dr. alice h. cash, ph.d., lcsw [email protected] music as an adjunct to anesthesia: a review of...
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Dr. Alice H. Cash, Ph.D., LCSW [email protected] 11
Music as an Adjunct to Anesthesia:Music as an Adjunct to Anesthesia:A Review of the ResearchA Review of the Research
Cleveland Clinic Florida Grand Rounds Presentation Alice H. Cash, Ph.D., LCSW
April 1, 2011
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Dr. Alice H. Cash, Ph.D., LCSW [email protected] 22
Cleveland ClinicCleveland Clinic
Cleveland Clinic has been a pioneer
in the use of music during surgery
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Dr. Alice H. Cash, Ph.D., LCSW [email protected] 33
The Phenomenon of Rhythmic EntrainmentThe Phenomenon of Rhythmic Entrainment
• Humans have been entraining to music since the beginning of time– Hand clapping– Dancing– Finger snapping– Swaying back and forth
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Dr. Alice H. Cash, Ph.D., LCSW [email protected] 44
Early publications suggesting benefits of music in Early publications suggesting benefits of music in surgery (1998)surgery (1998)
• “Use of intraoperative music in awake patients decreases patient-controlled sedative and analgesic requirements.”
• “Thus, the decrease in sedative and analgesic requirements could be caused by elimination of ambient operating room noise and not by the effects of music.”
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Dr. Alice H. Cash, Ph.D., LCSW [email protected] 55
The sedative and analgesic sparing effect of music. The sedative and analgesic sparing effect of music. Yale University Hospital study (1998) Yale University Hospital study (1998)
• Background: To determine whether music influences intraoperative sedative and analgesic requirements, two randomized controlled trials were performed.
• Methods: Phase 1 Phase 2
• Results: In phase 1, patients in the music group required significantly less propofol for sedation than patients in
the control group
Similarly, in phase 2, patients who listened to music had a significant reduction in alfentanil requirements
• Duration of stay in the postanesthesia care unit and the rate of adverse events was similar in both groups (P = NS).
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Dr. Alice H. Cash, Ph.D., LCSW [email protected] 66
Music as an Adjunct to AnesthesiaMusic as an Adjunct to Anesthesia
“The Efficacy of Music Therapy”
• Journal of Peri-anesthesia Nursing( 2010 Aug; 25(4):226-32) Wakim JH, Smith S, Guinn C. University of Tennessee
• Being anesthetized is anxiety provoking can cause– An increase in blood pressure– An increase in heart rate– Other effects that can have a negative impact pre-
operatively
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Dr. Alice H. Cash, Ph.D., LCSW [email protected] 77
Music’s Effect on the BodyMusic’s Effect on the Body
• Rhythmic Entrainment is one of the most important concepts in the fields of music therapy and music medicine.
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Dr. Alice H. Cash, Ph.D., LCSW [email protected] 88
Music for Surgeons and AnesthesiologistsMusic for Surgeons and Anesthesiologists
• Today music is often found in the operating room
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Dr. Alice H. Cash, Ph.D., LCSW [email protected] 99
Music for the PatientMusic for the Patient
• For decades, surgeons have used music in the operating room
• Rarely is the patient considered when the surgeon chooses his music.
• Ideally, the patient and the surgeon need their own unique types of music.
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Dr. Alice H. Cash, Ph.D., LCSW [email protected] 1010
A Three-Part PlaylistA Three-Part Playlist
• I recommend three distinct tempos of music for the surgical procedure. – Pre-Surgery– During Surgery– Post Surgery
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Dr. Alice H. Cash, Ph.D., LCSW [email protected] 1111
A Three-Part PlaylistA Three-Part Playlist
• Pre-Surgery– Music that is familiar to
them and makes them feel safe and comforted is ideal.
– Relaxing
– Example: Edelweiss
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Dr. Alice H. Cash, Ph.D., LCSW [email protected] 1212
A Three-Part PlaylistA Three-Part Playlist
• Surgery: – Slow, steady purely
instrumental music
– Tempo of the healthy, resting heartbeat.
– Perhaps “unknown”
Ex: Baroque or classical movements. “Pachelbel’s Canon”
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Dr. Alice H. Cash, Ph.D., LCSW [email protected] 1313
A Three-Part PlaylistA Three-Part Playlist
• Recovery area– Little more upbeat– Possibly with positive,
affirming lyrics
Ex: “Morning has Broken” “When you Wish upon a Star” “The Rainbow Connection”
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Dr. Alice H. Cash, Ph.D., LCSW [email protected] 1414
Reduction of Anxiety BeforeReduction of Anxiety Before
• Studies have shown that listening to calm, steady music for 30-40 minutes before surgery, can greatly decrease the amount of anxiety medication needed.
• Some patients state that they are so relaxed by the music that they do not need any added anxiety medications prior to being sedated.
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Dr. Alice H. Cash, Ph.D., LCSW [email protected] 1515
Reduction of Anesthesia During Reduction of Anesthesia During ProcedureProcedure
• After listening to calm, soothing music for 30-40 minutes prior to surgery, the patient arrives in the O.R. more calm and quiet.
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Dr. Alice H. Cash, Ph.D., LCSW [email protected] 1616
Review of Recent ResearchReview of Recent Research
• Today, I will focus on research studies and articles between 2001-2011.
• Although music has probably been used in one form or another for medical procedures over hundreds of years, we are only now understanding how to use it intentionally.
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Dr. Alice H. Cash, Ph.D., LCSW [email protected] 1717
Review of Recent ResearchReview of Recent Research
• Relaxing music as pre-medication before surgery
• Acta Anaesthesiol Scand 2009 Jul:53
• Dept of Surgery, Sodertalje Hospital Sodertalje, Sweden.
• Conclusion: Higher effectiveness and absence of apparent adverse effects makes pre-operative relaxing music a useful alternative to midazolam for pre-medication.
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Dr. Alice H. Cash, Ph.D., LCSW [email protected] 1818
Review of Recent ResearchReview of Recent Research
• The effect of music on preoperative sedation and the bispectral index
Anesthesia and Analgesia 2005 Jul; 101 Harran University, School of Medicine,
Sanliurfa, Turkey
• Conclusions: Listening to music during midazolam pre-medication is associated with an increase in sedation level in the preoperative period as reflected by a lower BIS value.
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Dr. Alice H. Cash, Ph.D., LCSW [email protected] 1919
Review of Recent ResearchReview of Recent Research
• The effect of music listening on older adults undergoing cardiovascular surgery.
Nursing in Critical Care. 2006 Sep-Oct;11(5):224-31. Delray Medical Center, Delray Beach, FL
• Conclusions: Listening to music during and after cardiovascular surgery is an effective and safe intervention for older adults.
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Dr. Alice H. Cash, Ph.D., LCSW [email protected] 2020
Review of Recent ResearchReview of Recent Research
• Music and ambient operating room noise in patients undergoing spinal anesthesia
• Yale University School of Medicine, New Haven, CT
Anesthesia & Analgesia, 2005 May; 100 (5)
• Results: Intraoperative music decreases propofol requirements. We also found that Lebanese patients used less propofol as compared with American patients.
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Dr. Alice H. Cash, Ph.D., LCSW [email protected] 2121
Review of Recent ResearchReview of Recent Research
• Clinical trial: music reduces anxiety levels in patients attending for endoscopy
• Alimentary Pharmacology Therapy 2009 Oct, Kent & Canterbury Hospital, Canterbury, UK.
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Dr. Alice H. Cash, Ph.D., LCSW [email protected] 2222
Review of Recent ResearchReview of Recent Research
• Listening to music decreases need for sedative medication during colonoscopy
• Indian Journal of Gastroenterology 2006 Jan Feb;25(1):3-5, Medical College Hospital, Kozhikode 673 008, Kerala
• Conclusion: Listening to music during colonoscopy helps reduce the dose of sedative medications and decreases discomfort experienced
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Dr. Alice H. Cash, Ph.D., LCSW [email protected] 2323
Review of Recent ResearchReview of Recent Research
• Music Therapy in Gastrointestinal Endoscopic Procedures.
World Journal of Gastroenterology, 2007 Sep 7;13(33):4533
• Background: To elucidate the role of music therapy in gastrointestinal endoscopic procedures following the conflicting outcomes reported in two recent studies
• Conclusions: The beneficial effects were shown on analgesia and sedation requirements and procedure duration times when used as an adjunct to pharmacotherapy.
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Dr. Alice H. Cash, Ph.D., LCSW [email protected] 2424
Review of Recent ResearchReview of Recent Research
• Patients' perception of music versus ordinary sound in a post-anaesthesia care unit
• Intensive and Critical Care Nursing. 2009 Aug;25(4):208-13. Malmoe University Hospital, Sweden
• Conclusions: Promote the use of listening to music to establish a healing environment for patients in a post-anaesthesia care unit.
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Dr. Alice H. Cash, Ph.D., LCSW [email protected] 2525
Review of Recent ResearchReview of Recent Research
• Music as a nursing intervention for postoperative pain: a systematic review
• University College in Dalarna, Falun, Sweden 2009 Dec;24(6):370-83.
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Dr. Alice H. Cash, Ph.D., LCSW [email protected] 2626
Review of Recent ResearchReview of Recent Research
• The Effect of Music on postoperative pain and anxiety
Pain Management Nursing 2010 Mar University of Central Florida, USA
• Background: Determine if listening to music or having a quiet rest period just before and just after the first ambulation on postoperative day 1 can reduce pain and/or anxiety or affect mean arterial pressure, heart rate, oxygen saturation, and respiratory rate
• Conclusions Nurses can offer music as an intervention to decrease pain and anxiety in this patient population with confidence,
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Dr. Alice H. Cash, Ph.D., LCSW [email protected] 2727
Review of Recent ResearchReview of Recent Research
• Evidence That Music Listening Reduces Patients' Anxiety
• Biological Research for Nursing. Jan 28, 2011
• Results: The music group demonstrated significant reductions in VAS scores, patients in the control group showed no changes; frequency-domain parameters of HRV can be indicators for monitoring the change
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Dr. Alice H. Cash, Ph.D., LCSW [email protected] 2828
Review of Recent ResearchReview of Recent Research
• Effect of music therapy on postoperative analgesia and to determine the duration of its effect.
• Gülhane Military Medical Academy, Haydarpaşa Training Hospital, İstanbul, Turkey.
• Conclusion: Music therapy decreases postoperative pain in the first 24 hours and the analgesic consumption during the first four hours.
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Dr. Alice H. Cash, Ph.D., LCSW [email protected] 2929
Review Recent ResearchReview Recent Research• The role of music during surgery and the
effect on staff, users and patients
• Ahmadu Bello University Teaching hospital, Zaria. African Health Science 2010 Dec;10(4):386-9.
• Conclusion: music can prevent distraction, minimize annoyance, reduce stress and diminish the anxiety of patients, staff and users.
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Dr. Alice H. Cash, Ph.D., LCSW [email protected] 3030
Review of Recent ResearchReview of Recent Research
• Monitored Anesthesia Care.
Doctor’s Regional Medical Center, Corpus Christi, TX, USA.
• Conclusion: The use of music as an anesthetic adjunct during MAC cases can reduce the amount of sedation required, speed recovery time, and prevent the likelihood of converting to a general anesthetic.
• 2010 American Society of PeriAnesthesia Nursing
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Dr. Alice H. Cash, Ph.D., LCSW [email protected] 3131
Review of Recent ResearchReview of Recent Research
• Minimizing preoperative anxiety with music for day surgery patients
• Journal of Clinical Nursing. 2011 Feb 20. - a randomized clinical trial.
• Evaluate the effects of musical intervention on preoperative anxiety and vital signs in patients undergoing day surgery
• Relevance to clinical practice. Finding multimodal approaches to ease discomfort and anxiety from unfamiliar unit surroundings and perceived risks of morbidity
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Dr. Alice H. Cash, Ph.D., LCSW [email protected] 3232
Conclusion and RecommendationsConclusion and Recommendations
• Music is a powerful and effective adjunct to anesthesia and carries no known risks or downside.
And yet music for the patient, is still rarely seen in the operating room.
• When the music is delivered through cordless headphones, the patient can have his optimal type of music and the surgeon and O.R. staff can have their preferred music.
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Dr. Alice H. Cash, Ph.D., LCSW [email protected] 3333
Conclusion and RecommendationsConclusion and Recommendations
• Current practices:– Music being used now is chosen by staff for their
listening needs
– Patients sometimes report not liking the music that is being played in OR.
– Patients sometimes report hearing comments and conversations that are upsetting.
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Dr. Alice H. Cash, Ph.D., LCSW [email protected] 3434
Conclusion and RecommendationsConclusion and Recommendations
• Best practices
– Music through headphones, offered to each surgical patient, starting 30-45 minutes before procedure
– Same music be continued through-out the surgery
– Either the same music or music with a slightly more upbeat tempo and positive affect into the recovery area until patient is awake and alert
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Dr. Alice H. Cash, Ph.D., LCSW [email protected] 3535
Conclusion and RecommendationsConclusion and Recommendations
• Safety and efficacy– Music is a safe and risk-free adjunct to
traditional anesthesia and can assist in keeping the patient relaxed and comfortable while decreasing both anesthesia and analgesia
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Dr. Alice H. Cash, Ph.D., LCSW [email protected] 3636
Conclusion and RecommendationsConclusion and Recommendations
• Is There a Place for Music in Medical School?
• Music permeates the medical literature regarding disease therapy. However, there are only few articles concerning music as a tool for development of cultural competency and interpersonal relations.
Medical Teacher. 2011;33(1):76-7. Boston University School of Medicine, MA 02118, USA.
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Dr. Alice H. Cash, Ph.D., LCSW [email protected] 3737
Music as an Adjunct to Anesthesia:Music as an Adjunct to Anesthesia:A Review of the ResearchA Review of the Research
Do you have any questions?
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Dr. Alice H. Cash, Ph.D., LCSW [email protected] 3838
Music as an Adjunct to Anesthesia:Music as an Adjunct to Anesthesia:A Review of the ResearchA Review of the Research
Thank You for your time today!(It’s something you don’t have a lot of….)
Dr. Alice H. Cash