Benefits of intraoperative music on orthopedic surgeries under spinal anesthesia: A randomized clinical trial

Decreasing Preoperative Anxiety in Patients with Newly Available Multimodal Approaches-A Narrative Review

Preoperative anxiety affects approximately 80% of adult patients; thus, identifying patients with excessive anxiety and implementing appropriate interventions can significantly reduce the risk of deterioration during the perioperative period. This narrative review presents current knowledge about pharmacological and nonpharmacological methods for reducing preoperative anxiety. Commonly used pharmacological options include benzodiazepines, ketamine, or fentanyl. Antidepressants have also been shown to be effective in alleviating symptoms, but they typically require four weeks to take effect. Establishment of supportive relationships with medical staff to help patients express their feelings have been shown to have a positive impact on anxiety reduction. Other nonpharmacological methods include the provision of information through informed consent forms, video materials, virtual reality, or the use of psychotherapeutic interventions such as breathing techniques, music therapy, or cognitive-behavioural therapy. Some studies suggest that essential oils may have a role in reducing perioperative anxiety. Nonpharmacological interventions can be used in patients of different ages. An increasing number of researchers advocate for a holistic approach that integrates less invasive and cost-effective interventions with conventional medicine. While various interventions have been proposed to manage preoperative anxiety, more research is needed to establish the most effective and feasible interventions for different patient populations.

Music during cataract surgery: effect on anxiety

PURPOSE

To determine the effect of playing patient-selected music intraoperatively on patient self-reported anxiety and the amount of sedative administered during cataract surgery.

SETTING

Yale New Haven Hospital health system, New Haven, Connecticut.

DESIGN

Prospective, randomized, controlled clinical trial.

METHODS

Patients were randomized to either a music group or a control group, which had no music played. Patients were blinded to the purpose of the study. On postoperative day 1, patients were consented to participate in the study and asked to complete a 6-question Likert-style survey (modified from the State-Trait Anxiety Inventory) assessing anxiety at baseline and during surgery. Patients' intraoperative and postoperative vitals were recorded. The medication, dosage, and number of sedative injections given were also recorded. Paired t tests were used to assess for significant differences between the 2 groups.

RESULTS

107 patients (mean age 71.2 years) were enrolled in the study. There was no significant difference in baseline anxiety between the 2 groups. Patients randomized to the music group had significantly lower total self-reported anxiety (mean 5.98) than the control group (mean 7.13, P = .006). Moreover, patients exposed to music felt significantly less frightened, nervous, and confused during surgery ( P = .002, .007, and 0.017, respectively). There was no significant difference between the groups in number and dosage of sedatives given.

CONCLUSIONS

Playing patient-selected music during cataract surgery is an effective way to decrease anxiety. Music directly affects patient experience and is an inexpensive, low-risk method of reducing patient anxiety during surgery.

The effect of guided imagery applied on geriatric orthopaedic patients on preoperative anxiety and comfort

BACKGROUND

This study was designed to examine the effect of guided imagery applied to geriatric orthopaedic patients on preoperative anxiety and comfort.

METHODS

This study was conducted as a randomized controlled trial. The population of the study consisted of geriatric patients treated in the orthopaedics and traumatology clinic of a university hospital. The sample consisted of 80 patients, including the experimental group (n = 40) and the control group (n = 40). Personal Descriptive Form, The State-Trait Anxiety Inventory (STAI) and General Comfort Scale were used as data collection tools.

RESULTS

After the guided imagery application, it was determined that the anxiety of the experimental group decreased statistically significantly, and their comfort improved (P < 0.05).

CONCLUSION

After the imagery, it was determined that the patients in the experimental group had a decrease in their anxiety level and an improvement in their comfort. Since it is a low-cost and easily accessible method, applying imagery in the preoperative period is recommended.

Assessing the Safety and Efficacy of Spinal Anesthesia in Patients with Significant Comorbidities

BACKGROUND

Spinal anesthesia is an effective modality for lumbar surgery. Patient eligibility with respect to medical comorbidities remains a topic of debate. Obesity (body mass index ≥30 kg/m2), anxiety, obstructive sleep apnea, reoperation at the same level, and multilevel operations have variously been reported as relative contraindications. We hypothesize that patients undergoing common lumbar surgeries with these comorbidities do not experience greater rates of complications compared with controls.

METHODS

We analyzed a prospectively collected database of patients undergoing thoracolumbar surgery under spinal anesthesia and identified 422 cases. Surgeries were less than 3 hours (the duration of action of intrathecal bupivacaine) and include microdiscectomies, laminectomies, and both single-level and multilevel fusions. Procedures were performed by a single surgeon at a single academic center. In overlapping groups, 149 patients had a body mass index ≥30 kg/m2, 95 had diagnosed anxiety, 79 underwent multilevel surgery, 98 had obstructive sleep apnea, and 65 had a previous operation at the same level. The control group included 132 patients who did not have these risk factors. Differences in important perioperative outcomes were assessed.

RESULTS

There were no statistically significant differences in intraoperative and postoperative complications except 2 cases of pneumonia in the anxiety group and 1 case in the reoperative group. There were also no significant differences for patients with multiple risk factors. Rates of spinal fusion were similar among groups, although mean length of stay and operative time were different.

CONCLUSIONS

Spinal anesthesia is a safe option for patients with significant comorbidities and can be considered for most patients undergoing routine lumbar surgeries.

Music therapy for reducing anxiety in patients undergoing total knee replacement surgery under subarachnoid anesthesia

BACKGROUND

Non-pharmacological interventions such as music are being increasingly used in clinical settings.

OBJECTIVE

To assess the effects of music on patients undergoing total knee replacement (TKR) surgery under subarachnoid anesthesia.

METHODS

This randomized controlled trial examined participants (45/group) in a music and non-music group. Anxiety was measured in both the groups using (1) the adapted hospital anxiety and depression scale (HADS), (2) Spielberger state trait anxiety inventory (STAI-S), (3) visual analog scale (VAS), (4) cortisol levels, and (5) blood pressure. Music was delivered using an MP3 player and headphones. Hemodynamic data was collected before, during, and after music therapy. Cortisol and stress levels were measured postoperatively. VAS was assessed 30 min before surgery, 30 min after the administration of anesthesia, and 30 min after the surgery ended in the recovery room to obtain comparative data on pain levels at 3 different phases using a numeric rating scale.

RESULTS

Changes in the mean VAS scores from the pre-to postoperative phase were significantly different between the music and non-music groups (p = .001). The mean (±standard deviation [SD]) HADS and STAI-S scores of the non-music group were higher than those in the music group (HADS:15.58 ± 2.231 vs 11.91 ± 3.218; STAI-S: 54.04 ± 2.899 vs 48.87 ± 4.595). There were significant differences in the mean systolic and diastolic blood pressure and mean heart rate between the groups based on time (both, p < .001). Correlation regression analysis for the cortisol level revealed a certain relationship between age and cortisol level (p < .05).

CONCLUSIONS

These results suggest that music can reduce patients' anxiety level in the operating room. Studies on music therapy for patients undergoing lower limb orthopedic surgery, especially under subarachnoid anesthesia, are extremely limited. Therefore, this study can serve as a reference regarding the application of music therapy in the medical field.