Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 11370

AbstractMaterial and MethodsResultsDiscussionReferences
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2010 | Month : August | Volume : 4 | Issue : 4 | Page : 2782 - 2787 Full Version

The Effect Of Music Therapy On Sedative Requirements And Haemodynamic Parameters In Patients Under Spinal Anaesthesia; A Prospective Study


Published: August 1, 2010 | DOI: https://doi.org/10.7860/JCDR/2010/.833
BANSAL P*, KHAROD U**, PATEL P***, SANWATSARKAR S****, PATEL H*****, KAMAT H******
Correspondence Address :
Dr. Pranav Bansal
135-Shanti Kutir, Manoranjan Park, Saket Road, Meerut Cantt, U.P.
Phone No.: +91-9837009394
E-Mail- drpranav_bansal@yahoo.com

Abstract

Background: Music therapy is the application of music in the treatment of physiological and psychological aspects of an illness or disability. Music has been shown to modulate the stress response in minor operations, intensive care and other various hospital settings. We designed this study to determine the effects of music therapy on intraoperative sedative requirements in achieving similar degrees of sedation and on Haemodynamic parameters in patients undergoing surgery under spinal anaesthesia.
Methods: We prospectively studied 100 cases of ASA Grade I and II between 15-65 years of age from both sexes, undergoing abdominal, urological and lower extremity surgery under spinal anaesthesia. The patients were randomized into Group M (those who listened to music) and Group C (those who didn't listen to music). After the induction of spinal anaesthesia, and after achieving the desired effects and levels, headphones were applied to all the patients and music was started in group M. The intraoperative vital parameters and total sedative requirements were recorded and compared in both the groups.
Observations: The total midazolam requirements were significantly lower in patients who listened to music intraoperatively (2.17 ± 0.53 mg versus 3.25 ± 0.77 mg; P =0.02), for achieving similar degree of sedation (Ramsay grade 3). The mean pulse rate was significantly lower in group M as compared to group C (from 68-76 versus 86-98; P<0.05) at 30-90 minutes intervals intraoperatively. Systolic and diastolic blood pressure were comparable in both the groups, with insignificant difference at all times (P > 0.05), though the patients in group M reported a higher sense of satisfaction and well- being postoperatively.
Conclusions: Our findings suggest an important role of music in perianesthetic patient care. We conclude that music is a non-pharmacological alternative which is suitable for decreasing intraoperative sedative requirements under spinal anaesthesia.

Keywords

: Music Therapy, Spinal Anaesthesia, Sedative, Midazolam, Operation Theater (OT)

Introduction
The perioperative period is not only physically traumatic, but is also a source of significant fear and anxiety to patients (1). Surgical procedures performed using regional anaesthetic techniques present a special challenge to anaesthesiologists, because patients are awake and are exposed to multiple anxiety provoking visual and auditory stimuli (2). Therefore, sedative and anxiolytic drugs are regularly administered before and during surgery, for the purpose of calming patients, but at the cost of dose dependent central nervous system and cardio-respiratory system depression (3),(4). Different drugs have been tried in the past to achieve sedation, the most prominent among them being diazepam, propofol, midazolam and ketamine. Non-pharmacological alternatives like acupressure, hypnosis, therapeutic suggestions and music have also been tried in the past, with varying results, to avoid the complications from the overdose of the sedative drugs (3),(4),(5). Music has found its application during various out-patient or minor procedures, ICU stay, in cancer wards, labour rooms, or other hospital settings and has been seen to reduce stress and anxiety levels in patients. A few previous studies have compared the efficacy of intra- or post-operative music therapy in decreasing sedative or analgesic requirements by using various drug combinations (4),(5). We aimed to observe the role of music therapy in the modulation of Haemodynamic variables such as heart rate and mean blood pressure and on the intraoperative requirement of sedatives for achieving similar degrees of sedation.

Material and Methods

Methods
This prospective controlled study was carried out at our institute from April 2004- March 2007 (3 years), after approval from the ethical review board of the institute. 100 cases of ASA Grade I and II, between 18-65 years of age from both sexes, undergoing abdominal, urological or lower extremity surgery under spinal anaesthesia were enrolled for the study. The exclusion criteria were patients with any contraindication to spinal anaesthesia, those with refusal for procedures or music therapy and those with hearing disorders. After the pre-anaesthetic check up and routine investigations, the patients were explained about the procedure of spinal anaesthesia and their written/informed consent was taken.
On the day of the surgery, the patients who would listen to music were randomly allocated by using the lottery method to Group M, and those in whom headphones would be applied but who would not listen to music were allocated to Group C. . In the operation theatre, standard ASA monitors were attached and the baseline parameters were recorded. Spinal anaesthesia was administered by using bupivacaine (0.5% heavy) in the doses of 3.2-3.5 cc and the T10 level was achieved. Thereafter, occlusive headphones rooted to a compact disc player (Discman, Sony Corp. Ltd, China) were applied to all the patients. In group M, the patients were asked about the choice of music that they would prefer to listen intraoperatively, which comprised of the classical, folk or religious category. Music was started in accordance with the patient's choice and the volume was adjusted according to the patient's comfort. All the music albums contained soothing music with slow beats. Music with fast beats or rhythms is known to cause more excitement and anxiety and hence, it was avoided. In Group C, occlusive headphones were applied to eliminate ambient noise, but no music was started. It is important to note that with this type of intervention, the subjects and investigators are difficult to be blinded to group assignment. Moreover, the requests of the patients to change the music album, track or volume adjustments, draws the attention of all the operating room staff and so, the study was single-blinded.
The intraoperative vital parameters, sedative requirements and the sedation scores were recorded. Intravenous midazolam was given in a bolus dose of 1.5-2 mg, followed by incremental doses of 1 mg after every half hourly assessment of the sedation score, to achieve the Ramsay Sedation Score of 3 in both the groups (Table/Fig 1).

Appropriate intravenous fluids were given as per the individual’s requirements. Haemodynamic variables were recorded every 15 minutes and the total midazolam requirements were calculated at the end of the surgery.

Statistical Analysis
The power of our study was determined by using the decrease in the sedative requirements by 40% as shown in previous studies (6),(11). Based on the α-error of 5% and the β-error of 25%, a sample size of 96 patients was required so we enrolled 100 patients and allocated them in two groups. The data was analyzed by using statistical software SPSS, version 12.0 (SPSS Inc., Chicago, IL). The categorical data was analyzed by using the Chi-square test. The continuous variables were analyzed by using the Student's t-test. The data was expressed as median (range) and mean ± standard deviation for continuous variables. A P value < 0.05 was considered as statistically significant and P values < .001 were considered to be highly significant.

Results

The demographical data was comparable in both the groups, with no significant difference in age, weight, gender and the duration of surgery (Table/Fig 2).

Due to the study design, the mean sedation scores were comparable with the non-significant differences in both the groups at all time intervals (P > 0.05 at baseline, 30, 60 and 90 min intervals). The average requirements of midazolam were similar in both the groups at the start of surgery (1.5mg vs.1.67 mg in group M and group C respectively; P=0.82) (Table/Fig 3). Thereafter, at half hourly intervals, the requirements of midazolam were observed to be low in group M for achieving similar degrees of sedation.
The total intraoperative requirements of midazolam were significantly lower in Group M (2.17 ± 0.53 mg) as compared to Group C (3.25 ± 0.77mg) (P=0.02) to achieve the Ramsay sedation grade 3 levels of sedation.
The values of the mean pulse rate in group M showed statistically significant differences (P= 0.04, 0.036, 0.015, 0.02, 0.012) at 30, 45, 60 75 and 90 minutes time interval respectively (Table/Fig 4). The mean arterial pressures were comparable in both the groups at various time intervals and showed no significant differences throughout the procedure (Table/Fig 5).

Our study group (group M) demonstrated a strong preference for religious music (48%), followed by the folk (32%) and the classical (20%) variety. Moreover, in Group M, 86% of the patients reported that music helped them relax intraoperatively and that they would opt for intraoperative music if operated again in future.

Discussion

Listening to music has been shown to modulate the mood, behavior and the psychology of the patient into a 'more positive frame of mind'. It has been shown to reduce the state of anxiety while having a favorable impact on Haemodynamic variables (7),(8),(9). We evaluated these effects of music therapy by recording the vital parameters such as pulse rate and mean arterial pressure, the increase of which is an indirect indicator of anxiety.
The neurophysiological mechanism of music therapy explains its effect on anxiety and stress. Listening to music leads to the release of endorphins, also commonly called the body's own morphine, in the brain. This facilitates an atmosphere of peace and tranquility (1). Endogenous endorphin release has also been implicated as a mechanism in decreasing pain and analgesic requirements in some studies (4),(10). The neural interconnections of the auditory pathway and the limbic system modulate emotional responses which are associated with the listening of music. Auditory interconnections with the hypothalamus, hippocampus and the reticular activating system are presumed to attenuate the release of excitatory neurotransmitters, thus providing relaxation and the sedative effects of music (1).
Another hypothesis suggests that our brain and heart beats synchronize with the rhythm and beats of music, thus leading to the entrainment phenomenon (11). Fast and loud music activates sympathetic responses, while slow and soft beats relax and calm the body. This calming and the sedative effect of music is best observed when the composition is instrumental and has slow rhythm and is of the patient’s choice, as reported by many music therapists (11),(12). Earlier studies have described the beneficial effects of musical elements such as tempo and pitch on physiological and emotional responses, though the reaction to any piece of music can vary widely among listeners (13). It is also important to understand that age, culture, socioeconomic status and religion affects the way people respond to pain and music (14). Keeping these facts in consideration, we allowed our patients to select their own choice of music from our collection which contained soft and slow rhythmic music.
Our study group showed a strong preference for religious (48%) or folk music (22%), which reflects that the patient's choice of music is strongly associated with their cultural background. Similar findings have been reported by Ovayolu et al, where Turkish classical music decreased sedative requirements during colonoscopy (15). A study done by Chan et al using Chinese and Western classical music with slow beats on patients undergoing a C-clamp procedure, found significant reduction in heart rate, respiratory rate, and pain scores in the intervention group (16). These few studies demonstrate the role of cultural and patient-selected music in coping with the stress and anxiety of the unfamiliar hospital environment (17),(18).

As patients are exposed to multiple anxiety-provoking visual and auditory stimuli under regional anaesthesia, concerns are also rising over the use of loud music which is played in the OT. Music which is rooted through wall speakers contribute to the overall level of background noise, it impairs effective communication among staff members and makes the patients' choice secondary (8),(19). The application of headphones is therefore a preferable solution to all these problems in operating room settings (20).
It is well-known that intraoperatively used sedatives delay the recovery of patients and are liable to cause adverse effects like oversedation and respiratory depression in the postoperative phase. Our results showed that intraoperative music provided a consistent decrease in the sedative requirements in patients who were allotted to the music therapy group as compared to patients in the control group. The average midazolam requirement to achieve an equal sedation score was significantly less in the music group [1.31 (1 – 2.5) mg/ hr] as compared to the control group [2.18 (1.5 – 4.5) mg/hr]. In studies conducted by Carolina Lepage et al (11) and Marc E. Koch et al (6), a significant decrease in sedative requirements in the music group was observed, as compared to non-music group for achieving similar levels of sedation. Lai HL reported that music resulted in a significantly better sleep quality; longer sleep duration, shorter sleep latency and less sleep disturbance in older patients with sleep disorders (12). By decreasing sedative requirements, music can aid in faster recovery whilst preventing the adverse effects of sedative drugs. On the contrary, Tej Kaul et al reported that patients with occlusive head phones had similar requirements of propofol as compared to those who listened to music intraoperatively and that the head phone setting eliminated the ambient noise in operation theatre and decreased the sedative requirements in patients under regional anaesthesia (21).
We observed a significant drop in the mean heart rate intraoperatively in the music therapy group as compared to the control group, which correlates with the observations made by Good M and many other researchers [4-6],(22). A study in Taiwan, in 64 parturients, reported that music therapy decreased heart rate by 7 beats/min and improved satisfaction scores by 3.4 points on a 35-point scale, though the clinical benefit of this observation was subtle and questionable (23). Contrary to our study, Shu-Ming Wang et al (24) and Ebneshahidi (17) noted no significant changes in heart rate during music therapy and explained that it was due to variations in individual autonomic responsiveness to a stressful situation. In intensive care settings, a single session of music with 25–90 minutes of listening time has been shown to reduce heart rate, blood pressure, respiratory rates and anxiety levels in intubated patients during the weaning phase (25). Compared to the operating room, the patients stay for a longer duration in the confined environment of the ICU, which suggests that music is a definite source of distraction and relaxation in these settings.
We did not observe any significant reduction in the blood pressure in the intervention group as compared to the control group, which is in agreement with the results of most recent studies (5),(26). Sendelbach et al reported that music did not cause significant decreases in systolic and diastolic blood pressures in patients recovering from cardiac bypass surgery, though significant decreases in anxiety levels attributed to music are beneficial to patients with coronary heart disease (27). On the contrary, a meta-analysis of 23 trials performed by Bradt J, showed that listening to music has a beneficial effect on blood pressure, heart rate, respiratory rate, anxiety and pain in patients with coronary heart disease, with consistent results in all the studies. However, the clinical significance of these decreased parameters was found to be subtle and more of academic interest (28).
Other than the objective parameters like decrease in the dose of midazolam or decrease in pulse rate which can be taken as signs of sympathetic activity, the subjective observations made during our study were noteworthy. Patients who had listened to music during their first surgery actually demanded for music in subsequent orthopedic or plastic surgery corrections. Those patients who had been operated previously under regional anaesthesia, found the intraoperative period with music this time much better, less stressful and more relaxing. The average reduction of midazolam in the music therapy group amounted to less than 0.20 USD savings per case and did not seem to have a significant economical impact, but the levels of patient satisfaction achieved with this intervention was invaluable. Moreover, the strong preference of people towards religious and folk music indicated that music can prove to be a reliable companion in the unfamiliar and stressful environment of hospitals.
Due to the non-availability of some advanced facilities, there were a few limitations in our study. The monitoring of the plasma levels of stress hormones (adrenaline, nor-adrenaline and cortisol) and objective or complex questionnaires could have helped the evaluation of anxiety levels and added precision to our results. Incorporating a patient controlled sedation device in the study could also have helped in maintaining the same level of sedation throughout the study period and in accurately calculating intraoperative sedative requirements (29). Moreover, extending music therapy to the preoperative and postoperative period could have helped us in evaluating the analgesic sparing efficacy of music therapy. In future studies, the effects of music on the operating room staff and the environment can also be carried out (22),(30).
In conclusion, this study shows that music is an attractive adjuvant to sedative drugs for alleviating anxiety and distress which is suffered by patients undergoing surgeries under regional anaesthesia. We recommend the incorporation of this low-cost intervention in routine anaesthesia practice because of its beneficial effect on Haemodynamic parameters and also because of its enhancing effect on the sedatives used in regional anaesthesia.

Conflict of Interest: Nil

Work Attributed To –Department Of Anesthesiology, Pramukh Swami Medical College, Karamsad, Anand, Gujarat
Financial Support- Self

References

1.
Myskja A, Lindbaek M. How does music affect the human body? Tidsskr Nor Laegeforen. Apr 2000; 120(10): 1182-5.
2.
Kari Christiansen: The history of music therapy. Available from: http://www.creative exchange music.com
3.
Byers JF, Smyth KA. Effect of a music intervention on noise annoyance, heart rate and blood pressure in cardiac surgery patients. Am J Crit Care. May 1997; 6(3):183-91.
4.
Good M, Stanton-Hicks M, Grass JA, Cranston Anderson G, Choi C, Schoolmeesters LJ, et al. Relief of postoperative pain with jaw relaxation, music and their combination. Pain. May 1999; 81(1-2): 163-72.
5.
Nilsson U, Rawal N, Unestahl LE, Zetterberg C, Unosson M. Improved recovery after music and therapeutic suggestions during general anesthesia: a double-blind randomized controlled trial. Acta Anaesthesiol Scand. 2001; 45(7): 812-7.
6.
Marc E. Koch, Zeev N. Kain, Chakib Ayoub, Stanley H. Rosenbaum, The sedative and analgesic sparing effect of music. Anesthesiology 1998; 89(2): 300-6.
7.
Lee D, Henderson A, Shum D. The effect of music on preprocedure anxiety in Hong Kong Chinese day patients. J Clin Nurs. Mar 2004; 13(3): 297-303.
8.
Kliempt P, Ruta D, Ogston S, Landeck A, Martay K. Hemispheric-synchronisation during anesthesia: a double-blind randomised trial using audiotapes for intra-operative nociception control. Anesthesia Aug 1999; 54(8): 769-73.
9.
Menegazzi JJ, Paris PM, Kersteen CH, Flynn B, Trautman DE. A randomized, controlled trial of the use of music during laceration repair. Emerg Med 1991; 20(4): 348-50.
10.
Good M, Anderson GC, Stanton-Hicks M, Grass JA, Makii M. Relaxation and music reduce pain after gynecologic surgery. Pain Manag Nurs. Jun 2002; 3(2): 61-70.
11.
Carolina L, Pierre D, Michel G, Yvan G. Music decreases sedative requirements during spinal anesthesia Anesth Analg 2001; 93: 912–6.
12.
Lai HL, Good M. Music improves sleep quality in older adults. Journal of Advanced Nursing 2005; 49(3): 234–44.
13.
Suda M, Morimoto K, Obata A, Koizumi H, Maki A. Emotional responses to music: towards scientific perspectives on music therapy. Neuroreport 2008; 19(1): 75-8.
14.
Camara JG, Ruszkowski JM, Worak SR. The Effect of Live Classical Piano Music on the Vital Signs of Patients Undergoing Ophthalmic Surgery. Medscape J Med. 2008;10(6):149.
15.
Ovayolu N, Ucan O, Pehlivan Y, et al. Listening to Turkish classical music decreases patients' anxiety, pain, dissatisfaction and the dose-sedative and analgesic drugs during colonoscopy: A prospective randomized controlled trial. World J Gastroenterol. 2006;12:7532-7536.
16.
Chan HL, Fong MC, Lai SY, Lo CW, et al.Effects of music on patients undergoing a C-clamp procedure after percutaneous coronary interventions. Journal of Advanced Nursing 2006; 53 (6): 669-79.
17.
Ebneshahidi A, Mohseni M. The effect of patient-selected music on early postoperative pain, anxiety, and Haemodynamic profile in cesarean section surgery. J Altern Complement Med 2008 Sep;14(7):827-31.
18.
Ann-Charlotte F, Leif H, Ulrica N. Patients’ perception of music versus ordinary sound in a postanaesthesia care unit: A randomized crossover trial. Intensive and critical care nursing. 25(4): 208-13.
19.
Chakib MA, Laudi BR, Chadi IY, Dorothy G, Zeev NK. Music and Ambient Operating Room Noise in Patients Undergoing Spinal Anesthesia. Anesth Analg 2005; 100: 1316–9.
20.
Lewis AK, Osborn IP, Roth R. The effect of hemispheric synchronization on intraoperative analgesia. Anesth Analg. 2004 Feb; 98(2): 533-6.
21.
Kaul TK, Ahuja N, Avtar S. Does music reduce sedative requirement under regional anesthesia? J Anaes Clin Pharmac 2003; 19(2): 203-6.
22.
Nilsson U, Rawal N, Unosson M. A comparison of intra-operative or postoperative exposure to music--a controlled trial of the effects on postoperative pain. Anesthesia. 2003 Jul; 58(7): 699-703.
23.
Laopaiboon M, Lumbiganon P, Martis R, Vatanasapt P, Somjaivong B. Music during caesarean section under regional anaesthesia for improving maternal and infant outcomes. Cochrane Database of Systematic Reviews 2009, Issue 2. Art. No.: CD006914. DOI: 10.1002/14651858. CD006914.pub2
24.
Shu MW, Kulkarni L, Jackqulin D, Kain ZN. Music and Preoperative Anxiety. Anesth Analg 2002; 94:1489–94.
25.
Jaber S, Bahloul H, Guétin S, Chanques G et al. Effects of music therapy in intensive care unit without sedation in weaning patients versus non-ventilated patients. Ann Fr Anesth Reanim 2007;26(1):30-8.
26.
Mandel SE, Hanser SB, Secic M, Davis BA. Effects of music therapy on health-related outcomes in cardiac rehabilitation: A randomized controlled trial. Journal of Music Therapy 2007; 34(3): 176-97.
27.
Sendelbach SE, Halm MA, Doran KA, Miller EH et al. Effects of Music Therapy on Physiological and Psychological Outcomes for Patients Undergoing Cardiac Surgery. Journal of Cardiovascular Nursing 2006 May-Jun;21(3):194-200.
28.
Bradt J, Dileo C. Music for stress and anxiety reduction in coronary heart disease patients. Cochrane Database of Systematic Reviews 2009, Issue 2. Art. No.: CD006577. DOI: 10.1002/14651858.CD006577.pub2.
29.
Voss JA, Good M, Yates B, Baun MM, Thompson A, Hertzog M. Sedative music reduces anxiety and pain during chair rest after open-heart surgery. Pain. 2004 Nov; 112(1-2):197-203.
30.
Nilsson U, Rawal N, Enqvist B, Unosson M: Analgesia following music and therapeutic suggestions in the PACU in ambulatory surgery; a randomized controlled trial. Acta Anaesthesiol Scand 2003; 47(3): 278-83.

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com