SPA Newsletter

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Interactive Music Therapy as a Treatment for Preoperative Anxiety in Children: A Randomized Controlled Trial

Kain Z, Caldwell-Andrews A, Krivutza D, Weinberg M, Gaal D, Wang SM, Mayes L. Anesthesia & Analgesia 2004;98:1260-1266.

Review: The goal of the study was to determine whether interactive music therapy was effective in reducing preoperative anxiety in children undergoing outpatient elective surgery.

Interactive music therapy is described as an interactive relationship between the therapist and patient that is based on communication through music. This randomized, controlled study consisted of 123 patients, aged three - seven yrs, American Society of Anesthesiologists physical status I or II, and scheduled for elective outpatient surgery with general anesthesia. Exclusion criteria for this study were any history of chronic illness, prematurity, or developmental delay or significant hearing or visual impairments.

Patients were randomized to one of three groups: 1) control group - children were not offered midazolam or music therapy, 2) music therapy group - children received interactive music therapy, and 3) midazolam group - children received oral midazolam 0.5 mg/kg 30 minutes before surgery up to a maximum of 20mg.

All children in the study were videotaped, beginning in the holding area, until the anesthesia induction in the operating room (OR). The videotape was later used to rank the child's anxiety at various time points. The four time points included: the holding area (T1), separation to the OR (T2), entrance to the OR (T3), and introduction of the anesthesia mask until anesthesia was induced (T4).

For all groups, parents were allowed to accompany their child to the OR doors before separation. If a child demonstrated extreme anxiety (as determined by the attending anesthesiologist), then parental presence during the induction of anesthesia was offered.

Patients in the music therapy group were accompanied by the music therapist into the OR and continued music intervention until the child was "asleep."

An inhalation induction consisting of sevoflurane in oxygen and nitrous oxide was the technique of choice. There was no further discussion of anesthesia management.

Following final analysis of the data, this study resulted in several conclusions. First, the patients receiving midazolam were significantly less anxious overall than the music therapy and control groups, and that the anxiety levels of children in the music therapy and control groups did not differ significantly. Second, the patients receiving midazolam were much more likely to be compliant during the induction of anesthesia, and that there was no difference in compliance between the control and the music therapy groups. Third, anxiety levels were lower in one of the music therapy groups as compared to the other music therapy or control groups, when separation to the OR and entrance to the OR were assessed. However, the anxiolytic effect of music therapy was non-existent with the introduction of the anesthesia mask.

Comments: The use of music therapy in the field of medicine is steadily expanding. By and large, the majority of studies in the medical literature that relate to music therapy were performed in adults and consisted of patients passively listening to music. Of special interest, the investigators report that in their earlier study they conclude that reduced sensory stimuli in combination with background music decreased children's anxiety during the induction of anesthesia. However, the overall conclusion of this present study was that interactive music therapy for children undergoing surgery did not by any significant measure reduce preoperative anxiety. On the contrary, the authors point out that some children may benefit from interactive music therapy for preoperative anxiety. Further studies are necessary to determine in which group of patients this intervention may be most beneficial. "Stay tuned for more to come!"

Reviewed by: Cheryl K. Gooden, MD, FAAP
Mount Sinai Medical Center
New York, NY

Table of Contents

• Editor's Corner
• President's Message
• Society for Pediatric Anesthesia Policy Statment on Provision of Pediatric Anesthesia Care
• Williams Syndrome, Supravalvar Aortic Stenosis and Cardiac Arrest During Anesthesia
• Book Corner
• Out of Africa
• Peds Passport
• MHAUS Research Opportunities
• For Patients: Frequently Asked Questions


• Reviews & Commentary
  • Bariatric surgery for severely overweight adolescents: concerns and recommendations.
    Inge T, et al. Pediatrics 2004;114;217-223
  • Conscious sedation of children with propofol is anything but conscious
    Reeves ST, Havidich JE, and Tobin DP. Pediatrics 2004;114:e74-e76. URL http://www.pediatrics.org/cgi/content/ full/114/1/e74
  • A factorial trial of six interventions for the prevention of postoperative nausea and vomiting.
    Apfel CC, et al. N Engl J Med 2004; 50:2441-2451
  • The effect of dexrazoxane of myocardial injury in dozorubicin-treated children with acute lymphoblastic leukemia
    Lipshultz SE, et al. N Engl J Med 2004; 351:145-153
  • Unilateral negative-pressure pulmonary edema in an infant during bronchoscopy
    Shai Hannania, MD, et al. Pediatrics 2004;113:e501-e503. URL: http://www.pediatrics.org/cgi/content/full/113/5/e501
  • Does pediatric surgical specialty training affect outcome after Ramstedt Pyloromyotomy? A population-based study.
    Langer J, To T. Pediatrics 2004;113:1342-1347
  • Overweight children and adolescents; A risk group for iron deficiency
    Nead KG, et al. Pediatrics 2004;114:104-108
  • A comparison of conservative and aggressive transfusion regimens in the perioperative management of sickle cell disease
    Elliot P. Vichinsky, MD, et al and the Preoperative Transfusion in Sickle Cell Disease Study Group
  • Cholecystectomy in sickle cell anemia patients: Perioperative outcome of 364 cases from the National Preoperative Transfusion Study
    Charles M. Haberkern, et al, and the Preoperative Transfusion in Sickle Cell Disease Study Group
  • Effect of hydroxyurea on the frequency of painful crises in sickle cell anemia
    Samuel Charache, MD, et al
  • Epidural Analgesia in the Management of Severe Vaso-Occlusive Sickle-Cell Crisis.
    Yaster M, et al. Pediatrics 1994;93:310-315


• Literature Reviews
  • A case of propofol toxicity: further evidence for a causal mechanism
    Davinia E Withington, Mary K. Decell, Tareq Al Ayed. Pediatric Anesthesia 2004;14:505
    Death after re-exposure to propofol in a 3-year-old child: a case report
    Josef Holzki, Christoph Aring, Alex Gillor. Paediatric Anaesthesia 2004;14:265
  • Does anaesthesia harm the developing brain - evidence or speculation?
    Andrew Davidson and Sulpicio Soriano. Paediatric Anaesthesia 2004; 14: 199-20.
  • An evaluation of pediatric in-hospital advanced life support interventions using the pediatric Utstein guidelines: a review of 203 cardiorespiratory arrests.
    J. Guay, L. Lortie.Can J Anesth 2004:51:4:373-378
  • A factorial trial of six interventions for the prevention of postoperative nausea and vomiting
    Christian C. Apfel, MD, et al. IMPACT Investigators. N Engl J Med 2004;350:2441-51
  • Interactive Music Therapy as a Treatment for Preoperative Anxiety in Children: A Randomized Controlled Trial
    Kain Z, Caldwell-Andrews A, Krivutza D, Weinberg M, Gaal D, Wang SM, Mayes L. Anesthesia & Analgesia 2004;98:1260-1266.
  • Trends in the practice of parental presence during induction of anesthesia and the use of preoperative sedative premedication in the United States, 1995-2002: results of a follow-up national survey.
    Kain, Z.N. et al. Anesth Analg 2004; 98:1252-9.
  • Anesthetic Complications of Tympanostomy Tube Placement in Children.
    Hoffmann KK, Thompson GK, Burke BL et al. Arch Otolaryngol Head Neck Surg. 128:1040-1043, 2002
  • Neurobehavioral Implications of Habitual Snoring in Children.
    O'Brien CM, et al. Pediatrics 2004; 116:44-50

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