The effect of music with and without binaural beat audio on operative anxiety in patients undergoing cataract surgery: a randomized controlled trial

Can Binaural Beat Music Be Useful as a Method to Reduce Dental Patients' Anxiety?

BACKGROUND

One of the main issues in dentistry and a barrier to offering dental treatment is anxiety. The usage of music is one of the nonmedical ways to reduce anxiety. Binaural beat technology is used as a music treatment technique. The goal of this study wasto determine whether employing binaural beat technology during and after dental appointments can help patients feel less anxiety and pain.

METHODS

In this clinical trial, 80 patients who were candidates for mandibular wisdom tooth surgery (in 2 test and control groups) were examined. In the control group, after the injection of anaesthesia and before surgery, they waited for 10 minutes and during this time no intervention was done. In the test group, thought, after the injection of anaesthesia, the patients were asked to listen to binaural beat music with headphones for 10 minutes. The level of anxiety of the patients before and after the intervention was checked with the Spielberger State-Trait Anxiety Inventory and finally the data were entered into SPSS version 21 software.

RESULTS

The score of overt anxiety (P = .524) and covert anxiety (P = .118) before the start of the study was not significant between the 2 groups, but overt anxiety (P = .001) and covert anxiety (P = .000) after the intervention in the test group decreased significantly.

CONCLUSIONS

The research showed that the use of binaural beat music has significantly reduced the level of overt and covert anxiety in patients and can be used as an alternative nonpharmacologic method to reduce anxiety.

Pentatonic sequences and monaural beats to facilitate relaxation: an EEG study

Introduction

In two studies we investigated if specific acoustic stimulations could be more effective to induce a relaxation response in comparison to silence. Acoustic stimulations included monaural beats and musical sequences based on a pentatonic scale.

Methods

In the first study, 47 participants evaluated monaural beats and pentatonic sequences presented through loudspeakers and varying along three frequencies (0.2, 2, 4 Hz). In the second study, 31 participants relaxed with their eyes closed for 10 min during a passive listening of monaural beats and a pentatonic sequence presented through loudspeakers. A silence condition was introduced as control. All auditory stimuli were designed with a temporal modulation of 0.2 Hz. Concomitant EEG was recorded with a 64-channel system and spectral analysis was performed on delta, theta, alpha, beta, and gamma oscillations to test if each of the three auditory stimulations had a significant effect on EEG spectral power in comparison to silence.

Results

In the first study, pentatonic sequences were evaluated as more pleasant and more relaxing than monaural beats. Pleasantness and relaxation were inversely related to frequency. Visual imagery and emotion induction had higher frequency and were rated with a more positive valence in pentatonic sequences than in monaural beats. In the second study monaural beats in comparison to silence strongly decreased beta and gamma oscillations in the first three minutes and strongly increased theta oscillations in the last three minutes. Pentatonic sequences increased delta, theta, and alpha oscillations in the last three minutes while decreasing beta, and gamma oscillations for the whole auditory stimulation.

Discussion

The results show that auditory signals with a very low temporal modulation (0.2 Hz) could be more effective than silence in inducing a relaxation response. Although 0.2 Hz monaural beats were effective in inducing a relaxation response, they tended to be perceived as unpleasant. Pentatonic sequences could be considered as a better alternative to promote relaxation by auditory stimulation.

The association between cataract surgery and mental health in older adults: a review

BACKGROUND

Although cataract surgery has been proposed as a potentially modifiable protective factor for enhancing emotional well-being in cataract patients, studies examining the relationship between anxiety or depression and cataract surgery have yielded inconsistent findings. This review summarizes existing evidence to establish whether cataract surgery is associated with depression and anxiety in older adults.

METHODS

A literature search was conducted across PubMed, Medline, Web of Science, and Embase databases. An initial screening by abstracts and titles was performed, followed by a review and assessment of the methodological quality of the relevant full papers, and final inclusion of 44 studies were deemed eligible for inclusion in this review.

RESULTS

Among 44 included studies, 36 studies (81.8%) were observational studies concerning the association of cataract surgery or cataracts with anxiety or depression, four studies (9.1%) were interventional studies, and four studies (9.1%) were reviews. Cataract surgery notably enhances the mental health of individuals with impaired vision. However, the multifaceted nature of psychological well-being, influenced by various factors, suggests that cataract surgery may not address all aspects comprehensively. Additionally, preoperative anxiety and depression significantly impact cataract surgery outcomes.

CONCLUSION

Vision impairment in older adults is closely associated with increased symptoms of depression and anxiety. While surgical intervention for cataracts improves these symptoms, it might be less effective for mental disorders with multifactorial causes. Notably, anxiety or depression poses challenges to successful preoperative and intraoperative cataract surgeries.

Effects of a music-based intervention on psychophysiological outcomes of patients undergoing medical imaging procedures: A systematic review and meta-analysis

INTRODUCTION

Musical intervention (MI) is a valuable strategy for addressing the psychological and emotional challenges faced by patients undergoing imaging procedures. This study explores MI's impact on psychophysiological outcomes during imaging procedures, detailing the sound repertoire and technical characteristics employed in MI.

METHODS

A systematic review (SR) and meta-analysis (MA) were conducted. Electronic database searches of PubMed, Web-of-Science, and Scopus were performed encompassing original randomised research and quasi-experimental articles published until June 2023.

RESULTS

Thirteen articles were included in this SR, scoring between 23 and 68 on the Joanna Briggs Institute (JBI) Checklist. Four articles were included to perform a MA concerning anxiety and heart rate (HR) outcomes. Most studies utilised digital playlists as the medium for MI. Headphones were commonly used, with an average volume of 50-60 dB and a musical frequency of 60-80 beats/min. While authors generally preferred selecting musical genres for the repertoire, two articles specifically chose Johann Pachelbel's "Canon in D major" as their musical theme. In terms of psychological parameters, the experimental groups exhibited lower anxiety values than the control groups, with further reductions after MI. However, MA shows that this trend is only marginally significant. Patient comfort and overall examination experience showed improvement with MI. Regarding physiological parameters, HR, especially in the final phase of the examination, was significantly lower in the experimental group compared to the control group.

CONCLUSION

Across multiple studies, MI demonstrated the ability to reduce anxiety and HR. However, no specific music repertoire emerged as the most effective.

IMPLICATIONS FOR PRACTICE

MI arises as a painless, reliable, low-cost, and side-effect-free strategy, presenting imaging departments with a practical means to enhance patient comfort and mitigate anxiety and stress during medical procedures.

Listening to music during intranasal (es)ketamine therapy in patients with treatment-resistant depression correlates with better tolerability and reduced anxiety

Background

Although the effectiveness of (es)ketamine for therapy-resistant depression (TRD) has been established, potential treatment-limiting factors include side effects like dissociation, anxiety, or elevated blood pressure. Music can reduce stress and negative emotions as anxiety. This study aimed to investigate the impact of listening to music during intranasal (es)ketamine administration on both tolerability and efficacy.

Methods

Records of 494 sessions (of 37 patients) with intranasal (es)ketamine administration, each containing data of blood pressure measurements, DSS-IV (dissociation symptoms scale-IV), anxiety and euphoria analogue scale, MADRS (Montgomery-Åsberg Depression Rating Scale) and BDI (Beck's Depression Inventory) were evaluated.

Results

The between-group analysis, comparing participants who listened to music with those who did not, revealed significant differences in the administered dose (p-value: 0.003, mean: 131.5 mg with music vs. 116.7 mg without music), scores on the DSS Item 1 (p-value: 0.005, mean: 3 points vs. 2.4 points), levels of anxiety (p-value: <0.001, mean: 0.4 points vs. 1.4 points), and measurements of maximal systolic blood pressure after administration (p-value: 0.017, mean: 137.9 mmHg vs. 140.3 mmHg). Listening to music had no impact on the MARDS-change score between the sessions.

Limitations

Key limitations include a non-randomized naturalistic design and the non-standardized selection of music, which was based on individual patient preferences.

Conclusion

Listening to music during intranasal (es)ketamine therapy appears to be linked to reduced anxiety and lower blood pressure, stable or increased dissociation levels, and improved tolerance for higher doses. These findings could potentially contribute to the optimization of (es)ketamine therapy, both in terms of treatment efficacy and managing side effects.

Neural consequences of binaural beat stimulation on auditory sentence comprehension: an EEG study

A growing literature has shown that binaural beat (BB)-generated by dichotic presentation of slightly mismatched pure tones-improves cognition. We recently found that BB stimulation of either beta (18 Hz) or gamma (40 Hz) frequencies enhanced auditory sentence comprehension. Here, we used electroencephalography (EEG) to characterize neural oscillations pertaining to the enhanced linguistic operations following BB stimulation. Sixty healthy young adults were randomly assigned to one of three listening groups: 18-Hz BB, 40-Hz BB, or pure-tone baseline, all embedded in music. After listening to the sound for 10 min (stimulation phase), participants underwent an auditory sentence comprehension task involving spoken sentences that contained either an object or subject relative clause (task phase). During the stimulation phase, 18-Hz BB yielded increased EEG power in a beta frequency range, while 40-Hz BB did not. During the task phase, only the 18-Hz BB resulted in significantly higher accuracy and faster response times compared with the baseline, especially on syntactically more complex object-relative sentences. The behavioral improvement by 18-Hz BB was accompanied by attenuated beta power difference between object- and subject-relative sentences. Altogether, our findings demonstrate beta oscillations as a neural correlate of improved syntactic operation following BB stimulation.

Effect of music on preoperative anxiety using the Hamilton State-Trait Anxiety Inventory (STAI) in patients undergoing cataract surgery in the University of Nigeria Teaching Hospital, Ituku Ozalla

INTRODUCTION

To determine the effectiveness of music in allaying preoperative anxiety in patients scheduled for and undergoing surgery for age-related cataract.

METHODS

This is a randomised interventional study of individuals aged 50 years and above who were scheduled for and undergoing cataract surgery under regional anaesthesia, with music (test group) randomly matched with similar individuals undergoing the same procedure but without music (control group). The surgeries were performed at the Ophthalmology Theatre of the University of Nigeria Teaching Hospital (UNTH), Ituku Ozalla, Enugu, Nigeria. Using a systematic random sampling method, a total of 98 patients were selected into two groups. Both groups completed the State-Trait Anxiety Inventory (STAI) Questionnaire at baseline, immediately on entrance into the preoperative room and 5 min after intervention. The first group listened to music while the second group did not listen to music. Results were analysed using the SPSS V.20 and analysis of variance was used to compare means of variables measured at baseline, preoperative before intervention and preoperative after intervention. Categorical variables were compared using the χ2 test. Student's t-test was used to analyse the continuous variables.

RESULTS

There was an increase in the anxiety scores in the two groups on entrance into the preoperative room, however, 5 min into intervention, there was a significant decrease in the anxiety scores in the music group and a progressive increase in the anxiety scores in the group without music.

CONCLUSION

Music has a positive effect on preoperative anxiety evidenced by the indirect effect of music on the STAI anxiety scores.

Perioperative Anxiety and Depression in Older Adults: Epidemiology and Treatment

The intervals before and after major surgery is a high-risk period for older adults; in this setting, anxiety and depression are common and serious problems. We comprehensively reviewed current evidence on perioperative anxiety and depression in older adults, focusing on epidemiology, impact, correlates, medication risks, and treatment. Principles of perioperative mental healthcare are proposed based on the findings. Prevalence estimates of clinically significant anxiety and depression range from 5% to 45% for anxiety and 6% to 52% for depression, depending on surgical populations and measurement tools. Anxiety and depression may increase risk for surgical complications and reduce patient participation during rehabilitation. Medical comorbidities, pain, insomnia, cognitive impairment, and delirium are common co-occurring problems. Concomitant uses of central nervous system acting medications (benzodiazepines, anticholinergics, and opioids) amplify the risks of delirium and falls. Based on these findings, we propose that anxiety and depression care should be part of perioperative management in older adults; components include education, psychological support, opioid-sparing pain management, sleep management, deprescribing central nervous system active medications, and continuation and optimization of existing antidepressants. More research is needed to test and improve these care strategies.

Beta and gamma binaural beats enhance auditory sentence comprehension

Binaural beats-an auditory illusion produced when two pure tones of slightly different frequencies are dichotically presented-have been shown to modulate various cognitive and psychological states. Here, we investigated the effects of binaural beat stimulation on auditory sentence processing that required interpretation of syntactic relations (Experiment 1) or an evaluation of syntactic well formedness (Experiment 2) with a large cohort of healthy young adults (N = 200). In both experiments, participants performed a language task after listening to one of four sounds (i.e., between-subject design): theta (7 Hz), beta (18 Hz), and gamma (40 Hz) binaural beats embedded in music, or the music only (baseline). In Experiment 1, 100 participants indicated the gender of a noun linked to a transitive action verb in spoken sentences containing either a subject or object-relative center-embedded clause. We found that both beta and gamma binaural beats yielded better performance, compared to the baseline, especially for syntactically more complex object-relative sentences. To determine if the binaural beat effect can be generalized to another type of syntactic analysis, we conducted Experiment 2 in which another 100 participants indicated whether or not there was a grammatical error in spoken sentences. However, none of the binaural beats yielded better performance for this task indicating that the benefit of beta and gamma binaural beats may be specific to the interpretation of syntactic relations. Together, we demonstrate, for the first time, the positive impact of binaural beats on auditory language comprehension. Both theoretical and practical implications are discussed.

Benefits of Music Intervention on Anxiety, Pain, and Physiologic Response in Adults Undergoing Surgery: A Systematic Review and Meta-analysis

PURPOSE

Evidence on factors influencing the variations of music's effect on anxiety and pain in surgical patients is unclear. We aimed to elucidate the effects of music intervention on anxiety and pain throughstudy characteristics.

METHODS

We conducted a search on the PubMed, CINAHL, Embase, Cochrane, and Web of Science databases from March 7 to April 21, 2022, for randomized controlled trials (RCTs) for the effect of music intervention on anxiety, pain, and physiological responses in surgical patients. We included studies published within the last 10 years. We assessed the risk of bias in the study using the Cochrane risk of bias tool for randomized trials and performed meta-analyses using a random-effects model for all outcomes. We used change-from-baseline scores as summary statistics and computed bias-corrected standardized mean differences (Hedges'g) for anxiety and pain outcomes and mean differences (MD) for blood pressure and heart rate.

RESULTS

Of the 454 records retrieved, 30 RCTs involving 2280 participants were found to be eligible. Music intervention was found to be superior to standard care in reducing anxiety (Hedges' g = -1.48, 95% confidence interval: -1.97 to -0.98), pain (Hedges's g = -0.67, -1.11 to -0.23), systolic blood pressure (MD = -4.62, -7.38 to -1.86), and heart rate (MD = -3.37, -6.65 to -0.10) in surgical patients. The impact of music on anxiety and pain relief varied significantly depending on the duration of the intervention. The largest effect was observed in interventions lasting between 30 and 60 minutes, with a decrease in anxiety and pain.

CONCLUSIONS

Music intervention is an effective way to reduce anxiety, pain, and physiological responses in surgical patients. Future reviews examining the influence of different types of surgery on the effects of music would add to the body of knowledge in this field. This study has been registered on the International Prospective Register of Systematic Reviews (PROSPERO) under the number CRD42022340203, with a registration date of July 4, 2022.

Effect of binaural beat music and noise cancelling headphones on intraoperative anxiety in patients undergoing spinal anaesthesia - A randomised controlled study

Background and Aims

This study aimed to determine the effects of music and active noise cancellation on intraoperative anxiety in patients undergoing lower limb surgeries under spinal anaesthesia.

Methods

After obtaining ethical approval, this randomised controlled study was conducted in adult patients (18-50 years of age) of either gender. Patients were randomly allocated to binaural beat music (Group A), noise cancellation (Group B) or no headphones (Group C) group (n = 36 in each group). State-Trait Anxiety Inventory-6 (STAI-6) score and Visual Analogue Score for Satisfaction (VAS-S) were noted preoperatively and at the end of surgery. In addition, Ramsay sedation scores and Likert communication difficulty scores were noted at 30 min intraoperatively. Haemodynamic parameters were noted preoperatively and at different intervals intraoperatively till the end of the surgery.

Results

There was a significant decrease in anxiety scores in Group A, Group B and Group C with postoperative STAI-6 scores (mean ± standard deviation) of 7.8 ± 1.7, 11.7 ± 4.2 and 14.7 ± 5.3, respectively. The difference was significant in Groups A and B compared to Group C (P < 0.001). Patient satisfaction scores in Groups A and B were better than in Group C (7.3 ± 1.7 and 6.2 ± 1.6 vs. 5.2 ± 1.3, respectively). Sedation scores and communication difficulty was significantly better in Groups A and B compared to Group C. Systolic blood pressure was significantly better intra- and postoperatively. There were no significant differences in other haemodynamic parameters on most occasions.

Conclusion

Music and noise-cancellation headphones can reduce anxiety and improve satisfaction and sedation scores in patients undergoing spinal anaesthesia.

Case report: binaural beats music assessment experiment

We recruited subjects with the focus on people who were stressed and needed a break to experience relaxation. The study used inaudible binaural beats (BB) to measure the ability of BB to induce a relaxed state. We found through measuring brain wave activity that in fact BB seem to objectively induce a state of relaxation. We were able to see this across several scores, F3/F4 Alpha Assessment and CZ Theta Beta, calculated from EEG readings, that indicated an increase in positive outlook and a relaxing brain, respectively, and scalp topography maps. Most subjects also showed an improvement in Menlascan measurements of microcirculation or cardiovascular score, although the Menlascan scores and Big Five character assessment results were less conclusive. BB seem to have profound effects on the physiology of subjects and since the beats were not audible, these effects could not be attributed to the placebo effect. These results are encouraging in terms of developing musical products incorporating BB to affect human neural rhythms and corollary states of consciousness and warrant further research with more subjects and different frequencies of BB and different music tracks.

Using Alprazolam before phacoemulsification cataract surgery reduces complications and duration of the surgery

PURPOSE

To evaluate the effect of preoperative Alprazolam on complications of phacoemulsification cataract surgery, duration of surgery and early reoperation rate.

METHODS

Records of 1026 eyes of 1026 consecutive patients underwent phacoemulsification with topical and intracameral anesthesia between 2016 and 2020 years were retrospectively reviewed. Patients were divided into two groups, with or without using Alprazolam before surgery. Patients with planned first-time surgery for senile cataract and at least three months follow-up postoperatively were included. Those who had pseudoexfoliation, small pupil, zonular weakness, corneal and hearing problem as well as traumatic, brown, mature, hypermature, and posterior polar cataracts were excluded. Main outcome measures were duration of surgery, posterior capsule rupture, rapid posterior capsule opacification (PCO) formation requiring the neodymium: yttrium-aluminum-garnet (Nd:YAG) laser and reoperation rate in early postoperative periods.

RESULTS

Alprazolam and control groups included 490 and 536 eyes, respectively. Mean surgical time was shorter in Alprazolam group (10.2 ± 3 versus 12.2 ± 4 min; < 0.001). Rate of posterior capsule rupture was higher in control group (4 versus 15 eyes; = 0.02). Four eyes (0.8%) in control group underwent unplanned secondary surgical procedures in early postoperative period (P = 0.126). Rate of rapid PCO formation was higher in control group (1 versus 9 eyes; = 0.027).

CONCLUSIONS

Using Alprazolam before phacoemulsification can lead to less posterior capsule rupture, short operation time and prevent repetitive surgery. It also reduces rapid PCO formation and, thus, early Nd:YAG laser intervention due to better cleaning the posterior capsule during surgery. We conclude that Alprazolam not only reduces intraoperative complications, but also facilitates their management.

The effect of alpha binaural beat music on orthodontic pain after initial archwire placement: A randomized controlled trial

OBJECTIVE

The objective of this article was to evaluate the effect of alpha binaural beat music on pain level after initial placement of a maxillary fixed appliance, compared to music without binaural beats (placebo) and no music (control).

METHODS

60 patients undergoing maxillary fixed orthodontic appliance and initial archwire placement were randomly allocated into the three aforementioned groups. The pain level experienced was monitored for the following seven days, using the short-form McGill pain questionnaire (SF-MPQ).

RESULTS / DESCRIPTORS

Intensity of both sensory and psychological aspects of pain reduced significantly in the binaural beat music (BBM) group, compared to the control, after the 5th day. Statistically significant lower affective and total pain scores were also found on day 6 for the placebo group, compared to the control. Present Pain Intensity (PPI): Statistically significant lower scores were found between the BBM group and the control group from days 3 to 7. Statistically significant lower scores were also found between the placebo and the control groups on days 4, 5 and 6. Visual Analog Scale (VAS): Compared to the control group, the placebo group had a lower VAS score on day 4, and the BBM group had lower scores on days 6 and 7.

CONCLUSIONS

There was a significant reduction of pain demonstrated in the BBM group, compared to the control, toward the end of the first week of treatment. There was no difference in reported pain between the BBM and placebo groups for any of the scores.

Effect of real-time binaural music on sedation with dexmedetomidine during spinal anesthesia: A triple-arm, assessor-blind, randomized controlled trial

STUDY OBJECTIVE

Binaural audio induces sedation and reduces pain and anxiety in surgical patients. This study tested the hypothesis that dexmedetomidine requirement for adequate sedation during spinal anesthesia would be lower in patients listening to music with binaural sound than that in patients listening to plain or no music.

DESIGN

A triple-arm, assessor-blind, randomized controlled study.

SETTING

Operating room.

PATIENTS

One hundred and eighty-nine patients undergoing orthopedic surgery under spinal anesthesia.

INTERVENTIONS

Patients were randomly assigned to music with binaural sound, plain music, or no music groups. Dexmedetomidine was infused for sedation during surgery. The loading infusion rate was 6 μg/kg predicted body weight (PBW)/h, followed by continuous infusion at 0.6 μg/kg PBW/hr. Loading was stopped after achieving adequate sedation, defined as the Observer's Assessment of Alertness/Sedation (OAA/S) scale score of 3. Infusion rate was adjusted every 30 min per the OAA/S scale.

MEASUREMENTS

Primary outcomes were the difference in the dexmedetomidine loading dose adjusted for the patient's PBW between (1) the binaural and plain music groups and (2) the binaural and control groups. Secondary outcomes were the total dose and total loading time of dexmedetomidine; Patient State Index; relative powers of the alpha, theta, and delta bands; recovery from sedation; and patient satisfaction score.

MAIN RESULTS

The final analyses included 184 patients. The PBW-adjusted dexmedetomidine loading dose was significantly lower in patients listening to music with binaural sound (1.15 ± 0.30 μg/kg PBW) than that in patients without music (1.33 ± 0.33 μg/kg PBW; mean difference, 0.18 μg/kg PBW; 95% confidence interval [CI], 0.06 to 0.29; P = 0.002). However, the difference was not statistically significant when compared with the plain music group (1.26 ± 0.36 μg/kg PBW; mean difference, 0.11 μg/kg PBW; 95% CI, -0.01 to 0.23; P = 0.070). Dexmedetomidine total dose, recovery from sedation, and patient satisfaction score showed no difference among the three groups.

CONCLUSIONS

Compared with no music, music with binaural sound reduced the dexmedetomidine loading dose; however, this sedative-sparing effect of binaural sound was not found when compared to plain music.

Comparison of Binaural Tone Music vs Patient Choice Music vs Midazolam on Perioperative Anxiety in Patients Posted for Surgery Under Spinal Anaesthesia: a Randomized Control Trial

Background Perioperative anxiety affects patients' hemodynamics by increasing stress levels, leading to delayed recovery. In this study, we compared the anxiety-reducing effect of music (patient choice and binaural tone music) with midazolam for perioperative anxiolysis in patients undergoing surgery under spinal anaesthesia. Methods After obtaining institutional ethical clearance and informed written consent, a total of 225 patients classified as ASA grades 1 and 2 (American Society of Anesthesiologists) were enrolled and randomised into three groups of 75 patients per group. Group A patients received research-selected music (binaural tone) via noise-cancelling headphones, Group B received intravenous midazolam (minimum of 1 mg to 2 mg maximum) as per clinical judgement, and Group C participants provided patient-preferred music via noise-cancelling headphones. The patient's perioperative anxiety was assessed using a visual analogue anxiety scale at regular time intervals. Results Anxiety scores were significantly reduced in the patient's choice music group (Group C) and binaural tone music group (Group A) as compared to the midazolam group (Group B). Postoperative pain scores were statistically significantly lower in Group C, followed by Group A and Group B. On comparing patient satisfaction scores, using numerical rating scores, 96% of patients in Group C achieved excellent scores with a p-value of 0.007. Conclusion Binaural tone music and patient choice music can be suitable alternatives to pharmacological therapies for perioperative anxiolysis.

Study protocol to support the development of an all-night binaural beat frequency audio program to entrain sleep

Background

Given that the stages of sleep have specific brainwave patterns, it may be feasible to manipulate brainwaves to induce stages of sleep to improve better sleep quality. Binaural beat frequencies (BBFs) are an auditory-neurologic technique that uses auditory tones via headphones to manipulate brainwave activity in turn affecting the listener's state of consciousness. However, BBFs are often sold in only one frequency which may not allow the listener to transition through the phases of sleep. This study is Phase 2 of a four-phase feasibility study to assess if systematically sequencing a variety of BBFs can improve sleep efficiency.

Methods

This protocol uses a two cohort unblinded and double-blinded, randomized, pre- and post-intervention methods and crossover matched group design. In Cohort 1, a sample of 106 participants with poor sleep quality will be randomized into two groups. All participants will start with 1 week of no intervention. Group 1 will use theta/delta BBF for 2 weeks followed by 1 week of no intervention followed by music for 2 weeks. Group 2 will do the reverse. In Cohort 2, 62 participants will be blinded and randomized into two groups. Group 3 will use music for 2 weeks followed by a 1-week break followed by music embedded with theta/delta BBF for 2 weeks. Group 4 will do the reverse. Using Cohort 1 music only as a control, data will be collected using sleep actigraphy, sleep quality questionnaires, and sleep diaries with a crossover and match group analysis between cohorts to compare the effect of no intervention vs. music vs. BBF only vs. music with BBF on sleep quality.

Discussion

Phase 1 concluded that theta BBF was able to decrease stress to help induce sleep. Phase 2 will assess if theta and delta BBFs, with breaks to allow for REM, will be able to sustain sleep to improve sleep efficiency. The data from Phase 1 and 2 will provide information to help construct an all-night audio program with the appropriate BBF and timing to trigger the correct sleep stage for better sleep efficiency. If this concept is feasible, it could be beneficial for many sleep disorders.

Early intervention for perioperative hypertension in cataract surgery

PURPOSE

Although perioperative blood-pressure control is important, especially for high-risk patients, no previous report has examined early monitoring of perioperative blood-pressure changes before cataract surgery. In this single-center, retrospective, observational study, we evaluated the early intervention for perioperative hypertension in cataract surgery with topical anesthesia.

METHODS

Hospitalized patients who underwent phacoemulsification and intraocular-lens insertion and whose blood pressure was controlled using standardized management to start early monitoring and control (standardized group; 134 eyes of 134 patients) were compared to age- and sex-matched patients who underwent the same cataract surgery and whose blood pressure was controlled using conventional means (control group; 134 eyes of 134 patients). The perioperative blood pressure, pulse pressure, and heart rate were compared preoperatively, upon entering the operation room, and at the beginning, end, and after the operation.

RESULTS

Although there was no difference before the operation, the changes in systolic pressure in the standardized group were significantly lower at the point of entering the operation room, at the beginning of the operation, and at the end of the operation (P = 0.003, < 0.001, and < 0.001, respectively). No significant difference was observed between etizolam and nicardipine use.

CONCLUSION

Early monitoring and control of blood pressure in cataract surgery could effectively control perioperative hypertension without additional drug use and could be widely applied in the clinical setting.

Effects of Nursing Care Using Binaural Beat Music on Anxiety, Pain, and Vital Signs in Surgery Patients

PURPOSE

This study investigated the effects of binaural beat music on anxiety, pain, and vital signs in Korean surgical patients.

DESIGN

This study used a non-equivalent control group pre-and post-test design.

METHODS

This study included 54 patients who underwent spinal nerve plastic surgery under local anesthesia. The experimental group listened to binaural beat music twice, using headphones (20 minutes before surgery and 30 minutes after surgery). We measured the participants' pain and anxiety levels using a visual analog scale for pain and anxiety. In addition, we checked the participants' systolic and diastolic blood pressure and heart rate using a blood pressure monitor.

FINDINGS

The experimental group displayed significantly lower anxiety and pain scores than the control group after the intervention. Meanwhile, systolic and diastolic blood pressure did not show any statistically significant differences between the groups. However, the experimental group had a significantly lower pulse rate than the control group.

CONCLUSION

Our research findings showed that using binaural beat music in the nursing care of surgical patients under local anesthesia can effectively reduce postoperative pain and anxiety, contributing to improved mental health and physical well-being after surgery.

The Effect of Binaural Beat Audio on Operative Pain and Anxiety in Cataract Surgery under Topical Anaesthesia: A Randomized Controlled Trial

Background: The aim of this paper was to examine the analgesic and anxiolytic effects of binaural beat audio in patients undergoing cataract surgery under topical anaesthesia. Methods: This was a prospective, randomized controlled trial of 61 patients undergoing cataract surgery under topical anaesthesia. They were divided into two research conditions; the binaural beat audio group, and a sham-control group (ear phones with no music). Patients completed the State-Trait Anxiety Inventory questionnaire (STAI), and their blood pressure (BP) and heart rate (HR) were measured pre- and post-intervention. Intraoperative pain levels were ascertained using a visual analog scale (VAS) completed immediately after the surgery. Results: The binaural beat group had significantly lower pain scores (p < 0.001), HR (p < 0.001), diastolic BP (p = 0.003), mean arterial pressure (p = 0.007) and anxiety (p = 0.009) than the control group. Within the binaural beat group, subjects experienced a statistically significant reduction in HR (p = 0.004) and anxiety (p < 0.001) levels compared to baseline values, while all parameters, except anxiety, increased significantly in the control group. Conclusions: Binaural beat audio decreases operative pain and anxiety in cataract surgery under topical anaesthesia. It may have additional benefits in modulating the tachycardic response to stress.

Effects of Low-Concentration Nitrous Oxide Anesthesia on Patient Anxiety During Cataract Surgery: A Retrospective Cohort Study

Purpose

We investigated the effects of 30% low-concentration nitrous oxide (N₂O) anesthesia on anxiety, pain, and vital signs and the patient population that would benefit from low-concentration N₂O anesthesia during cataract surgery.

Patients and Methods

Sixty-three patients who underwent cataract surgery due to visual impairment from cataracts were included in this single-center retrospective cohort study conducted at the Ophthalmology Department of Shinseikai Toyama Hospital, Japan. Fifty eyes of 39 patients received a combination of local and N₂O anesthesia (N₂O group), and 30 eyes of 24 patients received local anesthesia without N₂O anesthesia (Air group). The primary outcome measures were visual analogue scale (VAS) scores for patient anxiety, pain, and vital signs. The secondary outcome measures were the patient population.

Results

The change in the VAS scores for anxiety and pain decreased significantly (p = 0.002 and p = 0.014, respectively) in the N₂O group (−15.6 ± 22.9 and 12.4 ± 14.9, respectively) compared with that in the Air group (1.2 ± 20.6 and 24.2 ± 22.4, respectively). The systolic and diastolic blood pressure changes did not significantly differ between both groups (p = 0.093 and p = 0.23, respectively). The change in heart rate decreased significantly (p = 0.001) in the N₂O group (−4.8 ± 4.8 bpm) compared with that in the Air group (−0.6 ± 5.8 bpm). Multivariate analyses demonstrated that the change in anxiety level in the N₂O group correlated significantly with patient age (p = 0.045) and preoperative VAS score for anxiety (p = 0.0001), whereas the change in anxiety level in the Air group did not correlate with any factor.

Conclusion

Low-concentration N₂O anesthesia showed beneficial effects on intraoperative anxiety and pain during cataract surgery; this may aid the stabilization of intraoperative vital signs. Moreover, low-concentration N₂O anesthesia during cataract surgery could benefit young patients and patients with high levels of preoperative anxiety.

The effect of binaural beat audio on anxiety in patients undergoing fiberoptic bronchoscopy: A prospective randomized controlled trial

BACKGROUND

Fiberoptic bronchoscopy is an invasive procedure known to induce anxiety in patients. Binaural beat therapy, in which sounds of different frequencies are delivered to the 2 ears to entrain the brainwaves, has been used to reduce anxiety in some operations. This study aimed to determine the anxiolytic effects of binaural beat audio in patients undergoing fiberoptic bronchoscopy.

METHODS

Eligible subjects were randomly assigned to receive binaural beat music, plain music, or no music. They were asked to wear earphones starting approximately 15 minutes before the bronchoscopy. The level of anxiety was measured using the State-Trait Anxiety Inventory questionnaire. Blood pressure, heart rate, and sedative drug administration were also recorded.

RESULTS

One hundred and twelve subjects were randomized into binaural beat music (n = 38), plain music (n = 38), and no music (n = 36) groups. The mean change in post-bronchoscopy State-Trait Anxiety Inventory state score in the binaural beat music, plain music, and no music group was -7.26 (P < .001), -3.92 (P = .005), and -1.12 (P = .454), respectively. The mean systolic blood pressure and diastolic blood pressure significantly decreased from baseline by -9.89 (P = .002) and -5.76 (P = .005), respectively, in the binaural group. The mean heart rate increased from baseline by 3.32 (P = .035), 5.21 (P = .038), and 3.64 (P = .149) in the binaural beat music, plain music, and no music groups, respectively.

CONCLUSION

Binaural beat music appeared to reduce anxiety among patients undergoing fiberoptic bronchoscopy.Trial registration: TCTR, TCTR20200915002. Registered 14 September 2020 - Retrospectively registered.

Nursing Care during the Perioperative within the Surgical Context

The study describes basic nursing care during the perioperative. Introduces the origins of perioperative nursing, general care that must be practiced with patient in this context. During the preoperative, care related with risk assessment and preparation of patient from the emotional and physical point of view are important. The trans-operative is related with the anesthesia used, surgical position, preparation of the skin, maintenance of normothermia, among many others. The postoperative depends on the type of anesthesia and surgical procedure, emphasizing on airway permeability, hemodynamic stability, pain, and symptomatology being presented by patients until they are stable and suitable for transfer to another service or their home.

The effects of music & auditory beat stimulation on anxiety: A randomized clinical trial

Background and objectives

Music and auditory beat stimulation (ABS) in the theta frequency range (4–7 Hz) are sound-based anxiety treatments that have been independently investigated in prior studies. Here, the anxiety-reducing potential of calm music combined with theta ABS was examined in a large sample of participants.

Methods

An open-label randomized controlled trial was conducted with participants taking anxiolytics (n = 163). Participants were randomly assigned using the Qualtrics randomizer algorithm, to a single session of sound-based treatment in one of four parallel arms: combined (music & ABS; n = 39), music-alone (n = 36), ABS-alone (n = 41), or pink noise (control; n = 47). Pre- and post-intervention somatic and cognitive state anxiety measures were collected along with trait anxiety, personality measures and musical preferences. The study was completed online using a custom application.

Results

Based on trait anxiety scores participants were separated into moderate and high trait anxiety sub-groups. Among participants with moderate trait anxiety, we observed reductions in somatic anxiety that were greater in combined and music-alone conditions than in the pink noise condition; and reductions in cognitive state anxiety that were greater in the combined condition than in the music-alone, ABS-alone, and pink noise conditions. While we also observed reductions in somatic and cognitive state anxiety in participants with high trait anxiety, the conditions were not well differentiated.

Conclusions

Sound-based treatments are effective in reducing somatic and cognitive state anxiety. For participants with moderate trait anxiety, combined conditions were most efficacious.

Music-based interventions to address well-being in people with a vision impairment: protocol for a scoping review

INTRODUCTION

Music-based interventions are used to improve well-being in individuals who are psychologically vulnerable and have long-term illnesses. To date, no study has systematically assessed the literature on music-based interventions aimed at improving well-being in people who have a vision impairment (VI). The purpose of the current protocol is to provide the methodology for a scoping review, to explore the therapeutic outcomes and strategies used in music-based interventions aimed specifically at people with a VI.

METHODS AND ANALYSIS

This scoping review protocol was developed according to the Joanna Briggs Institute methodology and reporting will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist and guidelines. The anticipated start date for this study was July 2021. The proposed review will include studies that use music therapeutically as part of a treatment intervention for all VI populations. Studies that meet the inclusion criteria with regards to population, concept and context will be included. Electronic database searches will be conducted independently by two researchers and include MEDLINE, EMBASE, CINAHL Plus, PsycINFO and Web of Science. Further searches will include the reference lists of included studies and grey literature. A narrative synthesis will be conducted to map out the types of therapeutic music interventions undertaken and to compare therapeutic outcomes.

ETHICS AND DISSEMINATION

As the methodology of this study consists of collecting data from publicly available articles, it does not require ethics approval. The findings of the planned scoping review are important to guide the development of future interventions, or strategies, that will attempt to use music to improve well-being in people with a VI. The results will be disseminated through a peer-reviewed publication and conference presentations.

Toward applying a device to reduce motion artifact during imaging: a randomized controlled trial

OBJECTIVE

One of the most critical problems in different types of medical imaging modalities is unwanted patient movement during imaging procedures, which mainly occurs because of stress, anxiety, and restlessness in patients, resulting in poor image quality and decreased diagnostic accuracy.

METHODS

This prospective, randomized, double-blinded, controlled trial comprised 267 patients who underwent MPI, randomly divided into three groups; Group I: streaming music with a special binaural beat frequency (MBB); Group II: streaming simple music (SM) and Group III: control group. Anxiety level was determined by DASS (Depression Anxiety Stress-Scale) questionnaire and heart rate was monitored.

RESULTS

Stress and anxiety scores were significantly lower in the MBB group compared with both SM and control group (P˂0.0001). Additionally, a significant decrease in heart rate of patients who were in the MBB group in comparison with the SM (p=0.005) and control group (P=0.018) was observed. The study revealed a significant decrease in motion artifact in the MBB group compared with the SM (P=0.003) and control (P˂0.0001) groups.

CONCLUSIONS

Using the proposed device capable of streaming special binaural beat frequency embedded music can cause a significant reduction in anxiety level, heart rate, and consequently motion artifact. This method can be useful during the imaging procedure due to several reasons. First, this can cause a significant reduction in motion artifacts. Next, anxiety and stress can be reduced significantly due to the application of special binaural beat frequency embedded music during an imaging procedure. Then, a significant reduction in post-imaging stress and anxiety scores was achieved after using it. Finally, binaural beat frequency embedded music leads to imaging repetition avoidance.

Effect of slow tempo music on markers of anxiety during cataract surgery: Randomized control trial

PURPOSE:

This study aims to objectively measure the effect of slow tempo music on various markers for anxiety.

MATERIALS AND METHODS:

This is a repeated measure randomized control trial of patients with age-related cataracts undergoing cataract extraction through phacoemulsification under local anesthesia. Patients were randomized into two groups: music group where a standardized piano music was played and control group. Salivary alpha-amylase (sAA) levels were measured at the beginning and at the end of surgery. Blood pressure and heart rate were also measured at 5 min before surgery and at four other standardized points during and after surgery. Visual Analog Scale for anxiety was also gauged: preoperatively, perioperatively, and 15 min postoperatively.

RESULTS:

Ninety-two patients were randomized equally to the music group and control group. Paired sample t-test showed a reduction in the level of sAA during surgery in the music group (P = 0.019). The odds ratio for a drop in sAA with music was 4.407 (P = 0.001). Lower systolic blood pressure was observed in the music group: at delivery of local anesthesia (P = 0.047), at first incision (P = 0.023), and during sculpting (P = 0.15). Similarly, diastolic blood pressure was lower at first incision (P = 0.019) in the music group. The visual analog scale for anxiety during surgery was found to be lower in the music group (P = 0.046).

CONCLUSION:

A slow tempo music during cataract surgery was shown to significantly reduce several indicators for anxiety at various points during cataract surgery.

The Listening to music tuned to 440 Hz versus 432 Hz to reduce anxiety and stress in emergency nurses during the COVID-19 pandemic: a double-blind, randomized controlled pilot study

BACKGROUND AND AIM

Healthcare providers in the emergency first response units have been exposed to a considerable stress during the SARS-CoV-2 pandemic. This study was designed to identify the effects of listening to music during the work break compared to the routine break (in the absence of listening to music) on the level of state anxiety and on the vital parameters of the nurses on duty at the operations center.

METHODS

Randomized, controlled, three-arm, double-blind, single-center clinical study. Healthcare providers were divided into three groups according to study intervention (Group 1: listening to 440Hz music; Group 2: listening to 432Hz music; Group 3: liberal activity). The study was conducted during the working hours of dayshifts in an emergency first response unit station located in Tuscany, Italy. Outcomes were measured against measures of stress (State-Trait Anxiety Inventory - STAIX1), heart rate (HR), respiratory rate (RR), systolic/diastolic blood pressure (SBP/DBP), pain and productivity (Likert Scale) measured at baseline (T0) and at the end of exposure (T1).

RESULTS

Overall, 54 healthcare providers were enrolled; 32 females (59.3%); mean age of 39.64 years (SD±9.94); the total measurements performed were 83. The median values of STAI X1 decreased in all the 3 groups from T0 to T1 (Group 1: 34.5 vs. 32, p=0.0001; Group 2: 34 vs. 29, p=0.001; Group 3: 33 vs. 31, p=0.028). In Group 2 a reduction of mean values of respiratory rate and systolic blood pressure was recorded at T1 (-2.714 b/min, p=0.000 and -3.821 mmHg, p=0.031, respectively).

CONCLUSIONS

Listening to music at 432 Hz is a low cost and short intervention that can be a useful resource to manage anxiety and stress. Further studies are needed to assess medium and long-term effects of listening to music.

Efficacy of Preoperative Music Intervention on Pain and Anxiety in Patients Undergoing Cataract Surgery

The aim of the present study was to investigate the impact of preoperative music exposure on intra- and post-operative pain during cataract surgery. This study was conducted alongside a prospective single-masked randomized controlled trial (ClinicalTrials.gov NCT02892825). Patients undergoing first eye cataract surgery were included and randomly assigned to either the intervention or control group. Patients in the intervention group had a 20-min music session through earphones before surgery, while patients in the control group wore earphones without music. Anxiety level evaluated using the visual analog scale and heart rate were collected before and after music intervention. Pain level was assessed using the Numerical Pain Rating Scale, during the surgical procedure, prior to discharge and 7 days postoperatively. A total of 243 patients were included: 119 in the intervention group and 124 in the control group. No significant differences in baseline characteristics, including age, sex and rate of treated hypertension were found between the 2 groups (all p-values > 0.05). In addition, no significantly differences were found in heart rate and anxiety level before music intervention between the 2 groups (all p-values > 0.05). Conversely, anxiety level was significantly lower in the music group after the intervention (respectively, 1.3 ± 1.1 vs 3.2 ± 2.2; p < 0.05). Patients in the music group reported a lower mean pain level during surgical procedure and before discharge compared with control group (respectively, 1.2 ± 0.5 vs 2.1 ± 1.1, p = 0.03 and 0.23 ± 0.4 vs 0.81 ± 0.7, p = 0.04). No difference was found in pain level 7 days postoperatively (0.1 ± 0.3 vs 0.2 ± 0.4, p = 0.1). A significant correlation was found between anxiety level and intraoperative pain level (R = 0.64, p = 0.02). In conclusion, music intervention was effective in reducing anxiety level and self-reported pain both during surgery and in the early postoperative period.

Clinical Trial Registration:https://clinicaltrials.gov/ct2/home, identifier NCT02892825.

Eye-tunes: role of music in ophthalmology and vision sciences

Although the healing effect of music has been recognized since time immemorial, there has been a renewed interest in its use in modern medicine. This can be attributed to the increasing focus on holistic healing and on the subjective and objective aspects of well-being. In ophthalmology, this has ranged from using music for patients undergoing diagnostic procedures and surgery, as well as for doctors and the operation theatre staff during surgical procedures. Music has proven to be a potent nonpharmacological sedative and anxiolytic, allaying both the pain and stress of surgery. This review aims to explore the available evidence about the role of music as an adjunct for diagnostic and surgical procedures in current ophthalmic practices.

A role for music in cataract surgery: a systematic review

PURPOSE

There have been several studies that explore the anxiolytic effects of music during cataract surgery. This is the first systematic review of literature highlighting the effects of music on patients undergoing cataract surgery without pharmacological anxiolytics.

METHODS

A systematic review of literature using PRISMA methodology identified randomized controlled trials involving patients undergoing cataract surgery with music as an intervention during the procedure with outcomes measured using at least one assessment of anxiety level, pain score, satisfaction, or vital sign measurements. Studies using pharmacological anxiolytics or additional pain-relieving medications besides local anesthetic were excluded.

RESULTS

Three studies, involving 523 patients, were included with patients undergoing cataract surgery with music intervention. Music intervention during cataract surgery has demonstrated use in reducing perceived pain, reducing anxiety, and improving vitals with increased benefit of reduced heart rate and blood pressures with binaural beat embedded music.

CONCLUSIONS

The clinical implications of this review identify non-traditional approaches to reducing anxiety intraoperatively for cataract surgeries, offering clinicians alternatives to minimizing benzodiazepine and medication use risks.

Fear and Anxiety Associated with Cataract Surgery Under Local Anesthesia in Adults: A Systematic Review

Cataract surgery is one of the most frequently performed surgical procedures worldwide. Patients usually experience strong negative emotions, such as fear and anxiety. A systematic review of the recent literature regarding the emotional states experienced during cataract surgery under local anaesthesia was performed based on the PubMed and Scopus databases. The objective of this review was to determine the causes and frequency of fear and anxiety, as well as methods for improving intraoperative experience and supporting the patient prior to surgery. Anxiety is mainly caused by fear of the surgery itself, fright of pain, and loss of vision. Abstaining and visual sensations experienced during cataract surgery also increased the preoperative anxiety. Women and hypochondriacs showed higher levels of anxiety. The greatest intensity of negative emotions occurred on the day of the cataract surgery. Patients operated on both eyes experienced greater fear and anxiety before the operation of the first eye surgery. In order to reduce patients’ negative experiences, pharmacological sedation, preoperative education and counselling, manual massage immediately before surgery, and listening to music during surgery are used. Taking this information into consideration allows the introduction of effective methods of eliminating the patient’s negative feelings in connection with cataract surgery, which leads to an improvement in the results of the operation and an increase in the patients’ sense of satisfaction and quality of life.

Dealing with Anxious Patients: An Integrative Review of the Literature on Nonpharmaceutical Interventions to Reduce Anxiety in Patients Undergoing Medical or Dental Procedures

Objectives: A previous systematic literature review (SLR) evaluated 501 experiments on reducing patient anxiety across medical and dental environments. This integrative review examines those interventions and explores possible mechanisms leading to relative success or failure within those environments, in the interest of interprofessional education and communication. Methods: Reviewers evaluated 501 experiments testing interventions for reducing patient anxiety in a variety of medical and dental health care settings. Methodology for the SLR, largely following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, is briefly reviewed. Results: A total of 501 experiments (from 408 articles) met review criteria. One hundred and forty-three Music experiments were included, and Music interventions were largely effective, except in the case of colonoscopy. Education is the only intervention that occasionally (5 times of 130 experiments) raised patient anxiety in the face of a procedure; the discussion focuses on the wisdom of assessing patient need for information. Thirty-seven Cognitive Behavioral Therapy (CBT) experiments of various types are included, with a success rate of 89%, with a particularly high rate of success (12 of 12 experiments) in dentistry. Massage has a success rate that is similar to that of CBT, but Massage has been tested in far fewer specialty areas. Relaxation has been tested in every specialty area, except mechanical ventilation, with promising results. Acupuncture and Acupressure have not been widely tested, but their effectiveness rate is 100% when it comes to reducing patient anxiety in various procedural settings. Similarly, experiments show Hypnosis to be successful in 90% of trials. In contrast, Distraction was successful in only 40% of the experiments summarized, although it was more effective in dentistry. A variety of Nature-based Interventions (Aromatherapy, Nature Sounds, and Visual Stimuli) were highly successful across a variety of settings. Discussion: Possible mechanisms are discussed, along with commentary on feasibility. Limitations include publication bias, small sample sizes, and the lack of placebo controls. Future areas of research are pointed out.

Comparison of auditory sensations in patients who underwent cataract phacoemulsification surgery in the first and second eye

To compare subjective auditory sensations of patients during the first and second eye cataract surgeries. Consecutive patients who underwent phacoemulsification of the first eye (group I) and second eye (group II) completed questionnaires designed to evaluate their auditory sensations in the operating room including background music, sound of working equipment, staff conversations, and surgeon's voice. This study included 124 patients in group I and 76 patients in group II. Patients most often heard nursing staff's conversations (91.9% and 96%, respectively, p > 0.05), surgeon's voice (87.9% and 86.8%, respectively, p > 0.05), and music (70.9% and 75%, respectively, p > 0.05). Music was the most pleasant experience (78.2% and 78.9%, respectively, p > 0.05). The sound of the working phacoemulsifier was the most undesirable sound (20.2% and 15.8%, respectively, p > 0.05). Patients in group II more often indicated that none of the sounds required elimination (69.7% and 52.6%, respectively, p = 0.013) or that staff conversations should be eliminated (13.2% and 3.1%, respectively, p = 0.005). The most desirable sounds during phacoemulsification include music and the surgeon's voice regarding the procedure. The most unpleasant sound was that that of phacoemulsifier. The commonest sounds to be eliminated in groups I and II included those of equipment and staff conversations.

Meditation Monologue can Reduce Clinical Injection-Related Anxiety: Randomized Controlled Trial

Background.

Strategies to reduce anxiety prior to injection procedures are not well understood. The purpose is to determine the effect of a meditation monologue intervention delivered via phone/mobile application on pre-injection anxiety levels among patients undergoing a clinical injection. The following hypothesis was tested: patients who listened to a meditation monologue via phone/mobile application prior to clinical injection would experience less anxiety compared to those who did not.

Methods.

A prospective, randomized controlled trial was performed at an orthopedics and sports medicine clinic of a tertiary level medical center in the New England region, USA. Thirty patients scheduled for intra- or peri-articular injections were randomly allocated to intervention (meditation monologue) or placebo (nature sounds) group. Main outcome variables were state and trait anxiety inventory (STAI) scores and blood pressure (BP), heart rate, and respiratory rate.

Results.

There were 16 participants who were allocated to intervention (meditation monologue) while 14 participants were assigned to placebo (nature sounds). There was no interaction effect. However, a main time effect was found. Both state anxiety (STAI-S) and trait anxiety (STAI-T) scores were significantly reduced post-intervention compared to pre-intervention (STAI-S: p = 0.04, STAI-T: p = 0.04). Also, a statistically significant main group effect was detected. The pre- and post- STAI-S score reduction was greater in the intervention group (p = 0.028). Also, a significant diastolic BP increase between pre- and post-intervention was recorded in the intervention group (p = 0.028), but not in the placebo group (p = 0.999).

Conclusion.

Listening to a meditation monologue via phone/mobile application prior to clinical injection can reduce anxiety in adult patients receiving intra- and peri-articular injections. Registration:ClinicalTrials.gov NCT02690194

Effects of Listening to Binaural Beats on Anxiety Levels and Pain Scores in Male Patients Undergoing Cystoscopy and Ureteral Stent Removal: A Randomized Placebo-Controlled Trial

Purpose: To investigate the effects of pure binaural beats on anxiety and pain scores in male patients undergoing diagnostic cystoscopy (DC) and ureteral stent removal (USR) under local anesthesia. Materials and Methods: This was a prospective, randomized placebo-controlled study. Patients in the DC group (DCG) and USR group (USRG) were divided into three subgroups according to interventions applied; DCG-1 and USRG-1, patients listened to binaural beats; DCG-2 and USRG-2, patients listened to classical music; and DCG-3 and USRG-3, patients wore headphones, but were not exposed to audio (control group). The State-Trait Anxiety Inventory (STAI) and Visual Analog Scale (VAS) were used for measuring anxiety and pain scores, respectively. Demographic data, initial STAI, tolerance rate of interventions, terminal STAI (STAI-T), differences of STAI (delta STAI, STAI-D), and VAS scores were compared. Results: Between July 2019 and March 2020, a total of 252 and 159 eligible male patients for DCG and USRG were included, respectively. After exclusions, remaining patients were DCG-1, n = 61; DCG-2, n = 73; DCG-3, n = 75; USRG-1, n = 41; USRG-2, n = 50; and USRG-3, n = 52. The tolerance rate in binaural beat groups was significantly lower than in other groups (p < 0.05 for all). There were significant decreases in terms of STAI-T when DCG-1 and DCG-2 were compared with DCG-3 and USRG-1 and USRG-2 were compared with USRG-3 (p < 0.05 for all). There were significant decreases in STAI-D scores when DCG-1 and DCG-2 were compared with DCG-3 and when USRG-1 and USRG-2 were compared with USRG-3 (p < 0.001 for all). Binaural beat groups had significantly lower VAS scores than other groups and classical music groups had significantly lower VAS scores than control groups (p < 0.05 for all). Conclusions: Listening to pure binaural beats may be a simple and effective method to reduce anxiety levels and pain scores associated with the DC and USR procedures in males.

Effect of Music on Patient Experience during Intravitreal Injection

Introduction

Many patients remain anxious during intravitreal injections, despite its increasing use. As music can alleviate anxiety for other procedures, we wanted to evaluate its effect during intravitreal injection.

Methods

Patients undergoing routine intravitreal injection were recruited for a randomized controlled trial. Subjects complete a State-Trait Anxiety Inventory (STAI-S) questionnaire before and after undergoing injection with or without background music. They were also assessed for subjective satisfaction, anxiety, pain, and future preferences after the injection.

Results

There were 39 and 37 Chinese subjects in the music (age 68.08 ± 13.67) and control (age 73.24 ± 11.17) groups, respectively. The music group reported lower anxiety and pain, and a greater reduction in STAI-S score, but the differences were not statistically significant (P = 0.830, 0.655, 0.199, respectively). More subjects in the music group (92.3%, control group 64.9%) preferred music for future injections (P = 0.003). Age, but not the number of previous injections, was negatively correlated with reported anxiety (r = −0.27, P = 0.021).

Conclusion

Most subjects preferred music during future injections. Although music reduced anxiety, the effect was not statistically significant and may be masked by the higher age of our control group, as increasing age was correlated with lower anxiety.

Possible Effect of Binaural Beat Combined With Autonomous Sensory Meridian Response for Inducing Sleep

Sleep is important to maintain physical and cognitive functions in everyday life. However, the prevalence of sleep disorders is on the rise. One existing solution to this problem is to induce sleep using an auditory stimulus. When we listen to acoustic beats of two tones in each ear simultaneously, a binaural beat is generated which induces brain signals at a specific desired frequency. However, this auditory stimulus is uncomfortable for users to listen to induce sleep. To overcome this difficulty, we can exploit the feelings of calmness and relaxation that are induced by the perceptual phenomenon of autonomous sensory meridian response (ASMR). In this study, we proposed a novel auditory stimulus for inducing sleep. Specifically, we used a 6 Hz binaural beat corresponding to the center of the theta band (4-8 Hz), which is the frequency at which brain activity is entrained during non-rapid eye movement (NREM) in sleep stage 1. In addition, the "ASMR triggers" that cause ASMR were presented from natural sound as the sensory stimuli. In session 1, we combined two auditory stimuli (the 6 Hz binaural beat and ASMR triggers) at three-decibel ratios to find the optimal combination ratio. As a result, we determined that the combination of a 30:60 dB ratio of binaural beat to ASMR trigger is most effective for inducing theta power and psychological stability. In session 2, the effects of these combined stimuli (CS) were compared with an only binaural beat, only the ASMR trigger, or a sham condition. The combination stimulus retained the advantages of the binaural beat and resolved its shortcomings with the ASMR triggers, including psychological self-reports. Our findings indicate that the proposed auditory stimulus could induce the brain signals required for sleep, while simultaneously keeping the user in a psychologically comfortable state. This technology provides an important opportunity to develop a novel method for increasing the quality of sleep.

Effect of live oud music on physiological and psychological parameters in patients undergoing cardiac surgery

Background. Music therapy has emerged as a promising evidence-based adjuvant method of intervention. This study aims to assess the effect of live oud music on physiological and psychological parameters in patients undergoing cardiac surgery, pre- and post-operatively. Methods. Twelve patients undergoing cardiac operations were randomly allocated into either intervention group or control group, six patients in each group. Patients in the intervention group listened to 20 minutes of improvised and personally customized live oud music before and after surgery while patients in the control group heard the normal hospital sounds. While anxiety scores were assessed preoperatively, vital signs and pain scores were assessed postoperatively together with serum levels of cortisol, which was used as a surrogate marker of the stress response. Results. In the intervention group, pain scores and respiratory rates showed statistically significant reduction after listening to music (P values of 0.043 and 0.034 respectively). Additionally, heart rates, anxiety scores and serum cortisol levels showed borderline significant reduction in patients who listened to music with P values, 0.063, 0.066 and 0.068 respectively. These changes were not found in the control group. Conclusions. This preliminary study suggests a role of live oud music therapy in decreasing stress response of the patients undergoing cardiac surgery, in addition to its positive effects on pain perception and anxiety scores.

Meta-analysis evaluating music interventions for anxiety and pain in surgery

BACKGROUND

This study aimed to evaluate anxiety and pain following perioperative music interventions compared with control conditions in adult patients.

METHODS

Eleven electronic databases were searched for full-text publications of RCTs investigating the effect of music interventions on anxiety and pain during invasive surgery published between 1 January 1980 and 20 October 2016. Results and data were double-screened and extracted independently. Random-effects meta-analysis was used to calculate effect sizes as standardized mean differences (MDs). Heterogeneity was investigated in subgroup analyses and metaregression analyses. The review was registered in the PROSPERO database as CRD42016024921.

RESULTS

Ninety-two RCTs (7385 patients) were included in the systematic review, of which 81 were included in the meta-analysis. Music interventions significantly decreased anxiety (MD -0·69, 95 per cent c.i. -0·88 to -0·50; P < 0·001) and pain (MD -0·50, -0·66 to -0·34; P < 0·001) compared with controls, equivalent to a decrease of 21 mm for anxiety and 10 mm for pain on a 100-mm visual analogue scale. Changes in outcome corrected for baseline were even larger: MD -1·41 (-1·89 to -0·94; P < 0·001) for anxiety and -0·54 (-0·93 to -0·15; P = 0·006) for pain. Music interventions provided during general anaesthesia significantly decreased pain compared with that in controls (MD -0·41, -0·64 to -0·18; P < 0·001). Metaregression analysis found no significant association between the effect of music interventions and age, sex, choice and timing of music, and type of anaesthesia. Risk of bias in the studies was moderate to high.

CONCLUSION

Music interventions significantly reduce anxiety and pain in adult surgical patients.

Intraoperative Meditation Music as an Adjunct to Subarachnoid Block for the Improvement of Postoperative Outcomes Following Cesarean Section: A Randomized Placebo-controlled Comparative Study

Context

Music therapy is a nonpharmacological modality which can provide promising results for postcesarean section recovery.

Aims

The aim of this study was to compare the effects of two types of intraoperative meditation music with control group on postcesarean section pain, anxiety, nausea, vomiting, and psychological maternal wellbeing.

Settings and Design

A prospective, randomized, controlled study was conducted on 189 patients.

Patients and Methods

The inclusion criteria were the American Society of Anaesthesiologists physical status classes 1E and 2E women aged over 18 years posted for emergency cesarean section under spinal anesthesia. The exclusion criteria were patients with hearing/ear abnormalities and psychiatric disorders. Patients were randomly allocated into three groups - soothing meditation music (M) group, binaural beat meditation music (B) group, and control (C) group - where no music was played. After intervention, data were collected and statistically analyzed.

Statistical Analysis Used

Student's t-test was applied for calculation of normative distribution and Mann-Whitney U-test for nonnormative distribution. Nominal categorical data between the groups were compared using Chi-squared test. P <0.05 indicated a statistically significant difference.

Results

Both intraoperative meditation music groups had statistically significant less postoperative pain and anxiety and a better overall psychological wellbeing as compared to the control. There was no statistically significant difference in the occurrence and severity of postoperative nausea and vomiting across all three groups.

Conclusions

Intraoperative meditation music as good adjunct to spinal anesthesia can improve a cesarean section patient's postoperative experience by reducing postoperative pain, anxiety, and psychological wellbeing.