Perioperative music therapy: state of the art and applicability in anesthesia

Música perioperatoria: estado del arte y aplicabilidad en la práctica anestésica

Audition is a complex process in which sound transduces into electrical energy which is processed and interpreted at the auditory cortex. Music therapy is an inexpensive technique applicable to anesthesia. As an adjuvant to pharmacological interventions it allows reducing the requirements of certain medicines. Objective: a non-systematic review in recognized databases. Methodology: A thorough search of systematic reviews, consensuses and meta-analyses on electronic databases PubMed, Science Direct, OvidSP, EBSCO and SciELO using electronic descriptors. 393 articles were retrieved from the searches which included 80 related with music, music therapy, medicine and adults; 77 regarding electrencephalography, acoustic stimulation and cortical synchronization; 32 on balanced anesthesia and methyl ethers; and, 68 related with music and anesthesia. Only 100 articles were eligible for inclusion as only full text reports were considered. Two university physics textbooks were used as supplemental reading resources. Conclusions: music is a valuable adjuvant of anesthesia which can provide reduced morbidity and mortality and related costs. Further studies  are needed to determine the scope of this association.

1. Hole J, Hirsch M, Ball E, Meads C. Music as an aid for postoperative recovery in adults: a systematic review and meta-analysis. The Lancet. 2015;386(10004):1659–71.
2. Dobek CE, Beynon ME, Bosma RL, Stroman PW. Music modulation of pain perception and pain-related activity in the brain, brain stem, and spinal cord: a functional magnetic resonance imaging study. J Pain Off J Am Pain Soc. 2014;15(10):1057–68.
3. Nilsson U. The anxiety- and pain-reducing effects of music interventions: a systematic review. AORN J. 2008;87(4):780–807.
4. Ames N, Shuford R, Yang L, Moriyama B, Frey M, Wilson F, et al. Music Listening Among Postoperative Patients in the Intensive Care Unit: A Randomized Controlled Trial with Mixed-Methods Analysis. Integr Med Insights. 2017;12:1178633717716455.
5. Bradt J, Dileo C, Shim M. Music interventions for preoperative anxiety. Cochrane Database Syst Rev. 2013; 6(6):CD006908.
6. Giancoli DC. Physics: principles with applications. 1st ed. N.J: Pearson/Prentice Hall; 2005.
7. Freedman, Roger A, Hugh D Young. Sears and Zemansky’s university physics: with modern physics [Internet]. 12th ed. San Francisco : Pearson Addison-Wesley; 2008. Available from: http:// lib.ugent.be/catalog/rug01:001316743
8. White JM. State of the science of music interventions. Critical care and perioperative practice. Crit Care Nurs Clin North Am. 2000; 12(2):219–25.
9. Boso M, Politi P, Barale F, Enzo E. Neurophysiology and neurobiology of the musical experience. Funct Neurol. 2006; 21(4):187–91.
10. Limb CJ. Structural and functional neural correlates of music perception. Anat Rec A Discov Mol Cell Evol Biol. 2006;288(4):435–46.
11. Kemper KJ, Danhauer SC. Music as therapy. South Med J. 2005; 98(3):282–8.
12. Merriam AP. The anthropology of music. Northwestern University Press, 1964;
13. McNeill WH. Keeping Together in Time Dance and Drill in Human History. Massachusetts: Harvard University Press; 1995. 216 p.;
14. Soto D, Funes MJ, Guzmán-García A, Warbrick T, Rotshtein P, Humphreys GW. Pleasant music overcomes the loss of awareness in patients with visual neglect. Proc Natl Acad Sci U S A. 2009;106(14):6011–6.



15. Terry PC, Karageorghis CI, Saha AM, D’Auria S. Effects of synchronous music on treadmill running among elite triathletes. J Sci Med Sport. 2012;15(1):52–7.
16. Gulledge SL, Kline OR. Use of stereo headphones for patient relaxation during cataract surgery under local anesthesia. Ophthalmic Surg. 1981;12(4):289–90.
17. Kaempf G, Amodei ME. The effect of music on anxiety. A research study. AORN J. 1989 Jul;50(1):112–8.
18. Szmuk P, Aroyo N, Ezri T, Muzikant G, Weisenberg M, Sessler DI. Listening to music during anesthesia does not reduce the sevoflurane concentration needed to maintain a constant bispectral index. Anesth Analg. 2008;107(1):77–80.
19. Menon V, Levitin DJ. The rewards of music listening: response and physiological connectivity of the mesolimbic system. NeuroImage. 2005 Oct 15;28(1):175–84.
20. Berridge KC. The debate over dopamine’s role in reward: the case for incentive salience. Psychopharmacology (Berl). 2007;191(3):391–431.
21. Berridge KC, Kringelbach ML. Affective neuroscience of pleasure: reward in humans and animals. Psychopharmacology (Berl). 2008
;199(3):457–80.
22. Berridge KC. Robinson TE. What is the role of dopamine in reward: hedonic impact, reward learning, or incentive salience? Brain Res Rev. 1998;28(3):309-69.
23. Barbano MF, Cador M. Opioids for hedonic experience and dopamine to get ready for it. Psychopharmacology (Berl). 2007;191(3):497–506.
24. Schultz W. Dopamine signals for reward value and risk: basic and recent data. Behav Brain Funct BBF. 2010;23:6:24.
25. Blood AJ, Zatorre RJ. Intensely pleasurable responses to music correlate with activity in brain regions implicated in reward and emotion. Proc Natl Acad Sci U S A. 2001 Sep 25;98(20):11818–23.
26. Koelsch S, Fritz T, V Cramon DY, Müller K, Friederici AD. Investigating emotion with music: an fMRI study. Hum Brain Mapp. 2006 Mar;27(3):239–50.
27. Khalfa S, Schon D, Anton J-L, Liégeois-Chauvel C. Brain regions involved in the recognition of happiness and sadness in music. Neuroreport. 2005 Dec 19;16(18):1981–4.
28. Altenmüller E. How many music centres are in the brain? The Cognitive Neuroscience of Music. New York: Oxford University Press; 2003.; 346–53 p.
29. Trainor L SL. Processing emotions induced by music. The Cognitive Neuroscience of Music. New York: Oxford University Press; 2003; 310–24 p.
30. Avanzini G. Musicogenic seizures. Ann N Y Acad Sci. 2003 Nov;999:95–102.
31. Burneo JG, Villanueva V, Knowlton RC, Faught RE, Kuzniecky RI. Kaplan-Meier analysis on seizure outcome after epilepsy surgery: do gender and race influence it? Seizure. 2008 Jun;17(4):314–9.
32. Wieser HG. Music and the brain. Lessons from brain diseases and some reflections on the “emotional” brain. Ann N Y Acad Sci. 2003 Nov;999:76–94.
33. Evers S, Ellger T. The clinical spectrum of musical hallucinations. J Neurol Sci. 2004 Dec 15;227(1):55–65.
34. Hughes JR. The Mozart Effect: Additional Data. Epilepsy Behav EB. 2002 Apr;3(2):182–4.
35. Jausovec N, Habe K. The “Mozart effect”: an electroencephalographic analysis employing the methods of induced event-related desynchronization/synchronization and event-related coherence. Brain Topogr. 2003;16(2):73–84.
36. Gold C, Heldal TO, Dahle T, Wigram T. Music therapy for schizophrenia or schizophrenia-like illnesses. Cochrane Database Syst Rev. 2005 Apr 18;(2):CD004025.
37. Wang S-M, Kulkarni L, Dolev J, Kain ZN. Music and preoperative anxiety: a randomized, controlled study. Anesth Analg. 2002 Jun;94(6):1489–94, table of contents.
38. Wakim JH, Smith S, Guinn C. The efficacy of music therapy. J Perianesthesia Nurs Off J Am Soc PeriAnesthesia Nurses. 2010 Aug;25(4):226–32.
39. Koch ME, Kain ZN, Ayoub C, Rosenbaum SH. The sedative and analgesic sparing effect of music. Anesthesiology. 1998 Aug;89(2):300–6.
40. Ikonomidou E, Rehnström A, Naesh O. Effect of music on vital signs and postoperative pain. AORN J. 2004 Aug;80(2):269–74, 277–8.
41. Padmanabhan R, Hildreth AJ, Laws D. A prospective, randomised, controlled study examining binaural beat audio and pre-operative anxiety in patients undergoing general anaesthesia for day case surgery. Anaesthesia. 2005 Sep;60(9):874–7.
42. Zhang XW, Fan Y, Manyande A, Tian YK, Yin P. Effects of music on target-controlled infusion of propofol requirements during combined spinal-epidural anaesthesia. Anaesthesia. 2005 Oct;60(10):990–4.
43. Sendelbach SE, Halm MA, Doran KA, Miller EH, Gaillard P. Effects of music therapy on physiological and psychological outcomes for patients undergoing cardiac surgery. J Cardiovasc Nurs. 2006 Jun;21(3):194–200.
44. Boeke S, Bonke B, Bouwhuis-Hoogerwerf ML, Bovill JG, Zwaveling
A. Effects of sounds presented during general anaesthesia on postoperative course. Br J Anaesth. 1988 May;60(6):697–702.
45. van der Laan WH, van Leeuwen BL, Sebel PS, Winograd E, Baumann P, Bonke B. Therapeutic suggestion has not effect on postoperative morphine requirements. Anesth Analg. 1996 Jan;82(1):148–52.
46. Migneault B, Girard F, Albert C, Chouinard P, Boudreault D, Provencher D, et al. The effect of music on the neurohormonal stress response to surgery under general anesthesia. Anesth Analg. 2004 Feb;98(2):527–32, table of contents.
47. Spielberger CD, Gorsuch RL, Lushene R, Vagg PR, Jacobs GA. Manual for the State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press.; 1983;
48. Ganidagli S, Cengiz M, Yanik M, Becerik C, Unal B. The Effect of Music on Preoperative Sedation and the Bispectral Index: Anesth Analg. 2005 Jul;101(1):103–6.
49. Lepage C, Drolet P, Girard M, Grenier Y, DeGagné R. Music decreases sedative requirements during spinal anesthesia. Anesth Analg. 2001 Oct;93(4):912–6.
50. Rojas JMO. Efecto ansiolítico de la musicoterapia: aspectos neurobiológicos y cognoscitivos del procesamiento musical. Rev Colomb Psiquiatr. 2011 Dec;40(4):748–59.
51. Goldbeck L, Ellerkamp T. A randomized controlled trial of multimodal music therapy for children with anxiety disorders. J Music Ther. 2012;49(4):395–413.


52. Scarpetta RA. Musicoterapia para el control de ansiedad odontológica en niños con Síndrome de Down. Hacia la Promoción de la Salud. 2012;17:13–24.
53. Good M, Stanton-Hicks M, Grass JA, Anderson GC, Lai HL, Roykulcharoen V, et al. Relaxation and music to reduce postsurgical pain. J Adv Nurs. 2001 Jan;33(2):208–15.
54. Good M, Anderson GC, Stanton-Hicks M, Grass JA, Makii M. Relaxation and music reduce pain after gynecologic surgery. Pain Manag Nurs Off J Am Soc Pain Manag Nurses. 2002 Jun;3(2):61–70.
55. 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. 1999 May;81(1– 2):163–72.
56. Nilsson U, Rawal N, Uneståhl LE, Zetterberg C, Unosson M. Improved recovery after music and therapeutic suggestions during general anaesthesia: a double-blind randomised controlled trial. Acta Anaesthesiol Scand. 2001 Aug;45(7):812–7.
57. 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. Anaesthesia. 2003 Jul;58(7):699–703.
58. Evans C, Richardson PH. Improved recovery and reduced postoperative stay after therapeutic suggestions during general anaesthesia. Lancet Lond Engl. 1988 Aug 27;2(8609):491–3.
59. Kliempt P, Ruta D, Ogston S, Landeck A, Martay K. Hemispheric- synchronisation during anaesthesia: a double-blind randomised trial using audiotapes for intra-operative nociception control. Anaesthesia. 1999 Aug;54(8):769–73.
60. Lewis AK, Osborn IP, Roth R. The effect of hemispheric synchronization on intraoperative analgesia. Anesth Analg. 2004 Feb;98(2):533–6, table of contents.
61. Landgraf R, Neumann ID. Vasopressin and oxytocin release within the brain: a dynamic concept of multiple and variable modes of neuropeptide communication. Front Neuroendocrinol. 2004 Dec;25(3–4):150–76.
62. Chrousos GP. Stress and disorders of the stress system. Nat Rev Endocrinol. 2009 Jul;5(7):374–81.
63. Blood AJ, Zatorre RJ, Bermudez P, Evans AC. Emotional responses to pleasant and unpleasant music correlate with activity in paralimbic brain regions. Nat Neurosci. 1999 Apr;2(4):382–7.
64. McKinney CH, Antoni MH, Kumar M, Tims FC, McCabe PM. Effects of guided imagery and music (GIM) therapy on mood and cortisol in healthy adults. Health Psychol Off J Div Health Psychol Am Psychol Assoc. 1997 Jul;16(4):390–400.
65. McKinney CH, Tims FC, Kumar AM, Kumar M. The effect of selected classical music and spontaneous imagery on plasma beta- endorphin. J Behav Med. 1997 Feb;20(1):85–99.
66. Pickrell KL, Metzger JT, Wilde NJ, Broadbent TR, Edwards BF. The use and therapeutic value of music in the hospital and operating room. Plast Reconstr Surg 1946. 1950 Aug;6(2):142–52.
67. Salamon E, Bernstein SR, Kim S-A, Kim M, Stefano GB. The effects of auditory perception and musical preference on anxiety in naive human subjects. Med Sci Monit Int Med J Exp Clin Res. 2003 Sep;9(9):CR396-399.
68. Juslin PN, Västfjäll D. Emotional responses to music: the need to consider underlying mechanisms. Behav Brain Sci. 2008 Oct;31(5):559–75; discussion 575-621.
69. Chapados C, Levitin DJ. Cross-modal interactions in the experience of musical performances: physiological correlates. Cognition. 2008 Sep;108(3):639–51.
70. Miu AC, Balteş FR. Empathy manipulation impacts music-induced emotions: a psychophysiological study on opera. PloS One. 2012;7(1):e30618.
71. Schiavio A, van der Schyff D, Kruse-Weber S, Timmers R. When the Sound Becomes the Goal. 4E Cognition and Teleomusicality in Early Infancy. Front Psychol. 2017;8:1585.
72. Griffiths TD, Uppenkamp S, Johnsrude I, Josephs O, Patterson RD. Encoding of the temporal regularity of sound in the human brainstem. Nat Neurosci. 2001 Jun;4(6):633–7.
73. Chanda ML, Levitin DJ. The neurochemistry of music. Trends Cogn Sci. 2013 Apr;17(4):179–93.
74. Knutson B, Burgdorf J, Panksepp J. Ultrasonic vocalizations as indices of affective states in rats. Psychol Bull. 2002 Nov;128(6):961–77.
75. Wallston KA. The validity of the multidimensional health locus of control scales. J Health Psychol. 2005 Sep;10(5):623–31.
76. Knappe S, Pinquart M. Tracing criteria of successful aging? Health locus of control and well-being in older patients with internal diseases. Psychol Health Med. 2009 Mar;14(2):201–12.
77. Grotz M, Hapke U, Lampert T, Baumeister H. Health locus of control and health behaviour: results from a nationally representative survey. Psychol Health Med. 2011 Mar;16(2):129–40.
78. Bernardi L, Porta C, Sleight P. Cardiovascular, cerebrovascular, and respiratory changes induced by different types of music in musicians and non-musicians: the importance of silence. Heart Br Card Soc. 2006 Apr;92(4):445–52.
79. Hébert S, Béland R, Dionne-Fournelle O, Crête M, Lupien SJ. Physiological stress response to video-game playing: the contribution of built-in music. Life Sci. 2005 Apr 1;76(20):2371–80.
80. Chamorro-Premuzic T, Furnham A. Personality and music: can traits explain how people use music in everyday life? Br J Psychol Lond Engl 1953. 2007 May;98(Pt 2):175–85.
81. Rentfrow PJ, Goldberg LR, Levitin DJ. The structure of musical preferences: a five-factor model. J Pers Soc Psychol. 2011 Jun;100(6):1139–57.
82. Furnham A, Strbac L. Music is as distracting as noise: the differential distraction of background music and noise on the cognitive test performance of introverts and extraverts. Ergonomics. 2002 Feb 20;45(3):203–17.
83. Möckel M, Röcker L, Störk T, Vollert J, Danne O, Eichstädt H, et al. Immediate physiological responses of healthy volunteers to different types of music: cardiovascular, hormonal and mental changes. Eur J Appl Physiol. 1994;68(6):451–9.
84. Nater UM, Abbruzzese E, Krebs M, Ehlert U. Sex differences in emotional and psychophysiological responses to musical stimuli. Int J Psychophysiol Off J Int Organ Psychophysiol. 2006 Nov;62(2):300–8.
85. Nilsson U. The effect of music intervention in stress response to cardiac surgery in a randomized clinical trial. Heart Lung J Crit Care. 2009 Jun;38(3):201–7.

86. Nilsson U, Unosson M, Rawal N. Stress reduction and analgesia in patients exposed to calming music postoperatively: a randomized controlled trial. Eur J Anaesthesiol. 2005 Feb;22(2):96–102.
87. Monroe Institute. The Surgical Support Series | Hemi-Sync [Internet] [Internet]. 2018. Available from: https://www. monroeinstitute.org/product/the-surgical-support-series
88. Atwater F. The Hemi-Sync® Process [Internet]. 2004. Disponible en: https://www.monroeinstitute.org/catalog/hemi- sync%C2%AE
89. Oster G. Auditory beats in the brain. Sci Am. 1973;229(4):94–102.
90. Smith JC, Marsh JT, Brown WS. Far-field recorded frequency- following responses: evidence for the locus of brainstem sources. Electroencephalogr Clin Neurophysiol. 1975;39(5):465–72.
91. Ozdamar O, Bohorquez J, Mihajloski T, Yavuz E, Lachowska M. Auditory evoked responses to binaural beat illusion: stimulus generation and the derivation of the Binaural Interaction Component (BIC). Conf Proc Annu Int Conf IEEE Eng Med Biol Soc IEEE Eng Med Biol Soc Annu Conf. 2011;2011:830–3.
92. Pratt H, Starr A, Michalewski HJ, Dimitrijevic A, Bleich N, Mittelman N. Cortical evoked potentials to an auditory illusion: binaural beats. Clin Neurophysiol Off J Int Fed Clin Neurophysiol. 2009 Aug;120(8):1514–24.
93. Atwater F. The Hemi-Sync® Process. [Internet]. Resources. 2004. Available from: http://www.monroeinstitute.org/resources/the- hemi-sync-process.
94. Ozdamar O, Bohorquez J, Mihajloski T, Yavuz E, Lachowska M. Auditory evoked responses to binaural beat illusion: stimulus generation and the derivation of the Binaural Interaction Component (BIC). Conf Proc Annu Int Conf IEEE Eng Med Biol Soc IEEE Eng Med Biol Soc Conf. 2011;2011:830–3.
95. Pratt H, Starr A, Michalewski HJ, Dimitrijevic A, Bleich N, Mittelman N. Cortical evoked potentials to an auditory illusion: binaural beats. Clin Neurophysiol Off J Int Fed Clin Neurophysiol. 2009 Aug;120(8):1514–24.
96. Marsh JT, Brown WS, Smith JC. Far-field recorded frequency- following responses: correlates of low pitch auditory perception in humans. Electroencephalogr Clin Neurophysiol. 1975 Feb;38(2):113–9.
97. Dabu-Bondoc S, Drummond-Lewis J, Gaal D, McGinn M, Caldwell- Andrews AA, Kain ZN. Hemispheric synchronized sounds and intraoperative anesthetic requirements. Anesth Analg. 2003 Sep;97(3):772–5.
98. Schwender D, Klasing S, Madler C, Pöppel E, Peter K. Depth of anesthesia. Midlatency auditory evoked potentials and cognitive function during general anesthesia. Int Anesthesiol Clin. 1993;31(4):89–106.
99. Wakim JH, Smith S, Guinn C. The efficacy of music therapy. J Perianesthesia Nurs Off J Am Soc PeriAnesthesia Nurses Am Soc PeriAnesthesia Nurses. 2010 Aug;25(4):226–32.
100. Leardi S, Pietroletti R, Angeloni G, Necozione S, Ranalletta G, Del Gusto B. Randomized clinical trial examining the effect of music therapy in stress response to day surgery. Br J Surg. 2007;94(8):943–7.