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  • Music to Tame Anxiety and Hypertension During Cataract Surgery

    By Jean Shaw
    Selected and Reviewed by Neil M. Bressler, MD, and Deputy Editors
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    Journal Highlights

    JAMA Ophthalmology, September 2021

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    Guerrier et al. evaluated whether having patients listen to music immediately prior to cataract surgery could lower the incidence of anxiety and hyperten­sive events during surgery. They found that it was effective on both fronts and that it also reduced the need for seda­tive medication during surgery.

    For this single-masked study, the re­searchers evaluated 309 patients (mean age, 68.9 years) who were scheduled for their first cataract surgery. Of these, 36 patients were already being treated for hypertension. The patients were randomly assigned to either the exper­imental arm (headphones with music from a web-based app; n = 154) or the control arm (noise-canceling head­phones without music; n = 155) for 20 minutes before surgery. The primary outcome was the occurrence of at least one hypertensive event during surgery (defined as systolic blood pressure [BP] of >160 mm Hg and/or diastolic BP >100 mm Hg plus a tachycardia level >85 beats per minute [bpm]). Second­ary outcomes included the patients’ anxiety levels at the end of the 20-min­ute pre-op sessions, as measured by a visual analog scale, and their need for antianxiety medication during surgery.

    All told, 21 patients in the treatment arm and 82 in the control experienced hypertension with tachycardia during surgery. During these events, mean BP was 149/95 and mean heart rate was 94 bpm in those who listened to music before surgery. In contrast, the mean BP of controls was 179/118, and their mean heart rate was 119 bpm. With regard to anxiety levels, the mean visual measure of anxiety was lower in the music arm than in the control arm (1.4 vs. 3.1, respectively). While the overall proportion of those who needed anxiolytic medication during surgery was similar between the two groups, the mean number of injections was lower in those who listened to music than in controls (.04 vs. .54, respectively).

    Overall, these findings suggest that the simple nonpharmacologic approach of listening to music before cataract surgery can help reduce patient anxiety and the risk of intraoperative hyper­tensive events. However, the inability to mask the study participants could have biased the study in favor of the music arm. Patients were informed of the music or control intervention during the consent process and knew which arm they were being randomized to. If they knew music was being evaluated as an intervention to lower anxiety, it may have increased their anxiety if they realized that they were not getting the study intervention. This could have resulted in more episodes of hyperten­sion or a greater requirement to need and receive anxiolytic drugs. (Also see related commentary by Julie M. Schallhorn, MD, and Jennifer Rose-Nussbaumer, MD, in the same issue.)

    The original article can be found here.