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Korean J Adult Nurs : Korean Journal of Adult Nursing

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Original Article

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., ANP2
Korean Journal of Adult Nursing 2016;28(5):525-535.
Published online: October 31, 2016

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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: July 10, 2016   • Accepted: October 25, 2016

Copyright © 2016 Korean Society of Adult Nursing

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.

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  • 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.
  • Key Words: Music therapy; Spinal anesthesia; Anxiety; Sedation; Stress
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
n (%) or M±SD n (%) or M±SD
Age (year) ＞40 10 (37.0) 6 (21.4) 1.62 .245
≤40 17 (63.0) 22 (78.6)
  43.41±2.01 48.86±10.83 -1.76 .085
Gender Male 14 (51.9) 15 (53.6) 0.02 .556
Female 13 (48.1) 13 (46.4)
Past surgical experience Yes 13 (48.1) 14 (50.0) 0.02 .553
None 14 (51.9) 14 (50.0)
Experience of spinal anesthesia Yes 8 (29.6) 8 (28.6) 0.01 .583
None 19 (70.4) 20 (71.4)
Preference of music listening Yes 24 (88.9) 22 (78.6) 1.07 .253
No 3 (11.1) 6 (21.4)
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*
Not slept 23 (85.2) 28 (100.0)
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
M±SD M±SD
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
M±SD M±SD
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 G*T 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 G*T 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; G*T=Group*Time; 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
M±SD M±SD
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 G*T 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 G*T 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 G*T 0.63 .598
Post op. 60 min 104.37±26.53 106.11±14.27      

Pre op.=pre operation; Post op.=post operation; G*T=Group*Time; 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
M±SD M±SD
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 G*T 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 G*T 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 G*T 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 G*T 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; G*T=Group*Time; min=minutes.

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    The Effects of Music Therapy on Anxiety, Sedation, and Stress Responses of Patients Undergoing Surgery with Spinal Anesthesia
    Korean J Adult Nurs. 2016;28(5):525-535.   Published online October 31, 2016
    DOI: https://doi.org/10.7475/kjan.2016.28.5.525
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    The Effects of Music Therapy on Anxiety, Sedation, and Stress Responses of Patients Undergoing Surgery with Spinal Anesthesia
    Korean J Adult Nurs. 2016;28(5):525-535.   Published online October 31, 2016
    DOI: https://doi.org/10.7475/kjan.2016.28.5.525
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    The Effects of Music Therapy on Anxiety, Sedation, and Stress Responses of Patients Undergoing Surgery with Spinal Anesthesia
    The Effects of Music Therapy on Anxiety, Sedation, and Stress Responses of Patients Undergoing Surgery with Spinal Anesthesia

    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
    n (%) or M±SD n (%) or M±SD
    Age (year) ＞40 10 (37.0) 6 (21.4) 1.62 .245
    ≤40 17 (63.0) 22 (78.6)
      43.41±2.01 48.86±10.83 -1.76 .085
    Gender Male 14 (51.9) 15 (53.6) 0.02 .556
    Female 13 (48.1) 13 (46.4)
    Past surgical experience Yes 13 (48.1) 14 (50.0) 0.02 .553
    None 14 (51.9) 14 (50.0)
    Experience of spinal anesthesia Yes 8 (29.6) 8 (28.6) 0.01 .583
    None 19 (70.4) 20 (71.4)
    Preference of music listening Yes 24 (88.9) 22 (78.6) 1.07 .253
    No 3 (11.1) 6 (21.4)
    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*
    Not slept 23 (85.2) 28 (100.0)
    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.

    Homogeneity of Variables between Treatment Group and Comparison Group

    Variables Categories   Treatment group (n=27) Comparison group (n=28) t p
    M±SD M±SD
    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.

    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
    M±SD M±SD
    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 G*T 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 G*T 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; G*T=Group*Time; BIS index=bispectral index; min=minutes.

    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
    M±SD M±SD
    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 G*T 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 G*T 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 G*T 0.63 .598
    Post op. 60 min 104.37±26.53 106.11±14.27      

    Pre op.=pre operation; Post op.=post operation; G*T=Group*Time; ACTH=Adrenocorticotropic hormone; min=minutes.

    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
    M±SD M±SD
    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 G*T 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 G*T 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 G*T 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 G*T 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; G*T=Group*Time; min=minutes.
    Table 1. Homogeneity of General Characteristics between Treatment Group and Comparison Group (N=55)

    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

    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)

    Pre op.=pre operation; Post op.=post operation; G*T=Group*Time; BIS index=bispectral index; min=minutes.

    Table 4. Differences in ACTH, Cortisol and Glucose between Treatment Group and Comparison Group (N=55)

    Pre op.=pre operation; Post op.=post operation; G*T=Group*Time; ACTH=Adrenocorticotropic hormone; min=minutes.

    Table 5. Differences in Vital Signs between Treatment Group and Comparison Group (N=55)

    Pre op.=pre operation; Post op.=post operation; G*T=Group*Time; min=minutes.

    Table 1.

    Table 2.

    Table 3.

    Table 4.

    Table 5.

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