,900 [0-7,200] microg; P = 0.005). This persisted after adjusting for duration of surgery (52+/-9 microg/min vs. 119 +/-16 microg/min, mean +/- SD, P < 0.001). Duration of stay in the postanesthesia care unit and the rate of adverse events was similar in both groups (P = NS).
                Use of intraoperative music in awake patients decreases patient-controlled sedative and analgesic requirements. It should be noted, however, that patients in the no-music group did not use a headset during operation. 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. Music has long been known to reduce anxiety, minimize the need for sedatives, and make patients feel more at ease. The purpose of the study was to evaluate the effect of music in elderly outpatients undergoing elective cataract surgery with retrobulbar block and monitored anaesthetic care using fentanyl or alfentanil and midazolam.
                One hundred and twenty one patients were prospectively and randomly assigned to hear: relaxing suggestions, white noise, operating room noise or relaxing music via audio-cassette headphones. Vital signs were documented before and after retrobulbar block and every 15 min thereafter. Anxiety was assessed using the State-Trait Anxiety Inventory (STAI) before and after surgery. Visual analogue scales (VAS) were used to assess anxiety and patient satisfaction postoperatively with a standardized questionnaire. Between group comparisons were made using Chi-Square, or ANOVA, where appropriate.
                There were no differences between groups in STAI or anxiety VAS scores at any time. Differences were noted in systolic blood pressure, but not in other vital signs. Patients' ratings of the whole operative experience, satisfaction with the tape played, general level of relaxation and preference for the chosen tape for subsequent surgery were different (music > relaxing suggestions > white noise and OR noise, P < 0.05).
                Elderly patients undergoing cataract surgery under retrobulbar block were more satisfied with their experience if they heard relaxing music, rather than relaxing suggestions or white noise or OR noise. The type of auditory stimuli to which the patients were exposed did not influence the level of anxiety. Administration of sedatives and analgetics during colonoscopy includes the risk for arterial hypotension and respiratory depression. The aim of this study was to assess whether music therapy increases patients tolerance and reduces the need of analgo-sedative premedication.
                146 consecutive patients were examined in a randomized, prospective study. Colonoscopy was performed under intravenous administration with titrated dosages of midazolam and pethidin. Oxygen was given in cases of blood desaturation below values of 90%. Patients younger than 18 and older than 80 years, patients with history of partial colectomy, gastrectomy or hysterectomy and patients with colonic tumorous or inflammatory stenosis were excluded. 60 patients underwent conventional procedure (Group A), whereas 59 patients received additional music therapy (Group B). Time required to reach the cecum (examination time) was measured and the rate of successful colonoscopies was determined.
                Most of the patients required sedation with midazolam in both groups (97 vs. 93%), whereas more group A patients required analgesia with pethidin than group B patients (43 vs. 31%, p<0.05). Under music therapy the rate of completed colonoscopies was higher (group A 93%, group B 98%) and examination time was significantly accelerated (group A 22.8 +/- 14.6 min, group B 16.8 +/- 11.8 min, p<0.03).
                Accompanying music therapy reduces requirement of analgesia during colonoscopy, favours completion of the procedure and shortens examination time. Music therapy seems to promote safer conditions for endoscopical practice and diminishs patients discomfort. The possible antinociceptive effect of hemispheric-synchronised sounds, classical music and blank tape were investigated in patients undergoing surgery under general anaesthesia. The study was performed on 76 patients, ASA 1 or 2, aged 18-75 years using a double-blind randomised design. Each of the three tapes was allocated to the patients according to a computer-generated random number table. General anaesthesia was standardised and consisted of propofol, nitrous oxide 66%/oxygen 33%, isoflurane and fentanyl. Patients breathed spontaneously through a laryngeal mask and the end-tidal isoflurane concentration was maintained near to its minimum alveolar concentration value of 1.2%. Fentanyl was given intravenously sufficient to keep the intra-operative heart rate and arterial blood pressure within 20% of pre-operative baseline values and the fentanyl requirements were used as a measure of nociception control. Patients to whom hemispheric-synchronised sounds were played under general anaesthesia required significantly less fentanyl compared with patients listening to classical music or blank tape (mean values: 28 microgram, 124 microgram and 126 microg, respectively) (p < 0.001). This difference remained significant when regression analysis was used to control for the effects of age and sex. Open-heart surgery patients report anxiety and pain with chair rest despite opioid analgesic use. The effectiveness of non-pharmacological complementary methods (sedative music and scheduled rest) in reducing anxiety and pain during chair rest was tested using a three-group pretest-posttest experimental design with 61 adult postoperative open-heart surgery patients. Patients were randomly assigned to receive 30 min of sedative music (N=19), scheduled rest (N=21), or treatment as usual (N=21) during chair rest. Anxiety, pain sensation, and pain distress were measured with visual analogue scales at chair rest initiation and 30 min later. Repeated measures MANOVA indicated significant group differences in anxiety, pain sensation, and pain distress from pretest to posttest, P<0.001. Univariate repeated measures ANOVA (P< or =0.001) and post hoc dependent t-tests indicated that in the sedative music and scheduled rest groups, anxiety, pain sensation, and pain distress all decreased significantly, P<0.001-0.015; while in the treatment as usual group, no significant differences occurred. Further, independent t-tests indicated significantly less posttest anxiety, pain sensation, and pain distress in the sedative music group than in the scheduled rest or treatment as usual groups (P<0.001-0.006). Thus, in this randomized control trial, sedative music was more effective than scheduled rest and treatment as usual in decreasing anxiety and pain in open-heart surgery patients during first time chair rest. Patients should be encouraged to use sedative music as an adjuvant to medication during chair rest. Management of pain in the immediate postoperative period is a major concern of postanesthesia nurses. Music is a nursing intervention with the potential to decrease patient perception of pain in the PACU. The purpose of this study was to examine the effect of the use of music on the level of patient pain in the immediate postoperative period. A quasi-experimental study design was used with three study groups. All patients scheduled for elective abdominal hysterectomies using a general anesthesia technique were eligible for participation in the study. The setting is a PACU in a community hospital in a suburban area. Subjects were asked to rate their pain level every 15 minutes while in the PACU using two valid and reliable measures, a verbal pain rating scale and a graphic numeric pain intensity scale. Repeated measures of analysis of variance showed no differences in level of pain between groups or over time. The sedative effects of music were evaluated using the bispectral index (BIS) during target-controlled infusion (TCI) propofol. A total of 110 women undergoing hysterectomy were randomly allocated to receive either music or no music. Propofol was administered using target-controlled infusion and the concentration adjusted gradually to achieve an observer's assessment of alertness/sedation (OAA/S) score of 3 intra-operatively. The haemodynamic and bispectral index values during the sedation phase were recorded. Interleukin-6 was evaluated before, immediately after and 1 h following intervention. The music group had a significant reduction in mean (SD) induction time of sedation: 12 (12) min vs. 18 (12) min, p < 0.01; propofol target concentration: 1.6 (0.3) microg.ml(-1) vs. 2.4 (0.4) microg.ml(-1), p < 0.0001; intra-operative amount of propofol: 171 (98) mg vs. 251 (92) mg, p < 0.0001; and significantly higher levels of satisfaction with their peri-operative care: 9.6 (0.6) compared to the control group: 8.1 (1.0), p < 0.0001. No other differences were found. The results show the influence of music on the induction time of sedation, concentration and level of propofol during surgery, and suggest sedative benefits of music. The objective of the study was to compare development in symptoms, behaviours, treatment and patient satisfaction of a traditional interior and an interior furnished like an ordinary home in a seclusion area. A naturalistic sample of 56 consecutive patients admitted to an acute ward was allocated to two different seclusion areas, one with a traditional interior and one decorated as an ordinary home. Symptoms of psychopathology, therapeutic steps taken, violent episodes, length of patient stay and patient satisfaction were recorded. There were no differences in changes in scores on The Positive and Negative Syndrome Scale for schizophrenia, The Brøset Violence Checklist or the Global Assessment of Function split version scale between the two patient groups. Therapeutic steps taken, number of violent episodes and length of patient stay was also similar. Female patients preferred an ordinary home interior. It was concluded that interior and furnishing like an ordinary home in the seclusion areas created an environment with comparable treatment outcomes to the traditional dismal interior, and had positive effects on many patients' well-being, at least among the women. The traditional beliefs that a sparsely decorated interior is a method to reduce symptoms of psychopathology and dangerous behaviours were not supported by our data. Colonoscopies are usually performed using pharmacological sedation. This process entails certain risks. In the search for alternative methods, some studies have analysed the effect music can have on patients during the procedure when used as a complement to sedation. We present a prospective, randomized study in which we assess the anxiolytic action music has when it is administered during a single colonoscopy.
                We included 118 patients who were scheduled for ambulatory colonoscopies. They were randomly assigned to the control group (n = 55) and the experimental group (n = 63). We determined their levels of anxiety using the State-Trait Anxiety Inventory Test (STAI) form, which they filled in before and after the examination. Patients listened to music through personal headphones.
                The score on the STAI form before the examination was 25.25 +/- 10.49 and 28.16 +/- 11.43 in the control and experimental groups, respectively (P > 0.05). The decrease of the score on the STAI scale after the colonoscopy in the control and experimental groups was 6.27 (95% confidence interval, 3.26-9.28) and 11.35 (95% confidence interval, 8.64-14.05), respectively (P < 0.01).
                Listening to music during ambulatory colonoscopies decreases the level of anxiety that is inherent to the process without other anxiolytic methods. Immediately before they underwent femoral angiography, 45 patients were given one of three types of audiotapes: a relaxation response tape recorded for this study, a tape of contemporary instrumental music, or a blank tape. All patients were instructed to listen to their audiotape during the entire angiographic procedure. Each audiotape was played through earphones. Radiologists were not told the group assignment or tape contents. The patients given the audiotape with instructions to elicit the relaxation response (n = 15) experienced significantly less anxiety (P less than .05) and pain (P less than .001) during the procedure, were observed by radiology nurses to exhibit significantly less pain (P less than .001) and anxiety (P less than .001), and requested significantly less fentanyl citrate (P less than .01) and diazepam (P less than .01) than patients given either the music (n = 14) or the blank (n = 16) control audiotapes. Elicitation of the relaxation response is a simple, inexpensive, efficacious, and practical method to reduce pain, anxiety, and medication during femoral angiography and may be useful in other invasive procedures. This paper reports a study to test the hypothesis that day surgery patients who listen to music during their preoperative wait will have statistically significantly lower levels of anxiety than patients who receive routine care.
                Although previous day surgery research suggests that music effectively reduces preoperative anxiety, methodological issues limit the generalizability of results.
                In early 2004, a randomized controlled trial design was conducted to assess anxiety before and after listening to patient preferred music. Participants were allocated to an intervention (n=60), placebo (n=60) or control group (n=60). Pre- and post-test measures of anxiety were carried out using the State-Trait Anxiety Inventory.
                Music statistically significantly reduced the state anxiety level of the music (intervention) group. No relationships were found between socio-demographic or clinical variables such as gender or type of surgery.
                The findings support the use of music as an independent nursing intervention for preoperative anxiety in patients having day surgery. This randomized controlled trial was designed to evaluate, first, whether intra- or postoperative music therapy could influence stress and immune response during and after general anaesthesia and second, if there was a different response between patients exposed to music intra- or postoperatively.
                Seventy-five patients undergoing open hernia repair as day care surgery were randomly allocated to three groups: intraoperative music, postoperative music and silence (control group). Anaesthesia and postoperative analgesia were standardized and the same surgeon performed all the operations. Stress response was assessed during and after surgery by determining the plasma cortisol and blood glucose levels. Immune function was evaluated by studying immunoglobulin A (IgA) levels. Patients' postoperative pain, anxiety, blood pressure (BP), heart rate (HR) and oxygen saturation were also studied as stress markers.
                There was a significantly greater decrease in the level of cortisol in the postoperative music group vs. the control group (206 and 72 mmol L(-1) decreases, respectively) after 2 h in the post anaesthesia care unit. The postoperative music group had less anxiety and pain and required less morphine after 1 h compared with the control group. In the postoperative music group the total requirement of morphine was significantly lower than in the control group. The intraoperative music group reported less pain after 1 h in the post anaesthesia care unit. There was no difference in IgA, blood glucose, BP, HR and oxygen saturation between the groups.
                This study suggests that intraoperative music may decrease postoperative pain, and that postoperative music therapy may reduce anxiety, pain and morphine consumption. We previously demonstrated that audio distraction using relaxation music could lead to a decrease in the dose of sedative medication required and improve patient satisfaction during colonoscopy. This prospective randomized controlled trial was designed to test the hypotheses that visual distraction may also decrease the requirement for sedatives and that audio and visual distraction may have additive beneficial effects when used in combination.
                165 consecutive patients who underwent elective colonoscopy were randomly allocated into three groups to receive different modes of sedation: group 1 received visual distraction and patient-controlled sedation (PCS); group 2 received audiovisual distraction and PCS; group 3 received PCS alone. A mixture of propofol and alfentanil, delivered by a Graseby 3300 PCA pump, was used for PCS in these groups. Each bolus of PCS delivered 4.8 mg propofol and 12 micro g alfentanil. Measured outcomes included the dose of PCS used, complications, recovery time, pain score, satisfaction score, and willingness to use the same mode of sedation if the procedure were to be repeated.
                Eight patients were excluded after randomization. The mean+/-SD dose of propofol used in group 2 (0.81 mg/kg +/- 0.49) was significantly less than the dose used in group 1 (1.17 mg/kg +/- 0.81) and that used in group 3 (1.18 mg/kg +/- 0.60) ( P < 0.01, one-way analysis of variance). The mean +/- SD pain score was also lower in group 2 (5.1 +/- 2.5), compared with the pain scores in group 1 (6.2 +/- 2.2) and group 3 (7.0 +/- 2.4) ( P < 0.01, one-way analysis of variance). The mean +/- SD satisfaction score was higher in groups 1 (8.2 +/- 2.4)) and 2 (8.4 +/- 2.4), compared with the score in group 3 (6.1 +/- 2.9) ( P < 0.01, one-way analysis of variance). A majority of patients in groups 1 (73 %) and 2 (85 %) said that they would be willing to use the same mode of sedation again, compared with only 53 % in group 3 ( P < 0.01, chi-squared test).
                Visual distraction alone did not decrease the dose of sedative medication required for colonoscopy. When audio distraction was added, both the dose of sedative medication required and the pain score decreased significantly. Both visual and audiovisual distraction might improve patients' acceptance of colonoscopy. Pre-operative anxiety is common and often significant. Ambulatory surgery challenges our pre-operative goal of an anxiety-free patient by requiring people to be 'street ready' within a brief period of time after surgery. Recently, it has been demonstrated that music can be used successfully to relieve patient anxiety before operations, and that audio embedded with tones that create binaural beats within the brain of the listener decreases subjective levels of anxiety in patients with chronic anxiety states. We measured anxiety with the State-Trait Anxiety Inventory questionnaire and compared binaural beat audio (Binaural Group) with an identical soundtrack but without these added tones (Audio Group) and with a third group who received no specific intervention (No Intervention Group). Mean [95% confidence intervals] decreases in anxiety scores were 26.3%[19-33%] in the Binaural Group (p = 0.001 vs. Audio Group, p < 0.0001 vs. No Intervention Group), 11.1%[6-16%] in the Audio Group (p = 0.15 vs. No Intervention Group) and 3.8%[0-7%] in the No Intervention Group. Binaural beat audio has the potential to decrease acute pre-operative anxiety significantly. nan
Music may improve patient-reported outcomes in certain circumstances, so support for this relatively inexpensive intervention may be justified. For some environmental interventions, well designed research studies have yet to take place.