A Randomized, Double-Blind, Placebo-Controlled Study to Explore Perioperative Functional Audio for Anxiety and Cognitive Recovery From Propofol Anaesthesia in Patients Undergoing Endoscopic Procedures

INTRODUCTION

Can perioperative music improve the patient experience, and speed recovery from propofol anaesthesia?

Difficulties around induction and emergence from general anesthesia are a burden on healthcare workers, and central to a patient's experience. Anxiety prior to a procedure, and confusion upon regaining consciousness, are common experiences that negatively affect both patients and staff. Presurgical anxiety can result in difficulty with intubation and longer presurgical delay periods, burdening nurses and slowing the pace of care. Postsurgically, the duration and quality of a patient's recovery from anesthesia affects healthcare providers and patients, both of whom want to minimize the time spent in the recovery room. Lengthy recovery periods may involve amnesic episodes, delirium, agitation, cognitive dysfunction or other emergence phenomenon, which place strain on patients and staff. Longer recoveries also place strain on the patient's caretaker (e.g., relatives waiting to take them home) and burden the healthcare facility, which may be limited in how quickly procedures can occur based on space available in the recovery area.

Perioperative music has been used effectively to control anxiety and pain (Bringman et al. 2009, Gooding et al. 2012, Tan et al. 2012, Fu et al. 2019,. 2020, 2021), but in these studies the music is chosen to be either relaxing or familiar, with no regard for how it drives brain activity. Prior work has focused on the pre-operative period, and has not considered how stimulative music might be used to kickstart cognition following emergence from anaesthesia. Binaural beats (a type of sound therapy that drives neural entrainment) has been recommended for perioperative use (Padmanabhan et al. 2012), but for relaxation only rather than stimulation. Indeed, no work has been done to distinguish music for induction and emergence, or to provide stimulative music to aid recovery from the unconscious state.

Sound is a powerful neuromodulator, and the auditory system can be used to drive neural activity conducive to a variety of mental states. Part of this effect may be due to how sound (and some music in particular) affects neural oscillations (Will & Berg 2007, Large 2010, Tierney et al. 2014), arousal systems (Thompson et al. 2001, Dillman et al. 2007, Gingras et al. 2014) and dopamine levels (Suttoo et al. 2004, Moraes et al. 2018). Propofol recovery is known to be accelerated by activating the brain's arousal systems via drugs (Chemali et al. 2012) or direct electrical stimulation (Bastos et al. 2021), and music targeting arousal is used to improve cognitive function in humans (Gupta et al. 2018, Woods et al. 2021). Auditory stimulation developed specifically to drive the brain in different ways (Brain.fm music) may be useful perioperatively, and different music may be useful for induction and emergence from anaesthesia.