Effect of music on pediatric endoscopic examinations: a randomized controlled trial

Abstract

Background and study aims The primary objective was to measure the effect of music as an adjunct to sedation in patient anxiety levels during pediatric endoscopic examinations.

Patients and methods We performed a single-blind randomized controlled trial comparing music with no music in children aged 2 to 18 years. Anxiety was measured using the Modified Yale Preoperative Anxiety Scale (m-YPAS) and the Visual Analog Anxiety Scale (VAS-anxiety). Patient perception of pain was evaluated with the Wong-Baker Faces Pain Rating Scale (WBFPRS). Patient experience, family satisfaction, and endoscopist perception of difficulty were evaluated. Sedative doses were recorded.

Results A total of 51 children were randomized to the experimental group and 49 children to the control group. The mean ages were 10.5 years and 12.3 years, respectively. There were 63 % female subjects with no differences between groups. Overall, there were 85 upper endoscopies and 15 colonoscopies. In the recovery unit, the experimental group had lower average m-YPAS scores (mean score 27.7 vs 34.7; P < 0.001), a higher proportion of them had low m-YPAS scores (80 % vs 49 % P < 0.001), had lower VAS-anxiety scores [mean score 0.55 vs 1.57 (P = 0.003)], and had lower WBFPRS scores [mean score 2.7 vs 1.3 (P = 0.001)]. There were no statistically significant differences found in the amount of standard sedation given to the groups, nor in additional sedation administered. In the experimental group, the patient-reported experience was significantly better.

Conclusions The study results show that music reduces anxiety and pain associated with endoscopic procedures in children. It also facilitates these procedures and improves patient satisfaction.

Publication History

Received: 11 August 2020

Accepted: 09 December 2020

Article published online:
13 April 2021

• References

• 1 Jevtovic-Todorovic V. Pediatric anesthesia neurotoxicity: an overview of the 2011 SmartTots panel. Anesth Analg 2011; 113: 965-968
• 2 Miller T, Park R, Sun L. Report of the Fourth PANDA Symposium on Anesthesia and Neurodevelopment in Children. J Neurosurg Anesthesiol 2014; 26: 344-348
• 3 Golan G, Tighe P, Dobija N. et al. Clowns for the prevention of preoperative anxiety in children: a randomized controlled trial. Pediatric Anesthesia 2009; 19: 262-266
• 4 Vagnoli L, Caprilli S, Robiglio A. et al. Clown doctors as a treatment for preoperative anxiety in children: a randomized, prospective study. Pediatrics 2005; 116: e563-567
• 5 Murphy G. Distraction techniques for venepuncture: a review. Paediatr Nurs 2009; 21: 18-20
• 6 Birnie KA, Noel M, Chambers CT. et al. Psychological interventions for needle-related procedural pain and distress in children and adolescents. Cochrane Database Syst Rev 2018; 4: CD005179
• 7 Melzack R, Casey KL. Sensory, motivational, and central control determinants of pain: a new conceptual model. In: Kenshalo DR. The Skin Senses. Illinois, USA: Thomas C; 1968: 423-439
• 8 Moayedi M, Davis K. Theories of pain: from specificity to gate control. J Neurophysiol 2013; 109: 5-12
• 9 Megel M, Houser C, Gleaves L. Children’s responses to immunizations: lullabies as a distraction. Issues Compr Pediatr Nurs 1998; 21: 129-145
• 10 Lee DW, Chan KW, Poon CM. et al. Relaxation music decreases the dose of patient-controlled sedation during colonoscopy: a prospective randomized controlled trial. Gastrointest Endosc 2002; 55: 33-36
• 11 Palakanis K, DeNobile J, Sweeney W. et al. Effect of music therapy on state anxiety in patients undergoing flexible sigmoidoscopy. Dis Colon Rectum 1994; 37: 478-481
• 12 Smolen D, Topp R, Singer L. The effect of self-selected music during colonoscopy on anxiety, heart rate, and blood pressure. Applied Nursing Research 2002; 15: 126-136
• 13 Schiemann U, Gross M, Reuter R. et al. Improved procedure of colonoscopy under accompanying music therapy. Eur J Med Res 2002; 7: 131-134
• 14 Rudin D, Kiss A, Wetz RV. et al. Music in the endoscopy suite: a meta-analysis of randomized controlled studies. Endoscopy 2007; 39: 507-510
• 15 El-Hassan H, McKeown K, Muller AF. Clinical trial: music reduces anxiety levels in patients attending for endoscopy. Aliment Pharmacol Therap 2009; 30: 718-724
• 16 Costa A, Montalbano LM, Orlando A. et al. Music for colonoscopy: A single-blind randomized controlled trial. Digest Liver Dis 2010; 42: 871-876
• 17 Mrázová M, Celec P. A systematic review of randomized controlled trials using music therapy for children. J Altern Complement Med 2010; 16 DOI: 10.1089/acm.2009.0430.
• 18 Klassen JA, Liang Y, Tjosvold L. et al. Music for pain and anxiety in children undergoing medical procedures: a systematic review of randomized controlled trials. Ambulat Ped 2008; 8: 117-128 DOI: 10.1016/j.ambp.2007.12.005.
• 19 van der Heijden MJE, Oliai Araghi S, van Dijk M. et al. The effects of perioperative music interventions in pediatric surgery: a systematic review and meta-analysis of randomized controlled trials. PLoS ONE 2015; 10: e0133608
• 20 Kain ZN, Mayes LC, Cicchetti DV. et al. The Yale Preoperative Anxiety Scale: how does it compare with a “gold standard”?. Anesth Analg 1997; 85: 783-788
• 21 Crandall M, Lammers C, Senders C. et al. Initial validation of a numeric zero to ten scale to measure children’s state anxiety. Anesth Analg 2007; 105: 1250-1253
• 22 Tomlinson D, von Baeyer CL, Stinson JN. et al. A systematic review of faces scales for the self-report of pain intensity in children. Pediatrics 2010; 126: e1168-1198
• 23 Young KD. Pediatric procedural pain. Ann Emerg Med 2005; 45: 160-171
• 24 DeLoach WalworthD. Procedural-support music therapy in the healthcare setting: a cost-effectiveness analysis. J Pediatr Nurs 2005; 20: 276-284
• 25 Gozal D, Gozal Y. Classical music during magnetic resonance imaging in children under propofol sedation. Cahiers D’Anesthesiol 1998; 46: 387-389