Interventional cardiology

Mozart may replace midazolam for cath lab sedation

Music may have a drug sparing role for patients undergoing conscious sedation during invasive cardiac catheterisation (ICC), US cardiologists have shown.

By reducing anxiety, music may serve as an adjunct or even an alternative to midazolam and fentanyl, a study carried out by  clinicians at the Veterans Affairs Greater Los Angeles Healthcare found.

In a retrospective analysis, they assessed the outcomes of 161 patients who underwent ICC and received music therapy and or intravenous sedation/analgesics according to patient preference.

In the study, patients undergoing ICC were offered to listen to music of their choice during the procedure. Music was started in the cardiac catheterisation laboratory after “time out” and was administered via speakers audible to staff as well as the patient. Music was continued until the end of the procedure, after which patients involved in the music arm were asked if they felt the music helped them relax during the procedure.

The analysis showed that 42 of the 49 patients (86%) received no benzodiazepine sedation or opioid analgesia compared to 29 of 112 patients (26%) of the control group without music.

The average dose of midazolam used was lower in the music group compared to the control  group (0.1 mg vs 0.7 mg) and likewise the average dose of fentanyl was lower for patients who listened to music during catheterisation ( 3 mcg vs  vs 39.5 mcg).

When asked about how they felt about the music, almost 90% of patients believed it helped them relax and reduced their stress/anxiety levels.

“Our preliminary findings for the first time confirm that music intervention monotherapy appears to be a reasonable alternative to standard pharmacotherapy with benzodiazepines and opioids during ICC,” the researchers said.

Music likely reduced anxiety by down-regulation of the sympathetic nervous system, they suggested.

“Music intervention may offer other advantages, such as lower rates of complications/side effects from sedatives and opioids, lower cost to institutions and patients, faster recovery and shorter lengths of hospital stay. In our small study, three overnight hospitalisations were prevented as a result of not using opioids and sedatives,” they noted.

The study is published in the American Journal of Cardiology.

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