Music in the perioperative period

Music in the perioperative period of dogs and cats: evidence and a framework for clinical application

Georgiou SG, Galatos AD

Introduction

Music is increasingly recognized as a safe, low-cost, and non-pharmacological

adjunct within multimodal perioperative care. In human medicine, it has

demonstrated anxiolytic, analgesic, and anaesthetic-sparing effects, while veterinary

evidence in dogs and cats, although still limited, has shown promising but variable

outcomes.

Importantly, recent work by Georgiou and Galatos (2025b) emphasizes that

music should not be regarded as passive background noise; instead, it represents a

structured sensory intervention that requires deliberate design, controlled delivery,

and integration into perioperative anaesthetic protocols.

Conceptual and physiological basis

The effects of music are thought to arise from multiple interacting physiological

pathways:

• autonomic modulation, promoting parasympathetic dominance (↓ HR, ↓ BP, ↑HRV),

• neurochemical effects, including activation of dopaminergic and endogenous opioid pathways,

• stress modulation, influencing hypothalamic-pituitary-adrenal (HPA) activity (↓cortisol),

• acoustic masking, reducing exposure to aversive environmental noise,

• arousal regulation, affecting behavioural and physiological state transitions.

Although much of this evidence originates from human studies, these

mechanisms are considered relevant to veterinary patients and support the role of

music as a safe adjunct in perioperative care (Georgiou & Galatos 2025a).

Experimental veterinary data also indicate that music can induce measurable

physiological changes, including alterations in cardiovascular parameters, HRV, and

stress biomarkers. These effects are influenced by acoustic characteristics such as frequency, tempo, and complexity, and may vary between species.

Critically, music effects depend on the integrity of auditory processing.

Anaesthetic agents such as isoflurane and propofol suppress auditory transmission

in a dose-dependent manner, potentially limiting central processing of acoustic

stimuli. As a result, depth of anaesthesia is a key determinant of efficacy, as

supported by recent experimental and clinical studies (Georgiou et al. 2023, 2024,

2026).

Evidence Overview

Across veterinary studies, music exposure has been associated with:

• increased preoperative sedation and reduced anaesthetic induction requirements,

• modulation of intraoperative autonomic responses and potential

• anaesthetic/analgesic-sparing effects,

• improved postoperative recovery and reduced stress-related behaviours.

  
  

However, findings remain inconsistent, largely due to methodological variability,

small sample sizes, and the absence of standardized intervention protocols.

Preoperative phase

A prospective, randomized, blinded, crossover study (Georgiou et al. 2023)

demonstrated that exposure to classical music (Chopin or Mozart) via loudspeakers

resulted in:

• increased sedation following premedication (acepromazine-butorphanol)

• approximately 20% reduction in propofol requirements for induction and intubation.

These findings suggest that music may enhance central nervous system

depression and facilitate induction.

Intraoperative light-plane anaesthesia

In dogs undergoing minor skin surgery under a light plane of anaesthesia (BIS ≈ 70),

a prospective, randomized, blinded crossover study (Georgiou et al. 2024) showed:

• reduced isoflurane requirements,

• reduced fentanyl requirements,

• changes in nociceptive modulation, reflected by substance P dynamics.

These results suggest a potential anaesthetic- and analgesic-sparing effect

when auditory processing is still preserved.

Intraoperative deep surgical anaesthesia

In contrast, a prospective, randomized, double-blind clinical study (Georgiou et al.

2026) in dogs undergoing ovariohysterectomy found:

• no significant effect on inhalant or opioid requirements,

• no differences in autonomic parameters or recovery quality.

This likely reflects suppression of auditory processing at deeper anaesthetic

planes, limiting central integration of acoustic stimuli.

Supporting this interpretation, evidence in cats suggests partial preservation of

auditory processing under anaesthesia (Mira et al. 2016), indicating potential

species-specific differences.

Collectively, current evidence supports a phase- and depth-dependent effect:

• strongest effects: preoperative period,

• conditional effects: light-plane anaesthesia,

• minimal or absent effects: deep surgical anaesthesia.

Music should therefore be considered a context-dependent adjunct rather than a

universally effective intervention.

Framework for Perioperative Clinical Application

General Principles

Music should complement, not replace, pharmacological management.

 The perioperative environment must be calm, controlled and low-stimulus.

 Competing noise should be minimized to enhance effect consistency.

Core Implementation Parameters

Music Characteristics

Optimal effects are associated with:

 slow tempo and stable rhythm,

 predictable musical structure,

 minimal abrupt changes in pitch or dynamics,

 simple instrumentation (e.g., piano-based compositions).

No single genre is universally optimal; instead, objective acoustic properties are

more relevant than genre classification.

Species-specific considerations are critical:

Dogs: avoid excessive low-frequency stimulation.

Cats: may respond more favourably to higher-frequency ranges.

Volume (Sound Intensity)

 Recommended: <65 dB.

 Avoid sudden changes in intensity.

 Levels <85 dB may induce stress responses and impair sedation quality.

Delivery Method

 Pre- and postoperative periods: ambient delivery via speakers.

 Intraoperative period: headphones may be used to deliver music and reduce

environmental noise.

However, even optimal delivery cannot overcome the limitations imposed by

deep anaesthesia, where auditory processing is significantly suppressed (Georgiou

et al. 2024, 2026).

Timing of Application

Music may be used across all perioperative phases:

 Preoperative: reduces anxiety, enhances sedation, facilitates induction, and

reduces induction agent requirements (Georgiou et al. 2023).

 Intraoperative: may support autonomic stability and reduce anaesthetic and

analgesic requirements, primarily under lighter planes of anaesthesia

(Georgiou et al. 2024); effects may be minimal or absent at surgical depths

due to central suppression of auditory pathways (Georgiou et al. 2026).

 Postoperative: promotes calmer recovery and reduced stress-related

behaviours.

Multiphase application is likely more effective than single-phase exposure,

although optimal protocols remain to be defined.

Duration and Exposure

 Minimum effective exposure: 20-60 minutes.

 Can be extended across perioperative phases.

 Avoid continuous or prolonged uninterrupted exposure to prevent habituation.

Frequency and Continuity

 Adapt exposure to clinical workflow and procedure duration.

 Postoperative application: once or twice daily sessions.

 Avoid repetitive single-track loops; use varied playlists.

Individualization and Habituation

 Allow acclimatization to the environment prior to intervention.

 Consider previous auditory exposure or familiarity.

 Monitor behavioural responses and adjust accordingly.

 If stress or aversive responses occur, modify selection or discontinue use.

Individual variability is a key determinant of response.

Practical integration

Effective clinical use of music requires:

•  a calm, low-stress perioperative environment,

•  standardized yet flexible application parameters,

•  species-specific auditory considerations,

•  individual patient assessment and adjustment,

•  integration within multimodal perioperative care, including pharmacological

• and non-pharmacological strategies (e.g. gentle handling, pheromones).

  
  

Key Concept

Music should be understood as a controlled, biologically active sensory intervention,

not background noise. Its clinical value depends on how it is designed, delivered and

integrated into perioperative care, rather than its mere presence.

Future Directions

Further research is needed to develop standardized, reproducible veterinary music protocols, investigate multiphase perioperative applications, identify objective biomarkers (e.g. cortisol, HRV, neurochemical markers), clarify species-specific auditory and behavioural responses, define anaesthetic depth thresholds for auditory responsiveness, conduct larger, well-controlled randomized clinical trials, explore interactions between anaesthetic drugs and auditory processing.

Conclusion

Music represents a promising non-pharmacological adjunct in veterinary

perioperative medicine, with evidence supporting benefits in sedation, stress

modulation, and perioperative drug requirements in dogs and cats.

However, its efficacy is not inherent to the stimulus itself but depends on

contextual variables, including acoustic design, delivery method, perioperative phase,

and depth of anaesthesia. Recent evidence indicates that its effects are most

consistent in the preoperative period and under light-plane anaesthesia, while

diminishing at deeper anaesthetic planes due to suppression of auditory processing.

These findings support a shift from viewing music as environmental enrichment

toward recognizing it as a structured, biologically active sensory intervention

requiring protocol-driven application.

When integrated into a multimodal perioperative strategy, music may contribute

to improved patient welfare and more refined anaesthetic management in small

animal practice.

This guest post was written by Apostolos D. Galatos DVM, PhD, Dip ECVAA, EVS

Professor of Animal Anaesthesia and Surgery, University of Thessaly, Greece.

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