Introducing a music program in the perioperative area

The benefits of perioperative music interventions for patients undergoing neurosurgery: a mixed-methods systematic review

BACKGROUND

Several studies have demonstrated music intervention as a safe and inexpensive option for reducing anxiety and pain perioperatively. We performed a systematic review to evaluate its possible benefit in perioperative neurosurgical management.

METHODS

The following databases were searched with no restrictions on publication date: PubMed, Embase, CINAHL, PsycINFO, CENTRAL and ClinicalTrials.gov. All studies that quantitatively or qualitatively assessed the effects of any music-based intervention administered within one week of cranial or spinal neurosurgery were eligible. Meta-analysis could not be performed, and quantitative findings were instead summarised narratively. We then synthesised qualitative observations through thematic analysis before conducting an integrative review. PROSPERO registration: CRD42019152626.

RESULTS

Seven studies, of sample sizes ranging from 8 to 60, were included, with the timing, duration, frequency and type of music intervention varying considerably across studies. Quantitative analysis involving five studies showed a significant decrease in anxiety following music intervention in four studies (p < 0.05), and reduced pain perception in three studies (p < 0.05). Mixed evidence was obtained for physiological outcomes including heart rate and blood pressure. Risk of bias was moderate to high. Quantitative findings were generally supported by qualitative analysis which provided additional insight into the factors influencing music intervention's effectiveness.

CONCLUSION

Despite the heterogeneity in study characteristics, this review, which is the first mixed-methods systematic review assessing the effects of perioperative music intervention, not only reveals a potential role for music intervention in neurosurgery, but also highlights the possible importance of considering qualitative evidence in future studies to better characterise its effectiveness.

Non-pharmacologic Approaches in Preoperative Anxiety, a Comprehensive Review

During the pre-operation period, surgical candidates experience situations that stimulate psychological anxiety leading to stress during and after surgery which is known as preoperative anxiety. This condition can cause psychological and physiological adverse effects on both children and adults. Due to the high prevalence and adverse effects of preoperative anxiety, different treatments have been evaluated including pharmacological and non-pharmacological approaches. As pharmacological treatments may cause adverse effects such as breathing problems, drowsiness, interfering with anesthetic drugs, and prolonged recovery, non-pharmacological interventions are becoming more popular. These methods include cognitive-behavioral therapy, music therapy, pre-op preparation video, aromatherapy, hypnosis, guided imagery relaxation therapy, and massage. In this study, the most popular non-pharmacological approaches to preoperative anxiety are reviewed focusing on more recent evidence provided by clinical studies. The reviewed clinical evidence on the mentioned methods shows the efficacy of non-pharmacological interventions for the treatment of preoperative anxiety, so they can be used in patients of different ages and types of disease and surgery.

The Multisensory/Snoezelen Environment to Optimize the Dental Care Patient Experience

This article provides a brief overview of how the environment can affect behavior and that well-designed spaces can affect how patients handle stress. The application of the Snoezelen multisensory interactive calming strategies and devices that were installed in all facets of a community dental practice are described. These principles of creating a calming dental home improved behavior, cooperation, and satisfaction with care in persons with disabilities and reduced the need for sedation or general anesthesia. It is proposed that the creation of similar clinics with multisensory calming features could improve community access to dental care for persons with special needs.

The Effects of Clinical Music Therapy on Resiliency in Adults Undergoing Infusion: A Randomized, Controlled Trial

CONTEXT

Eighty-seven patients newly diagnosed with lung, breast, or gastrointestinal cancer and undergoing chemotherapy in the infusion suite of a large urban hospital in New York City.

OBJECTIVE

Patients were enrolled in this study of music therapy's impact on resilience in coping with the impact of symptoms inclusive of symptom clustering.

METHODS

Patients were randomly assigned to three arms: clinical instrumental improvisation or clinical vocal improvisation 43 subjects to instrumental improvisation or vocal improvisation and 44 subjects to control. All subjects received a Medical Music Psychotherapy Assessment including psychosocial information and music preferences, pre-/post-Resilience Scale, Hospital Anxiety and Depression Scale, Visual Analogue Scale/Faces Scale, and a pain-Color Analysis Scale. Interventions included 20-minute music therapy (MT) and two additional sessions.

RESULTS

Significant increases in Resilience Scale in MT groups after treatment with instrumental and vocal MT interventions equally potent-reflect average changes of 3.4 and 4.83 (P = 0.625), respectively. Although Hospital Anxiety and Depression Scale scores showed little impact of MT on perceived anxiety/depression, a strong correlation is seen between vocal intervention and lower depression scores through Visual Analogue Scale-rendered postsessions. This yielded a significant decrease in pain levels immediately after MT, with the final session showing the most significant change in pain level. Resilience in enduring procedures is a necessary component of combating potential negative illness perception.

CONCLUSION

Our study shows MT's facility to propel resilience in patients newly diagnosed with cancer, particularly when promoting and pairing adaptation toward coping through the expression of perceived negative effects of emotional and physiological symptoms.

Effects of Tibetan Music on Neuroendocrine and Autonomic Functions in Patients Waiting for Surgery: A Randomized, Controlled Study

Background

The aim of this study was to investigate the effects of listening to Tibetan music on anxiety and endocrine, autonomic, cognitive responses in patients waiting for urologic surgery.

Methods

Sixty patients waiting for surgery were enrolled to the study. They were randomized in music (M) and control (C) groups. The M group listened to a low-frequency Tibetan music for 30 min (T₀-T₃₀) through headphones, and the C group wore headphones with no sound. The State Trait Anxiety Inventory Questionnaire (STAI) Y-1 was administered at T₀ and T₃₀. Normalized low (LFnu) and high frequencies (HFnu) of heart rate variability, LF/HF ratio, and galvanic skin response (GRS) data were analyzed at T₀, T₁₀, T₂₀, T₃₀, and T₃₅. The salivary α-amylase (sAA) samples were collected at T₀, T₃₅, and T₄₅.

Results

In the M group, the STAI Y-1 score decreased at T₃₀ versus baseline (p < 0.001), sAA levels decreased at T₃₅ versus T₀(p=0.004), and GSR remained unchanged. In the C group, the STAI Y-1 score remained unchanged, sAA level increased at T₃₅ versus T₀(p < 0.001), and GSR slightly increased at T₃₅ versus baseline (p=0.359). LFnu was lower, and HFnu was significantly higher (T₁₀-T₃₀) in M versus C group. Mean LF/HF ratio slightly reduced in the M group.

Conclusions

Our results suggest that preoperative listening to relaxing Tibetan music might be a useful strategy to manage preoperative anxiety.

Does Listening to Music during Tonsillectomy Affect Sevoflurane Consumption?

OBJECTIVE

The aim of this study was to investigate the effect of listening to music on the consumption of an anesthetic agent as well as postoperative recovery and pain in children undergoing elective tonsillectomy.

MATERIALS AND METHODS

Fifty patients were randomized into those to whom music was played during surgery (group M) and a control group to whom music was not played (group C). The depth of anesthesia was provided by entropy levels of 50 ± 5 in both groups. Demographic characteristics and hemodynamic parameters were recorded perioperatively. The duration of surgery, sevoflurane consumption, eye opening time, and extubation time were also recorded. p < 0.05 was considered statistically significant.

RESULTS

Surgical pleth index values measured intraoperatively were statistically lower in group M than in group C. In the postanesthesia care unit children in the music group felt less pain than those in the control group according to the Wong-Baker Faces Pain Rating Scale (p = 0.035). The heart rates of the patients in the music group were statistically lower at 30 min intraoperatively and at the end of the procedure compared to the values of the control group (p = 0.015). The consumption of sevoflurane was lower in group M than in group C but the difference was not statistically significant. The need for additional fentanyl was significantly lower in group M than in group C.

CONCLUSION

In this study, the children exposed to music intraoperatively needed less analgesia during surgery, and reported less pain postoperatively, but there was no difference in sevoflurane requirements.

Music Interventions in Oncology Settings: A Systematic Literature Review

This paper presents a systematic review of published research investigating therapeutic applications of music in cancer patients. The review focuses on published international research from the USA, Canada, Australia and European countries using four electronic databases: PSYCHINFO, WEB OF SCIENCE, MEDLINE and SCIENCEDIRECT. Twenty four papers were identified and each paper was coded in terms of sample type, basic research question, research design and methodological details, results and implications for future research. Utilising previous work such as Aldridge (2003) as a point of departure, this review provides information on the key areas of interest in the psychology of music therapy and the therapeutic use of music amongst cancer patients and gives an account of the methodological approaches that were adopted. Results provide an overview of reported outcomes of music interventions such as reduction in anxiety, reduction in side effects of chemotherapy, physiological effects, psychological effects, behavioural improvements and communication and expression improvements.

Music Therapy References Relating to Cancer and Palliative Care

Hospitals and clinics worldwide have incorporated music therapy in their work with cancer patients and in palliative care. As the music therapy profession has developed internationally, so has its role in palliative care. The arts and creative arts therapies are being seen as a form of spiritual care in healthcare settings, particularly where individuals are confronting life-threatening illnesses. By offering opportunities to engage in the arts and develop creative expression, people with cancer can be enabled to mourn, grieve, celebrate life, be empowered to endure their situation, and find healing and meaning. In many studies we find that music therapy is not simply used with the identified patients but also with their families and carers. As well as noting the importance of work with patients and their families, music therapists also emphasise the importance of music for their own healing. This is necessary to meet personal needs when working with the dying and in the context of a broader hospital milieu of colleagues and friends.

The World Health Organisation's recommendations for cancer relief and palliative care are to affirm life and regard dying as a normal process, to provide relief from pain and distressing symptoms, to integrate the psychological and spiritual aspects of patient care, to offer a support system to help patients as actively as possible until death, and to offer a support system to help the family cope during the illness and in their own bereavement. Music therapy has the potential to meet all of these recommendations.

Blood Pressure and Heart Rate Alterations through Music in Patients Undergoing Cataract Surgery in Greece

INTRODUCTION

Music has been proposed as a safe, inexpensive, nonpharmacological antistress intervention. The purpose of this study was to determine whether patients undergoing cataract surgery while listening to meditation music experience lower levels of blood pressure and heart rate.

METHODS

Two hundred individuals undergoing cataract surgery participated in the study. Hundred individuals listened to meditation music, through headphones, before and during the operation (intervention group) and 100 individuals received standard care (control group). Patients stress coping skills were measured by the Sense of Coherence Scale (SOC Scale). Systolic and diastolic blood pressure and heart rate were defined as outcome measures.

RESULTS

According to the SOC Scale, both groups had similar stress coping skills (mean score: 127.6 for the intervention group and 127.3 for the control group). Before entering the operating room (OR) as well as during surgery the rise in systolic and diastolic pressures was significantly lower in the intervention group (P < 0.001). Among patients receiving antihypertensive therapy, those in the intervention group presented a lower increase only in systolic pressure (P < 0.001) at both time recordings. For those patients in the intervention group who did not receive antihypertensive treatment, lower systolic blood pressure at both time recordings was recorded (P < 0.001) while lower diastolic pressure was observed only during entry to the OR (P = 0.021). Heart rate was not altered between the two groups in any of the recordings.

CONCLUSIONS

Meditation music influenced patients’ preoperative stress with regard to systolic blood pressure. This kind of music can be used as an alternative or complementary method for blood pressure stabilizing in patients undergoing cataract surgery.

Music is Beneficial for Awake Craniotomy Patients: A Qualitative Study

Objectives: Patients undergoing awake craniotomy may experience high levels of stress. Minimizing anxiety benefits patients and surgeons. Music has many therapeutic effects in altering human mood and emotion. Tonality of music as conveyed by composition in major or minor keys can have an impact on patients’ emotions and thoughts. Assessing the effects of listening to major and minor key musical pieces on patients undergoing awake craniotiomy could help in the design of interventions to alleviate anxiety, stress and tension. Methods: Twenty-nine patients who were undergoing awake craniotomy were recruited and randomly assigned into two groups: Group 1 subjects listened to major key music and Group 2 listened to minor key compositions. Subjects completed a demographics questionnaire, a pre- and post-operative Beck Anxiety Inventory (BAI) and a semi-structured open-ended interview. Results were analyzed using modified thematic analysis through open and axial coding. Results: Overall, patients enjoyed the music regardless of the key distinctions and stated they benefitted from listening to the music. No adverse reactions to the music were found. Subjects remarked that the music made them feel more at ease and less anxious before, during and after their procedure. Patients preferred either major key or minor key music but not a combination of both. Those who preferred major key pieces said it was on the basis of tonality while the individuals who selected minor key pieces stated that tempo of the music was the primary factor. Conclusion: Overall, listening to music selections was beneficial for the patients. Future work should further investigate the effects of audio interventions in awake surgery through narrative means.

Sensory environment on health-related outcomes of hospital patients

BACKGROUND

Hospital environments have recently received renewed interest, with considerable investments into building and renovating healthcare estates. Understanding the effectiveness of environmental interventions is important for resource utilisation and providing quality care.

OBJECTIVES

To assess the effect of hospital environments on adult patient health-related outcomes.

SEARCH METHODS

We searched: the Cochrane Central Register of Controlled Trials (last searched January 2006); MEDLINE (1902 to December 2006); EMBASE (January 1980 to February 2006); 14 other databases covering health, psychology, and the built environment; reference lists; and organisation websites. This review is currently being updated (MEDLINE last search October 2010), see Studies awaiting classification.

SELECTION CRITERIA

Randomised and non-randomised controlled trials, controlled before-and-after studies, and interrupted times series of environmental interventions in adult hospital patients reporting health-related outcomes.

DATA COLLECTION AND ANALYSIS

Two review authors independently undertook data extraction and 'Risk of bias' assessment. We contacted authors to obtain missing information. For continuous variables, we calculated a mean difference (MD) or standardized mean difference (SMD), and 95% confidence intervals (CI) for each study. For dichotomous variables, we calculated a risk ratio (RR) with 95% confidence intervals (95% CI). When appropriate, we used a random-effects model of meta-analysis. Heterogeneity was explored qualitatively and quantitatively based on risk of bias, case mix, hospital visit characteristics, and country of study.

MAIN RESULTS

Overall, 102 studies have been included in this review. Interventions explored were: 'positive distracters', to include aromas (two studies), audiovisual distractions (five studies), decoration (one study), and music (85 studies); interventions to reduce environmental stressors through physical changes, to include air quality (three studies), bedroom type (one study), flooring (two studies), furniture and furnishings (one study), lighting (one study), and temperature (one study); and multifaceted interventions (two studies). We did not find any studies meeting the inclusion criteria to evaluate: art, access to nature for example, through hospital gardens, atriums, flowers, and plants, ceilings, interventions to reduce hospital noise, patient controls, technologies, way-finding aids, or the provision of windows. Overall, it appears that music may improve patient-reported outcomes such as anxiety; however, the benefit for physiological outcomes, and medication consumption has less support. There are few studies to support or refute the implementation of physical changes, and except for air quality, the included studies demonstrated that physical changes to the hospital environment at least did no harm.

AUTHORS' CONCLUSIONS

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.

Clinical trial: music reduces anxiety levels in patients attending for endoscopy

BACKGROUND

Patients attending for endoscopy are generally anxious and worried.

AIMS

To examine whether music reduced anxiety levels in patients attending for endoscopic procedures.

METHODS

Prospective randomized controlled trial of 180 patients (M:F 81:99). The effect of age (< or = or >51 years) and procedure (gastroscopy or flexible sigmoidoscopy/colonoscopy) on anxiety levels (state-trait anxiety inventory) on arrival in the unit and immediately before the endoscopy procedure, after listening to music or no music (control group) for the same period.

RESULTS

At baseline, anxiety levels were not influenced by age (< or =51 years, n = 56:42.21 +/- 9.18; >51 years, n = 124:39.99 +/- 10.13 (P = 0.15) or procedure: gastroscopy, n = 87:39.43 +/- 9.9, flexible sigmoidoscopy/colonoscopy: n = 93:41.86 +/- 9.75 (P = 0.98). No difference was found in anxiety scores in the control group (n = 88) at baseline and immediately pre-endoscopy (P = 0.243), but music led to a significant reduction in anxiety scores (n = 92), which was maintained for all age groups irrespective of procedure (all P < 0.0001).

CONCLUSIONS

Anxiety levels in patients attending for endoscopy were not influenced by age or procedure, but were significantly reduced by listening to music compared to controls. The availability of music within the endoscopy unit is a simple strategy that will improve the well-being of patients.

[Diagnostic flexible bronchoscopy. Recommendations of the Endoscopy Working Group of the French Society of Pulmonary Medicine]

These guidelines on flexible bronchoscopy depict important clues to be known and taken into account while practicing flexible bronchoscopy, in adult, except in emergency situations. This is a practical clarification. Safety conditions, complications, anesthesia, infectious risks, cleaning and disinfection are detailed from a review of the literature. Intensive care practice of bronchoscopy requires more attention due to higher risks patients and is discussed extensively. Standards and performances of the various sampling techniques complete this work. Indications for bronchoscopy, therapeutic and paediatric bronchoscopy are not covered in these guidelines.

Effects of music therapy on women's physiologic measures, anxiety, and satisfaction during cesarean delivery

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.

A controlled trial of music and pre-operative anxiety in Chinese men undergoing transurethral resection of the prostate

AIM OF THE STUDY

To test the effects of music intervention on pre-operative anxiety in Chinese males undergoing transurethral resection of the prostate.

RATIONALE

No studies have measured the effects of music intervention in reducing pre-operative anxiety for patients with transurethral resection of the prostate (TURP). Previous studies have examined the effects of music on pre-operative anxiety but have not examined the possible effects of the presence of a carer as an independent variable in pre-operative anxiety levels of patients in addition to the music intervention. The cultural validity of applying a music intervention to the reduction of pre-operative anxiety was also investigated.

DESIGN

A quasi-experimental design with three groups: music intervention, nurse presence and control group.

METHOD

Thirty patients having TURP were randomly assigned (n = 10 each group) to one of the three groups. Pre- and post-test measures of systolic and diastolic blood pressure, heart rate and state anxiety using the Chinese State-Trait Anxiety Inventory (C-STAI) were obtained for the three groups.

RESULTS

The findings showed that the music intervention significantly reduced all blood pressure levels for the patients. A reduction in state anxiety level was also found for the music intervention group. No significant reductions in blood pressure, heart rate and state anxiety level were found in the nurse presence and control groups.

CONCLUSION

The results support the cross-cultural validity of using a music intervention in pre-operative anxiety reduction, in this case for TURP patients waiting in the theatre holding area.

Music, immunity and cancer

The effects of music on the immune system and cancer development were evaluated in rodents subjected to sound stress. Animals were exposed daily to broad band noise around midnight and/or music for 5 hours on the following morning. Thymus and spleen cellularity, peripheral T lymphocyte population, the proliferative response of spleen cells to mitogen concanavalin A and natural killer cell activity were calculated in BALB/c mice. Sprague Dawley rats were injected i.v. with Walker 256 carcinosarcoma cells; 8 days later the rats were sacrificed and the number of metastatic nodules on the surface of the lungs was calculated macroscopically. Music reduced the suppressive effects of stress on immune parameters in mice and decreased the enhancing effects of stress on the development of lung metastases provoked by carcinosarcoma cells. Music enhanced the immune parameters and the anti-tumor response in unstressed rodents. Our data at present demonstrates that music can effectively reverse adverse effects of stress on the number and capacities of lymphocytes that are required for an optimal immunological response against cancer in rodents.

Music and preoperative anxiety: a randomized, controlled study

Music may decrease the anxiety experienced by patients before surgery. Previous studies of this issue were hindered with multiple methodological problems. In this investigation, we examined this hypothesis while using a rigorous study design and objective outcome measures. Adult patients undergoing anesthesia and surgery were randomly assigned to two study groups. Subjects in Group 1 (n = 48) listened to a 30-min patient-selected music session, and subjects in Group 2 (n = 45) received no intervention. By using self-report validated behavioral (State-Trait Anxiety Inventory) and physiological measures of anxiety (heart rate, blood pressure, and electrodermal activity and serum cortisol, epinephrine, and norepinephrine), patients were evaluated before, during, and after administration of the intervention. We found that after intervention, subjects in the Music group reported significantly lower anxiety levels as compared with the Control group (F(1,91) = 15.4, P = 0.001). That is, the postintervention anxiety level of subjects in the Music group decreased by 16% as compared with the preintervention level, whereas the anxiety level of the Control group did not change significantly. Two-way repeated-measures analysis of variance performed for the electrodermal activity, blood pressure, heart rate, cortisol, and catecholamine data demonstrated no group difference and no time x group interaction (P = not significant). In conclusion, under the conditions of this study, patients who listened to music before surgery reported lower levels of state anxiety. Physiological outcomes did not differ, however, between the two study groups.

IMPLICATIONS

Patients who listen to music of their choice during the preoperative period report less anxiety.

Psychological preparation of the parent and pediatric surgical patient

Some 3 million children undergo anesthesia and surgery in the United States every year; 40% to 60% of these children develop significant behavioral stress prior to surgery. Multiple interventions have been suggested to treat the preoperative behavioral stress responses in children. There is a trend toward reducing both behavioral and pharmacological preoperative interventions aimed at children, perhaps because though there is a consensus that preoperative interventions can be useful, almost no outcome studies have evaluated the effects of these interventions on measurable, clinically "important" postoperative outcomes. More research is needed in this area.

The effectiveness of music as an intervention for hospital patients: a systematic review

INTRODUCTION

Over the past few decades there has been a growing interest in the use of music, which has seen it used to achieve a diverse range of outcomes. While music as an intervention for hospital patients has subject to considerable evaluation, many of these studies are small and findings are therefore often contradictory. This systematic review was conducted to investigate the effectiveness of music as an intervention for hospital patients.

METHOD

A comprehensive search was undertaken involving all major health care databases. For studies to be included in the review they must have investigated the effect of music, involved adult hospital patients and used a randomized controlled trial design. These studies must also have used outcome measures such as anxiety, satisfaction, pain, mood and vital signs. Identified studies were critically appraised, and then categorized according to whether music was evaluated during normal care delivery or during invasive and unpleasant procedures. When appropriate, studies were combined in a meta-analysis.

RESULTS

A total of 29 studies were identified that fulfilled the inclusion criteria, of which 10 were subsequently excluded following critical appraisal. Music played via headphones reduces anxiety of patients during normal care deliver, but it has no impact on the anxiety of patients undergoing procedures such as bronchoscopy, sigmoidoscopy or surgery with a spinal anaesthetic. Music produces a small reduction in respiratory rate during normal care delivery, but appears to have little effect on other vital sign parameters. It has no impact on the vital signs of patients undergoing procedures. Although the evidence is limited, music also appears improve the mood and tolerance of patients.

CONCLUSION

This review demonstrates the effectiveness of music for the reduction of anxiety during normal care deliver. Given the inexpensive nature of this intervention, and the lack of adverse events, it is recommended as an adjunct to normal care practices. This review also highlights the need for further research into many aspect of this intervention.

Sensory stimuli and anxiety in children undergoing surgery: a randomized, controlled trial

We assessed the effectiveness of a behavioral intervention aimed at reducing the anxiety of children undergoing anesthesia and surgery. The intervention consisted of dimmed operating room (OR) lights (200 Lx) and soft background music (Bach's "Air on a G String," 50-60 dB). Only one person, the attending anesthesiologist, interacted with the child during the induction of anesthesia. Children undergoing anesthesia and surgery were randomly assigned either to a low sensory stimulation group (LSSG, n = 33) or to control group (n = 37). By using validated behavioral measures of anxiety (mYPAS) and compliance (ICC), children were evaluated at the preoperative holding area and during the induction of anesthesia. On postoperative Days 1, 2, 3, 7, and 14, the behavioral recovery of the children was assessed by using the Post Hospitalization Behavior Questionnaire. We found that the LSSG was significantly less anxious compared with the control group on entrance to the OR (P = 0.03) and on the introduction of the anesthesia mask (P = 0.003). Also, the compliance during the induction of anesthesia was significantly better in children assigned to the LSSG (P = 0.02). The incidence of postoperative behavioral changes, however, did not differ significantly between the two groups (P = ns). We conclude that children who are exposed to low-level sensory stimuli during the induction of anesthesia and who are exposed to background music exhibit lower levels of anxiety and increased compliance.

IMPLICATIONS

Children are less anxious and show increased compliance during induction when exposed to a single care-provider in a dimmed, quiet operating room with background music.

Minimizing preoperative anxiety with alternative caring-healing therapies

This article reviews holistic caring-healing therapies that may decrease preoperative anxiety for the surgical patient, based on the philosophy and science of caring developed by Jean Watson, RN, PhD, FAAN. Dr Watson reveals a new paradigm emerging in health care that blends the compassion and caring of nursing in harmony with the curative therapies of medicine. Hypnosis, aromatherapy, music, guided imagery, and massage are integrative caring-healing therapies that may minimize preoperative anxiety. Alternative therapies offer a high-touch balance when integrated with high-tech conventional surgical treatments.

Reducing noise pollution in the hospital setting by establishing a department of sound: a survey of recent research on the effects of noise and music in health care

A proposal for a solution to reduce stress and anxiety in the hospital setting by combining the problems of excess noise in a hospital setting with the efficacy of music therapy is supported through an analysis of research in the field of noise, hospital noise pollution, and music medicine. Included in this overview are articles describing the effects of noise on health, the problems of noise pollution in the health care setting, and the benefits of replacing noise with music to reduce heart rate, blood pressure, breathing rate, emotional anxiety, and pain. By combining these areas of research, the authors propose the establishment of a department assigned to (1) control the amount of noise in a hospital and (2) provide a center of music therapy for all individuals in the hospital setting, including in-patients, out-patients, doctors, and staff. Due to the large specificity of these areas, this unifying source, or "Department of Sound," is suggested to aid in thoroughly addressing and combining these two concepts most effectively.