Role of Music for Conscious Sedation During Invasive Coronary Angiography

Background:
Patients undergoing invasive coronary angiography (ICA) routinely receive medications pre-procedurally for conscious sedation to reduce/prevent anxiety and pain. The goal of this study was to investigate if playing music in the peri-procedural period can decrease utilization of conscious sedation medications during ICA without effecting anxiety level.

Methods:
In this prospective randomized pilot study, subjects undergoing ICA were randomized to two groups; 1) standard conscious sedation (SCS) with versed and fentanyl, and 2) SCS plus music (MUSIC) during the peri-procedural period. Music was started at least 15 minutes prior to arrival to the cardiac catheterization laboratory. All subjects were asked whether they wanted to receive conscious sedation after “Timeout” and prior to local sedation injection with lidocaine 2%. All subjects were assessed for their levels of anxiety before and during the ICA. Emergency cases and those with significant hearing loss were excluded from the study. Anxiety assessment was based on numeric scale, zero (no anxiety) to 10 (extreme anxiety).

Results:
Of the 72 subjects, 37 were in the SCS arm and 35 were in the MUSIC arm. All procedures were performed by two experienced operators. Baseline characteristics were similar between the two groups. Use of any SCS medications was significantly higher in the SCS group versus the MUSIC group (62.2% vs 40.0% p=0.03). Average dose of versed (0.68 vs 0.37 p=0.047) was also significantly higher in the SCS than the MUSIC group. Fentanyl dose however was not significantly different (21.0 vs 15.7 mcg p= 0.36) between the SCS and MUSIC groups respectively. Subjects’ level of anxiety prior to ICA (3.0 vs 2.0 p=0.06) and during ICA (1.8 vs 1.7 p=0.44) were not significantly different between the SCS and the MUSIC groups respectively.

Conclusions:
Based on this pilot study, playing music in the peri-ICA period was associated with significantly lower utilization of pharmacologic agents for conscious sedation without adversely affecting anxiety.