Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
Department of Neuroscience, Erasmus MC, University Medical Centre Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
Can J Anaesth. 2021 Aug;68(8):1231-1253. doi: 10.1007/s12630-021-02015-0. Epub 2021 May 19.
Interest in implicit memory formation and unconscious auditory stimulus perception during general anesthesia has resurfaced as perioperative music has been reported to produce beneficial effects. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating explicit and implicit memory formation during general anesthesia and its effects on postoperative patient outcomes and recovery.
We performed a systematic literature search of Embase, Ovid Medline, and Cochrane Central from inception date until 15 October 2020. Eligible for inclusion were RCTs investigating intraoperative auditory stimulation in adult surgical patients under general anesthesia in which patients, healthcare staff, and outcome assessors were all blinded. We used random effects models for meta-analyses. This study adhered to the PRISMA guidelines and was registered in PROSPERO (CRD42020178087).
Fifty-three (4,200 patients) of 5,859 identified articles were included. There was evidence of implicit memory formation in seven out of 17 studies (41%) when assessed using perceptual priming tasks. Mixed results were observed on postoperative behavioural and motor response after intraoperative suggestions. Intraoperative music significantly reduced postoperative pain (standardized mean difference [SMD], -0.84; 95% confidence interval [CI], -1.1 to -0.57; P < 0.001; I = 0; n = 226) and opioid requirements (SMD, -0.29; 95% CI, -0.57 to -0.015; P = 0.039; I = 36; n = 336), while positive therapeutic suggestions did not.
The results of this systematic review and meta-analysis show that intraoperative auditory stimuli can be perceived and processed during clinically adequate, general anesthesia irrespective of surgical procedure severity, leading to implicit memory formation without explicit awareness. Intraoperative music can exert significant beneficial effects on postoperative pain and opioid requirements. Whether the employed intraoperative anesthesia regimen is of influence is not yet clear.
由于围手术期音乐已被报道具有有益效果，因此人们重新对全麻期间内隐记忆形成和无意识听觉刺激感知产生了兴趣。我们对评估全麻期间内隐和外显记忆形成及其对术后患者结局和恢复影响的随机对照试验（RCT）进行了系统回顾和荟萃分析。
我们对 Embase、Ovid Medline 和 Cochrane Central 进行了系统的文献检索，检索时间从建库开始到 2020 年 10 月 15 日。纳入的 RCT 研究对象为在全麻下接受手术的成年外科患者，术中对其进行听觉刺激，所有患者、医护人员和结果评估人员均设盲。我们使用随机效应模型进行荟萃分析。本研究遵循 PRISMA 指南，并在 PROSPERO（CRD42020178087）中进行了注册。
在 5859 篇文章中，有 53 篇（4200 例患者）符合纳入标准。使用知觉启动任务评估时，17 项研究中有 7 项（41%）有内隐记忆形成的证据。术中建议对术后行为和运动反应的影响结果不一。术中音乐可显著减轻术后疼痛（标准化均数差 [SMD]，-0.84；95%置信区间 [CI]，-1.1 至 -0.57；P < 0.001；I = 0；n = 226）和阿片类药物需求（SMD，-0.29；95%CI，-0.57 至 -0.015；P = 0.039；I = 36；n = 336），而积极的治疗建议则没有。
本系统评价和荟萃分析的结果表明，在临床充分的全麻期间，无论手术严重程度如何，听觉刺激都可以被感知和处理，导致内隐记忆形成而无外显意识。术中音乐可以显著减轻术后疼痛和阿片类药物需求。至于所采用的术中麻醉方案是否有影响，目前尚不清楚。
