Music Interventions in Pediatric Surgery (The Music Under Surgery In Children Study): A Randomized Clinical Trial.

BACKGROUND: Perioperative music interventions have been shown to reduce anxiety and pain in adults. This inexpensive, easily applicable intervention could be of benefit to children as well. Our objective was to determine the effects of music interventions on distress, anxiety, and postoperative pain in infants undergoing surgery. METHODS: The Music Under Surgery In Children study was designed as a parallel, single-blind, randomized controlled trial with an a priori formulated hypothesis. Data were collected between August 2015 and October 2016 in a single tertiary care children's hospital. There was a 24-hour follow-up with blind primary outcome assessment. A random sample of 432 eligible 0-3 years of age infants admitted for orchidopexy, hypospadias, or inguinal hernia repair receiving general anesthesia and caudal block were asked for participation. Subjects were assigned to a preoperative music intervention, pre- and intraoperative music intervention, or no music intervention (control) via random allocation using a computer-generated list with the use of opaque envelopes. The main outcome measure was the postoperative level of distress assessed with the COMFORT-Behavior scale, which is an observational scale; furthermore, preoperative level of distress, preoperative anxiety, and physiological measurements such as heart rate (HR) and blood pressure were measured. The trial was registered at the Dutch Trial Register, number NTR5402 (www.trialregister.nl). RESULTS: One hundred ninety-five infants with median age 6.9 months (interquartile range, 3.3-11.1) were randomized, 178 of whom were included in the primary analysis. A nonsignificant difference in COMFORT-Behavior scale scores between the pre- and intraoperative music intervention group and control group at 4 hours after surgery was found (mean difference, -1.22; 95% CI, 2.60-0.17; P = .085). Additional analysis showed weak nonsignificant evidence for an interaction effect between music exposure and COMFORT-Behavior score at baseline (P = .027 with a Bonferroni-adjusted significance level of .025). General linear modeling showed a statistically significantly reduced HR after the preoperative music intervention in the holding area in the combined preoperative music intervention and intraoperative music intervention group compared to the control group (P = .003). The differences in HR among the 3 study arms at all time points were not statistically significant (P = .069). CONCLUSIONS: Music interventions do not seem to benefit all young infants undergoing surgery. The potential benefits of music interventions in the preoperative period and in more distressed children warrant further exploration.

Humane Surgical Positioning During Minor Limb Surgeries Under Local Anesthesia in Young Children.

Injured children are in pain, anxious, scared, and intimidated by the emergency room environment and parents often compound this anxiety by their own fears. During minor surgical procedures, a child held in the "humane position" by the parent is helpful. The child is positioned on the parent's lap so that the affected extremity is drawn out and placed on the side of the parent. The surgeon and instruments are positioned behind the parent's back out of the child's and parent's field of vision especially if the wound is bleeding actively. Physical intimacy with the parent is capitalized upon; this makes the child feel secure, comfortable, relaxed, and reassured during the procedure.

Efficacy of hypnosis in adults undergoing surgery or medical procedures: a meta-analysis of randomized controlled trials.

This meta-analysis investigates the efficacy of hypnosis in adults undergoing surgical or medical procedures compared to standard care alone or an attention control. Through a comprehensive literature search N=34 eligible randomized controlled trials (RCTs) were included, comprising a total of 2597 patients. Random effects meta-analyses revealed positive treatment effects on emotional distress (g=0.53, CI 95% [0.37; 0.69]), pain (g=0.44, CI 95% [0.26; 0.61]), medication consumption (g=0.38, CI 95% [0.20; 0.56]), physiological parameters (g=0.10, CI 95% [0.02; 0.18]), recovery (g=0.25, CI 95% [0.04; 0.46]), and surgical procedure time (g=0.25, CI 95% [0.12; 0.38]). In conclusion, benefits of hypnosis on various surgically relevant outcomes were demonstrated. However, the internal validity of RCTs seems limited and further high methodological quality RCTs are needed to strengthen the promising evidence of hypnosis for adults undergoing surgery or medical procedures.

Intra-operative natural sound decreases salivary amylase activity of patients undergoing inguinal hernia repair under epidural anesthesia.

BACKGROUND: The perioperative period is psychologically as well as physically stressful for patients. Although music and sound are known to reduce patients' psychological stress, a few previous studies showed an objective outcome of music. The aim of the present study was to evaluate the relaxing effect of music during epidural anesthesia, using patients' salivary amylase activity. METHODS: Thirty-two American Society of Anesthesiologists (ASA) I or II patients presenting for inguinal hernia repair under epidural anesthesia were randomly assigned to listen to sounds of a soft wind and a twitter (S group) or to have no sounds (N group). Patients' salivary amylase activity was evaluated on arrival to the operating room and at wound closure. RESULTS: Intra-operative music significantly decreased salivary amylase activity at wound closure in the S group and the activity at wound closure of the S group was significantly smaller than that of the N group. CONCLUSION: Intra-operative natural sound significantly decreased salivary amylase activity of patients undergoing inguinal hernia repair under epidural anesthesia.

The effect of music listening on older adults undergoing cardiovascular surgery.

The purpose of this study was to determine the effect of music listening on postoperative anxiety and intubation time in patients undergoing cardiovascular surgery. Coronary artery disease and valvular heart disease affect approximately 15 million Americans and 5 million persons in the U.K. annually, with the majority of these patients being older adults. The anxiety experienced before, during and after surgery increases cardiovascular workload, thereby prolonging recovery time. Music listening as a nursing intervention has shown an ability to reduce anxiety. The study used a randomized control trial design. Sixty adults older than 65 years were randomly assigned to the control and the experimental groups. The experimental group listened to music during and after surgery, while the control group received standard postoperative care. The Spielberger State Trait Anxiety Inventory was administered to both groups before surgery and 3 days postoperatively. The mean of the differences between scores was compared using analysis of variance. Differences in mean intubation time were measured in both groups. Older adults who listened to music had lower scores on the state anxiety test (F = 5.57, p = .022) and had significantly fewer minutes of postoperative intubation (F = 5.45, p = .031) after cardiovascular surgery. Older adults undergoing cardiovascular surgery who listen to music had less anxiety and reduced intubation time than those who did not.

The effects of handholding on anxiety in cataract surgery patients under local anaesthesia.

AIM OF THE STUDY: To assess the effectiveness of handholding on the anxiety of patients undergoing planned cataract surgery under local anaesthesia. BACKGROUND: Anxiety concerning anaesthesia, pain, physical injuries, isolation, prognosis, possibilities of deformity, or loss of self-control may be stressful to patients undergoing surgery. Anxiety activates the sympathetic nervous system, characterized by an increase in catecholamine concentration, heart rate and blood pressure and increased glucocorticoid levels; it also affects immune responses. Therefore, there is a need for nursing interventions to reduce the anxiety of patients under local anaesthesia who are conscious. METHODS: An untreated control group design with pre and post-test was used. Among 62 patients, 30 were randomly assigned to the handholding group and 32 to the control group. Handholding was provided to subjects of the handholding group during surgery. Visual analogue scales and interviews were used to measure anxiety, and pulse rate and systolic and diastolic blood pressure were used as physiological measures of stress. Blood was taken for analysis of levels of epinephrine, norepinephrine, cortisol, neutrophils, lymphocytes and natural killer cells. RESULTS: The number of subjects who reported decreased anxiety during operation was significantly higher in the handholding group compared with the control group and most of the subjects reported that handholding during operation was very helpful in reducing anxiety. Epinephrine levels in the handholding group were significantly lower than in the control group. CONCLUSIONS: Results suggest that this noninvasive intervention has potential for reducing anxiety in patients having cataract surgery under local anaesthesia.

Incorporating music into the surgical environment.

Responsibility for patient comfort has always been the concern of the nurse. Conscious sedation and or local anesthesia are commonly becoming the primary method of anesthesia for a variety of outpatient plastic surgical procedures. These surgical methods require the nurse to become aware of nonchemical adjuncts that can assist in providing a safe comfortable atmosphere for the patients. Furthermore, many patients now request nonchemical adjuncts for anxiolysis and sedation as well as for analgesia in the surgical suite. This article will provide the nurse with a basic overview of one such alternative, music, including a brief historical review, relevant research, and guidelines for use of music with the operative client.