Use of music as an adjunct for sedation in transoesophageal echocardiography

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Abstract Background Transoesophageal Echocardiography (TOE) is semi-invasive examination used for cardiac evaluation, frequently associated to a certain degree of anxiety, and often requiring sedation for patient comfort; alternatively, sedation can result side effects such as hemodynamic changes (hypotension) or hypoventilation and hypoxemia. Music has been used as a non-pharmacological strategy to reduce stress and anxiety levels during medical procedures; accordingly, we hypothesized that music could be used to decrease anxiety and/or sedation dose in patients referred for TOE. Methods 63 patients over 18 years old undergoing TOE were randomized either to intervention (music group, 31 patients) or no intervention (control group, 32 patients); music was started before transthoracic echocardiography (TTE) and continued up to the end of TOE; an anxiety mini query consisting in 4 degrees of anxiety levels (no, mild, moderate and high) was answered before transthoracic echocardiography (TTE) and again just before sedation; data regarding hemodynamic status (blood pressure, heart rate, oximetry and respiratory incursions ) were examined before and after the intervention; additionally, groups were compared regarding administered total midazolam dose (initial dose plus additional doses). Results There was no difference between the groups regarding age (55.1 ±13.7 years vs 49.8± 15.5 p = NS), sex, ethnics, body mass index or the presence of comorbidities . Both groups presented a decrease in anxiety levels before TOE (p = 0.04), however the decrease was more substantial with music compared to control (p< 0.008). Hemodynamic variables were unchanged, except for diastolic blood pressure (p=0.03), showing a slight but significant decrease after music (Table). No difference was seen in the total midazolam dose between the groups (median 5.0 mg with range [4.5 - 7.0 mg] vs 5.0 mg [4.0 - 8.0 mg], p = 0.4; additionally, a negative correlation was found for midazolam dose and age, whereas no correlation was found for other hemodynamic parameters. Conclusion Despite no reduction in sedation dose in patients assigned for TOE, listening to music decreases the degree of anxiety, with a small decrease in blood pressure; therefore, music could be useful as an adjunct to sedation in this scenario.