The Effects of Music Therapy on Anxiety, Sedation, and Stress Responses of Patients Undergoing Surgery with Spinal Anesthesia

Gye Seon Jeong; Younhee Kang

doi:10.7469/kjan.2016.28.5.525

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Jeong and Kang: The Effects of Music Therapy on Anxiety, Sedation, and Stress Responses of Patients Undergoing Surgery with Spinal Anesthesia

Original Article

Korean J Adult Nurs 2016;28(5):525-535.

Published online: NaN October 2016

DOI: https://doi.org/10.7469/kjan.2016.28.5.525

The Effects of Music Therapy on Anxiety, Sedation, and Stress Responses of Patients Undergoing Surgery with Spinal Anesthesia

Gye Seon Jeong, Ph.D., APN¹, Younhee Kang, Ph.D., ANP^2,

^¹Assistant Professor, Chosun Nursing College, Gwangju

^²Professor, College of Nursing, Ewha Womans University, Seoul, Korea

Corresponding author: Kang, Younhee College of Nursing, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Korea. Tel: +82-2-3277-4483, Fax: +82-2-3277-2850, E-mail: yxk12@ewha.ac.kr

Received 10 July 20164 September 2016 Accepted 25 October 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study was conducted to examine the effects of music therapy on anxiety, sedation, and stress responses of patients during surgery with spinal anesthesia.

Methods

A quasi-experimental design with a non-equivalent control group pre-post test was used. There were 55 adults over 19 years of age scheduled for a lower leg surgery with spinal anesthesia: 27 in the treatment group and 28 in the comparison group. Each subject in the treatment group identified their music preference which was used during the period of surgery which usually lasted, 61 minutes. Data were analyzed using chi-square, Fisher's exact test, independent t-test and repeated measured ANOVA.

Results

There were significant reported differences in levels of anxiety, sedation, and stress responses which were measured by plasma cortisol levels, heart rate, and respiratory rate. The findings of all the variables were effectively decreased among those in the treatment group than the comparison group.

Conclusion

The preference based music therapy may be useful as a non-pharmacological intervention.

Keywords: Music therapy, Spinal anesthesia, Anxiety, Sedation, Stress

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Table 1.

Homogeneity of General Characteristics between Treatment Group and Comparison Group (N=55)

Characteristics	Categories	Treatment group (n=27)	Comparison group (n=28)	x² or t	p
Characteristics	Categories	n (%) or M±SD	n (%) or M±SD	x² or t	p
Age (year)	＞40	10 (37.0)	6 (21.4)	1.62	.245
	≤40	17 (63.0)	22 (78.6)	1.62	.245
		43.41±2.01	48.86±10.83	-1.76	.085
Gender	Male	14 (51.9)	15 (53.6)	0.02	.556
Gender	Female	13 (48.1)	13 (46.4)	0.02	.556
Past surgical experience	Yes	13 (48.1)	14 (50.0)	0.02	.553
Past surgical experience	None	14 (51.9)	14 (50.0)	0.02	.553
Experience of spinal anesthesia	Yes	8 (29.6)	8 (28.6)	0.01	.583
Experience of spinal anesthesia	None	19 (70.4)	20 (71.4)	0.01	.583
Preference of music listening	Yes	24 (88.9)	22 (78.6)	1.07	.253
Preference of music listening	No	3 (11.1)	6 (21.4)	1.07	.253
Frequency of music listening	Once/week	6 (22.2)	12 (42.9)	3.01	.277
	Twice/week	7 (25.9)	5 (17.9)
	Daily	8 (29.6)	5 (17.9)
	＞Once/day	6 (22.2)	6 (21.4)
Music genre preference	Ballad	8 (29.6)	7 (25.0)	9.95	.107
	Trot	9 (33.3)	17 (60.7)
	Others	10 (37.0)	4 (7.3)
Sleep during the operation	Slept	4 (14.8)	0 (0.0)	4.47	.051
Sleep during the operation	Not slept	23 (85.2)	28 (100.0)	4.47	.051
Surgery type	Knee arthroscopy	15 (55.5)	18 (64.3)	3.21	.241
	TKR	2 (7.4)	5 (17.9)
	Bone reduction /metal removal	10 (37.0)	5 (9.1)

TKR=total knee replacement; Fisher's exact test; Others: Hymn, idol music, Chang (Korean traditional narrative song), Western classic music, the latest American population music.

Table 2.

Homogeneity of Variables between Treatment Group and Comparison Group

Variables	Categories		Treatment group (n=27)	Comparison group (n=28)	t	p
Variables	Categories		M±SD	M±SD	t	p
Pre-operation	Anxiety		5.87±2.66	5.11±1.95	1.22	.233
	Sedation	BIS index	98.07±0.10	98.14±0.85	-0.28	.784
	Stress responses	ACTH	14.50±18.48	12.22±8.41	0.59	.557
		Cortisol	15.10±11.41	12.65±9.33	0.87	.386
		Glucose	98.00±15.96	104.46±16.99	-1.45	.152
		SBP	131.19±11.67	128.25±14.30	0.83	.409
		DBP	80.96±8.44	81.50±9.37	0.37	.821
		HR	78.33±12.88	80.00±12.28	-0.49	.625
		RR	19.63±1.47	19.39±0.99	0.70	.486
4 days post-operation (baseline)	Anxiety		0.99±0.96	0.88±1.58	0.30	.762
	Stress responses	ACTH	11.38±11.28	7.98±11.72	1.26	.214
		Cortisol	13.89±8.68	10.14±8.67	1.63	.108
		Glucose	114.15±25.85	111.29±16.19	0.49	.626
		SBP	126.81±8.73	123.04±7.84	1.69	.098
		DBP	80.00±7.76	78.64±8.11	0.63	.529
		HR	71.59±14.94	71.29±7.67	0.10	.925
		RR	19.48±1.40	19.57±0.10	-0.28	.785

ACTH=adrenocorticotropic hormone; SBP=systolic blood pressure; DBP=diastolic blood pressure; HR=heart rate; RR=respiration rate.

Table 3.

Differences in Anxiety and Sedation between Treatment Group and Comparison Group (N=55)

Variables	Categories	Treatment group (n=27)	Comparison group (n=28)	p Source	F	p
Variables	Categories	M±SD	M±SD	p Source	F	p
Anxiety	Pre op.	5.87±2.66	5.12±1.95	Group	0.04	.841
	30 min	3.16±1.67	4.14±1.47	Time	82.88	.001
	60 min	2.79±1.63	2.44±2.14	GT	4.10	.008
	Post op. 60 min	1.66±1.35	1.47±1.56
Sedation (BIS index)	Pre op.	98.07±0.10	98.14±0.85	Group	44.02	＜.001
	10 min	92.19±5.56	96.21±1.96	Time	80.16	＜.001
	20 min 30 min	91.04±3.90 88.56±4.22	94.59±2.58 93.75±2.77	GT	13.71	＜.001
	40 min	88.37±4.05	94.17±2.45
	50 min	87.33±4.59	94.29±2.54
60 min	86.85±6.07	92.93±2.62

Pre op.=pre operation; Post op.=post operation; GT=GroupTime; BIS index=bispectral index; min=minutes.

Table 4.

Differences in ACTH, Cortisol and Glucose between Treatment Group and Comparison Group (N=55)

Variables	Categories	Treatment group (n=27)	Comparison group (n=28)	p Source	F	p
Variables	Categories	M±SD	M±SD	p Source	F	p
ACTH (pg/ml)	Pre op.	14.50±18.47	12.22±8.41	Group	0.49	.488
	30 min	14.18±16.24	35.82±34.74	Time	2.77	.043
	60 min	13.82±20.36	23.50±32.96	GT	6.53	＜.001
	Post op. 60 min	23.47±53.53	10.56±16.31
Cortisol (㎍/dL)	Pre op.	15.10±11.41	12.65±9.33	Group	0.01	.981
	30 min	16.92±11.17	20.00±8.57	Time	7.46	＜.001
	60 min	15.65±10.92	17.73±8.73	GT	3.94	.010
	Post op. 60 min	16.15±12.18	13.69±10.43
Glucose (mg/dL)	Pre op.	98.00±15.96	104.47±16.99	Group	2.18	.146
	30 min	95.74±15.53	104.11±17.25	Time	1.64	.181
	60 min	99.59±18.85	106.07±19.69	GT	0.63	.598
	Post op. 60 min	104.37±26.53	106.11±14.27

Pre op.=pre operation; Post op.=post operation; GT=GroupTime; ACTH=Adrenocorticotropic hormone; min=minutes.

Table 5.

Differences in Vital Signs between Treatment Group and Comparison Group (N=55)

Variables	Categories	Treatment group (n=27)	Comparison group (n=28)	Source	F	p
Variables	Categories	M±SD	M±SD	Source	F	p
Systolic blood pressure (mmHg)	Pre op.	131.19±11.67	128.25±14.30	Group	0.32	.577
	10 min	120.89±25.92	124.32±13.98	Time	9.24	＜.001
	20 min	120.26±14.48	121.64±13.74	GT	1.39	.208
	30 min	120.44±20.04	122.36±11.90
	40 min	117.89±11.46	118.96±13.89
	50 min	109.67±24.48	117.96±13.72
	60 min	115.30±12.36	118.64±14.17
	Post op 60 min	122.04±10.48	119.25±12.28
Diastolic blood pressure (mmHg)	Pre op.	80.96±8.44	81.50±9.37	Group	0.35	.555
	10 min	72.07±12.70	76.96±10.16	Time	18.10	＜.001
	20 min	70.33±11.44	71.71±8.43	GT	0.76	.387
	30 min	70.11±10.84	70.82±10.08
	40 min	68.74±9.75	69.25±11.57
	50 min	68.93±11.23	70.86±9.06
	60 min	71.52±11.92	71.21±7.97
	Post op 60 min	74.15±7.23	74.43±9.56
Heat rate (rate/min)	Pre op.	78.33±12.88	80.00±12.28	Group	3.51	.067
	10 min	71.78±11.21	78.93±12.38	Time	16.67	＜.001
	20 min	68.70±10.40	77.36±13.27	GT	3.98	＜.001
	30 min	67.67±11.32	75.25±11.20
	40 min	66.26±10.80	72.82±12.46
	50 min	67.30±9.19	71.30±9.19
	60 min	68.37±6.91	70.21±6.68
	Post op. 60 min	71.04±11.66	70.21±7.77
Respiration rate (rate/min)	Pre op.	19.63±1.47	19.39±0.99	Group	5.18	.027
	10 min	18.93±1.82	19.04±1.17	Time	26.87	＜.001
	20 min	18.19±1.49	18.57±0.88	GT	3.27	.002
	30 min	17.19±1.55	18.39±1.29
	40 min	16.48±2.90	18.00±1.05
	50 min	17.33±1.88	18.21±1.23
	60 min	17.78±1.91	18.68±1.40
	Post op. 60 min	18.63±2.02	19.39±1.07

Pre op.=pre operation; Post op.=post operation; GT=GroupTime; min=minutes.

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