Effects of Intraoperative Auditory Stimulation after Pediatr
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Severe pain on awakening (POA) and emergence delirium (ED) are common following pediatric adenotonsillectomy. Intraoperative auditory stimulation is an effective nonpharmacologic intervention for postadenotonsillectomy pain and agitation in children.

The objective was to determine the effects of intraoperative auditory stimulation on the reduction of POA and ED after pediatric adenotonsillectomy.

Children were randomized to 1 of the following groups: auditory stimulation with music, auditory stimulation with noise, ambient noise insulation with masking earplugs, and a control group receiving no intervention. Ear inserts were placed in the operating room once general anesthesia was administered. Stimulation parameters were based on the preoperative audiological evaluation and the appropriate fitting of the transduction system, including ambient noise level monitoring. A total of 104 consecutive healthy children were included in the analysis.

--Music had a large effect size on POA and medium effect size on ED, while noise had a medium effect size on POA and a large effect size on ED compared with controls.

--The earplugs group showed a small effect size on POA and ED.

--Considering a clinically meaningful threshold of greater than 4 for POA and 10 or greater for ED at dichotomized analysis, a large effect size was achieved by music and noise, while earplugs resulted in small effect size.

In conclusion, children undergoing adenotonsillectomy who received intraoperative auditory stimulation demonstrated a clinically meaningful decrease in POA and ED in the immediate postoperative period.

Source: https://jamanetwork.com/journals/jamaotolaryngology/article-abstract/2780287