Effect of Preoperative Music Therapy Versus Intravenous Midazolam on Anxiety, Sedation and Stress in Stomatology Surgery: A Randomized Controlled Study

Abstract

Background: Patients undergoing surgery and general anesthesia often experience anxiety, fear and stress, with negative bodily responses. These may be managed by the pre-procedural application of anxiolytic, analgesic, and anesthetic drugs that have, however, potential risks or side effects. Music therapy (MT) can be used as a complementary no-drug intervention alongside standard surgical care before, during and after medical procedures. The aim of this study was to evaluate the effects of preoperative MT intervention compared to premedication with midazolam on levels of anxiety, sedation and stress during general anesthesia for elective stomatology surgery. Methods: A two-arm randomized and controlled single-center, parallel-group, pre–post event study was conducted. In total, 70 patients affected by stage I or II (both clinically and instrumentally N0) micro-invasive oral cancer and undergoing elective surgery under general anesthesia were assigned to the control group (CG) or to the music therapy group (MTG). MTG patients received preoperative music therapy intervention (MT) from a certified music therapist before surgery, while the CG patients did not receive MT but instead received premedication with intravenous midazolam, 0,02 mg/kg. Anesthesia was the same in both groups. The systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) were recorded at the entrance to the operating room, just before the induction of anesthesia and every 5 min until the end of surgery. An anxiety visual analogues scale (A-VAS) was used to evaluate the level of anxiety. The bispectral index (BIS) monitor was used to measure the depth of sedation just before and 10 min after both music intervention and midazolam administration. Stress response was assessed 5 min before and 20 min after surgery via the control of plasma prolactin (PRL), growth hormone (GH), and cortisol levels. The patient global impression of satisfaction (PGIS) was tested 1 h after surgery. Participants in the MTG were asked to answer 3 questions concerning their experience with MT. Results: No statistical differences among the PRL, GH and cortisol levels between the two groups were registered before and after the treatment, as well as for PAS, PAD and HR. Significant differences in the A-VAS scores between the MTG and CG (p < 0.01) was observed. Compared to the CG, MTG patients had a statistically significantly lower BIS score (p = 0.02) before induction. A PGIS score of 86.7% revealed that patients in the MTG were very satisfied, versus 80% in the CG (p < 0.05). Conclusion: Preoperative music therapy could be an alternative to intravenous midazolam when aiming to promote a preoperative and post-operative state of anxiolysis and sedation in stomatology surgery, even if no differences were found in terms of the surgery-related stress response according to physiological and hormonal determinations.

Eficácia das técnicas de aromaterapia, musicoterapia e hipnose no controle do medo, dor e ansiedade no consultório odontológico

“…Para tratamentos restauradores convencionais, ouvir música não afetou os parâmetros fisiológicos dos pacientes (Karapicak et al, 2023). Já a musicoterapia pré-operatória se apresentou como um tratamento de sucesso garantido de segurança e alívio de dor intensa, os efeitos da intervenção pré-operatória de musicoterapia em comparação à pré-medicação com midazolam foi capaz de reduzir os níveis de ansiedade, ocasionando assim sedação durante anestesia geral para cirurgia eletiva de estomatologia (Giordano et al, 2023).…”

Music combined with dexmedetomidine relieves preoperative anxiety and promotes postoperative recovery in patients undergoing gynecologic laparoscopic surgery: a randomized clinical trial

“…Giordano et al [31] reported that a 5-minute musical intervention before surgery was effective in decreasing anxiety in general anesthesia patients undergoing oral surgery; therefore, a 5-minute preoperative music intervention was chosen for this study. Like many other hospitals in China, we do not have a professional music therapist, so the music intervention is implemented by an assigned researcher.…”

Pain and Neurobiology

“…Physical therapy has always been helpful in pain management, including some specific painful pathologies [26]. Other studies also show the intricacy of interactions between neurobiology and pain, demonstrating how chronic pain patients may benefit from the beauty of the arts [27,28]. Additionally, cognitive-behavioral therapy, which instructs individuals on how to better cope with pain by altering their beliefs and actions is beneficial [29].…”