The effects of music, white noise, and ambient noise on sedation and anxiety in patients operated under spinal anesthesia

25 cases from each group, amounting to 75 patients, were included in the assessments. Group O: : Ambient noise in the operating room that is because of working, staff etc is usually seen at surgery center. The duration that participants listen to this noise is continuously after induction of anaesthesia, until the end of the operation. Also the patients is that were brought into the operating room, listened to the amplified ambient noise with the aid of a headset. Because of the noise was set at a comfortable audio level. Ambient noise in the operating room was augmented using an amplifier [Mini Amplifier, No: 9988, Ekincioglu (Registered Trademark), Istanbul], and the patients used a headset [SN-802, Snopy (Registered Trademark)] to listen to the ambient noise, during, and after the operation (until the end of the operation, not at the recovery room). Group B: The patients selected one compact disc (CD) among three white noise CDs (Babling Brook, Distant Thunderstorm, Restful Rain) provided from Pure White Noise(Registered Trademark) Co. USA and listened during preoperative, postspinal, intraoperative, and postoperative periods (the duration that participants listen to the white noise after induction of anaesthesia and continues until 30 minutes post-operatively). Also Group B patients started to listen to white noise using a headset connected to a computerized system. Because of their most comfortable sound level was maintained. Group M: Numerous musical pieces in the MP3 format were loaded on an Acer (Registered Trademark) laptop. In compliance with the patients’ wishes, the patients listened to the songs from their favorite playlists using the same headset during preoperative, postspinal, intraoperative, and postoperative periods (the duration that participants listen to the white noise after induction of anaesthesia and continues until 30 minutes post-operatively). Group M started to listen to songs from a preprepared playlist using a headset connected to a computerized system. Why that is their most comfortable sound level was maintained. When the patients entered into the waiting room for the first time, their state of anxiety, and sedation was evaluated using VAS (Visual Anxiety Scale: 0 = very calm; 10 = very anxious), STAI (The State-Trait Anxiety Inventory) and OAA/S (Observer's Assessment of Alertness/Sedation Scale) scale scoring systems. OAA/S was graded as follows: The patient (1) gives a response only when his /her shoulders prodded, (2) responds only after calling his/her name loudly, (3) responds slowly after calling his/her name with normal tone (4) responds normally when his/her name is spoken with normal tone. STAI consists of two different parts, as STAI-TA (Trait Anxiety Inventory) and STAI-SA (State Anxiety Inventory). The first test determines baseline anxiety level and the second one indicates anxiety level generated by environmental changes. This test requires from the patients to respond to the 40-item questionnaire. Twenty items were prepared for STAI-TA, and 20 items for STAI-SA scales. For each domain, the allocated scores vary between 20 and 80 points, representing the highest and the lowest levels of anxiety, respectively. In our study, STAI-TA test results were evaluated preoperatively. Assessments of STAI-SA tests were performed during preoperative period, before induction of prespinal anesthesia, 5 minutes before surgical intervention, and at 30 minutes recovery period. In the preoperative waiting room, Group B patients started to listen to white noise, while Group M listened to songs from a preprepared playlist using a headset connected to a computerized system. Their most comfortable sound level was maintained. All groups were asked about their educational level, their tastes in music, and frequency of listening to music. Their responses to the questions were recorded. When patients were brought to the regional anesthesia unit, their electrocardiogram (EKGs), non-invasive blood pressure test results, and saturation of peripheral oxygen (SpO2) levels were monitored and their preoperative baseline values were recorded. Before induction of spinal anesthesia, in addition to the measurements of hemodynamic parameters, VAS, STAI-SA, and OAA/S tests were reapplied to the patients. The patients stopped listening to musical pieces or white noise during institution of spinal anesthesia. After maintenance of adequate hydration, spinal anesthesia was achieved with administration of 10-15mg, 0.5% hyperbaric bupivacaine. All patients received 25microgram/kg IV midazolam after induction of spinal anesthesia. Their hemodynamic parameters, VAS and OAA/S scores were evaluated and recorded at 5-minute intervals before they were taken into the operating room. Five minutes before lying on the operating table, their STAI-SA scores were reevaluated for the third time. The patients were brought into the operating room, and underwent standard monitoring procedures. O2 was delivered through a nasal cannula at a rate of 3 L/min as patients in Group O listened to the amplified ambient noise with the aid of a headset. The noise was set at a comfortable audio level. During the intraoperative period, heart rate, diastolic/systolic blood pressure (mean blood pressure), SpO2, respiratory rate, VAS (0-10), and OAA/S (1-5) measurements were performed at 5-minute intervals. All patients received uninterrupted IV midazolam infusion at a dose of 0.5microgram/kg/min during the duration of the operation. At the end of the operation, IV infusion of midazolam was stopped. The duration of anesthesia was determined and recorded as the time interval between the induction of anesthesia to the end of the operation. The patients were transferred to the postoperative recovery room and monitored for 30 minutes for hemodynamic parameters, level of sedation, and occurrence of adverse effects. In the recovery room, vital signs, OAA/S, and VAS scores were evaluated at 5-minute intervals. Patients in Groups M and B continued to listen to their favorite songs, and STAI-SA scores were reevaluated 30 minutes later for the fourth time. Patient satisfaction with this application was evaluated (1: Poor, 2: Moderate, 3: Good, 4: Excellent) before their transfer to their wards.