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Table 1 Characteristics of the included studies

From: Efficacy of therapeutic suggestions under general anesthesia: a systematic review and meta-analysis of randomized controlled trials

First author (publication year) Country Surgical procedure Description of therapeutic suggestions a n Description of control group n Anesthesia Outcomes
Bethune et al. (1993) [47] UK Coronary artery bypass grafting Positive; based on text used by Evans & Richardson (1988) [48]; music at the beginning 16 Blank tape with musical leader 17 I Mental distress (mood, anxiety)
Pain intensity
Recovery (nausea, mobility, general recovery)
Length of procedure
Block et al. (1991) [15] USA Operation on the fallopian tubes, vertical banding gastroplasty, total abdominal hysterectomy, ovarian cystectomy, cholecystectomy, myomectomy Smooth, rapid recovery during a short post-operative stay; no pain, nausea or vomiting; rapid return of bowel and bladder function; rapid healing and mobility; comfort; relaxation; good appetite, sleep, mood, and feeling 109 Blank tape 100 I Medication (antiemetics, Analgesics)
Length of procedure
Boeke et al. (1988) [49] NL Elective cholecystectomy Relaxation, wellbeing, pleasant feeling in every respect, absence of nausea and vomiting, good recovery; with seaside sounds 24 Nonsense suggestions with seaside sounds 26 N Mental distress (well-being)
Pain intensity
Recovery (nausea, general recovery)
Length of procedure
Physiological parameters (blood loss)
Bonke et al. (1986) [50] NL Biliary tract surgery Relaxation, well-being, comfortable feelings in every respect, lack of nausea or vomiting, no difficulty with bladder function or bowel movement, rapid recovery 31 Monotonous low-frequency noise, resembling the sound of a vacuum cleaner 30 N Mental distress (well-being, relaxation)
Pain intensity
Medication (analgesics)
Recovery (PONV, general recovery)
Length of procedure
Physiological parameters (blood loss)
Caseley-Rondi et al. (1994) [51] Canada Elective total abdominal hysterectomy and/or bilateral salpingo oophorectomy Simple and positive; alternating with Japanese melodies 48 Blank tape alternating with Japanese melodies 48 I Mental distress (mood, anxiety)
Pain intensity
Medication (analgesics)
Recovery (nausea, general recovery)
Cowan et al. (2001) [52] USA Bariatric surgical patients Positive; cognitive-behavioural approach: reinforcement of information received preoperatively, encouragement of performance of recovery regimes, positive interactions with personnel, improved self-image, relaxation 10 Blank tape 17 I Recovery (turning, coughing, breathing, mobility)
Dawson et al. (2001) [29] UK Total abdominal hysterectomy with/without bilateral salpingo oophorectomy (1) No pain
(2) No sickness
(3) No sickness, no pain
35
34
34
White noise 35 N (no N2O) Pain intensity
Medication (antiemetics, analgesics)
Recovery (PONV)
Length of procedure
De Houwer et al. (1996) [53] Belgium Coronary artery bypass grafting Relaxation, fast recovery; based on Bonke et al. (1986) [50]; with background relaxing music 19 Blank tape 21 T Mental distress (mood, anxiety)
Recovery (general recovery)
Length of procedure
Physiological parameters (blood pressure, noradrenalin, adrenalin)
Eberhart et al. (1998) [54] Germany Thyroidectomy Smooth postoperative recovery; relaxation, security, absence of nausea and vomiting 36 Blank tape 35 N Medication (antiemetics, analgesics)
Recovery (PONV)
Length of procedure
Evans & Richardson (1988) [48] UK Total abdominal hysterectomy Direct (no sickness, no pain), third person (operation is going very well and the patient is fine), description of normal postoperative procedures and coping advices 19 Blank tape 20 I Mental distress (anxiety, mood)
Pain intensity
Recovery (PONV, pyrexia, bowel difficulties, flatulence, mobility, micturation, general recovery, complications)
Length of procedure
Physiological parameters (blood loss)
Furlong (1990) [55] USA Abdominal gynecological surgery Positive 10 Blank tape 9 I Mental distress (mood) Medication (analgesics)
Length of procedure
Furlong & Read (1993) [56] USA Gynecological surgery or mastectomy Positive; with background music 52 Blank tape 56 I Mental distress (anxiety)
Pain intensity
Medication (analgesics)
Recovery (PONV, mobility, bowel difficulties, micturition, wound healing)
Jelicic et al. (1993) [30] NL Cholecystectomy (1) Affirmative (relaxation, comfort, quick healing) and non-affirmative (absence of tension, nausea); alternating with seaside sounds
(2) Affirmative
(3) Non-affirmative
21
20
20
Irrelevant text, i.e. excerpts from a cookery book 21 N Mental distress (well-being)
Length of procedure
Physiological parameters (blood loss)
Korunka et al. (1992) [40] Austria Hysterectomy Positive; followed by indirect (general wellbeing, absence of pain) 55 Operation sounds 53 I Pain intensity
Medication (analgesics)
Length of procedure
Lebovits et al. (1999) [57] USA Elective hernia repair Positive postoperative course, well-being and relaxation, minimal side effects, no difficult voiding, minimal discomfort such as sore throat, muscle aches and emetic symptoms; requirement of minimal pain medication 34 History of hospital 36 T Pain intensity
Medication (analgesics)
Recovery (PONV, side effects)
Length of procedure
Liu et al. (1992) [58] UK Total abdominal hysterectomy Affirmative and non-affirmative (comfort and rapid recovery; absence of pain or feelings of sickness) 24 History of hospital 25 I Mental distress (mood)
Pain intensity
Medication (analgesics)
Recovery (nausea, pyrexia, wound healing, mobility, flatulence)
Length of procedure
Physiological parameters (blood loss)
Liu et al. (1993) [59] UK Surgical repair of fractured neck of femur Positive (relating to comfort, mobility, nausea, general recovery and discharge after surgery) 58 History of hospital 61 GA Pain intensity
Medication (analgesics, antiemetics)
Recovery (ADL, mobility, pyrexia)
Maroof et al. (1997) [60] Saudi Arabia Elective abdominal hysterectomy Positive (good progress, well-being after surgery, absence of sickness) 25 Blank tape 25 I Medication (antiemetics)
Recovery (PONV, fluid replacement)
Length of procedure
Mastropietro (1998) [31] USA Open gynaecological procedures through a midline incision (1) Synchronized with soothing music presented when stress test was positive (comfortable, relaxed intraoperative and postoperative experience)
(2) Randomly presented with soothing music (comfortable, relaxed intraoperative and postoperative experience)
24     
McLintock (1990) [61] UK Elective abdominal hysterectomy by Pfannenstiel’s incision Positive (positive progress, feelings of warmth, comfort, calmness and relaxation; absence of pain) 30 Blank tape 30 I Pain intensity
Medication (analgesics)
Recovery (PONV)
McWilliams (1990) [62] USA Lumbar laminectomy surgery Suggestions interspersed with environmental sounds 30 Environmental sounds alone 30 GA Medication (analgesics, antiemetics)
Recovery (general recovery)
Melzack et al. (1996) [63] Canada Cholecystectomy or hyterectomy Positive; regarding the recovery process (e.g., feeling fine, mild pain only); interspersed with music 10 Excerpts from physiology book 10 I Pain intensity
Length of procedure
Moix et al. (1996) [64] Spain Abdominal hysterectomy Affirmative (feeling of relaxation during surgery, good progress, easy and rapid recovery, rapid mobility, comfort, good appetite, digestion, micturition, sleep and mood) 14 Monotonous sounds 13 I Pain intensity
Medication (analgesics)
Recovery (vomiting, pyrexia, digestion, appetite, sleep, bowel function, general recovery, micturition, complications)
Length of procedure
Physiological parameters (blood pressure, heart rate)
Münch & Zug (1990) [65] Germany Thyroidectomy General (comfort and well-being), direct (relaxing and feeling well, no vomiting, no nausea, only little pain); classical music played in a modern fashion 18 Blank tape 18 N Mental distress (well-being)
Pain intensity
Recovery (PONV)
Length of procedure
Nilsson et al. (2001) [66] Sweden Hysterectomy Relaxing and encouraging; music (relaxing and calming; accompanied by soothing sounds of sea waves) 31 Operation room sounds 28 I Mental distress (well-being) Pain intensity
Medication (analgesics)
Recovery (nausea, fatigue, mobility)
Length of procedure
Physiological parameters (blood loss)
Oddby-Muhrbeck et al. (1995) [67] Sweden Elective breast surgery Affirmative (safe atmosphere, quick recovery, feelings of hunger and thirst) 35 Low electronic sound set 35 I Pain intensity
Medication (analgesics)
Recovery (PONV, general recovery)
Length of procedure
Physiological parameters (blood loss)
Pearson (1961) [39] USA Thyroidectomy, gastrectomy, hernia repair, hysterectomy, pelvic laparoscopy, vein stripping In a permissive manner (relaxation and selfresponsibility of the patient for the course of recovery) 43 Blank tape 38 GA Medication (analgesics)
Recovery (general recovery)
Rosenberg (1992) [68] USA Hysterectomy, myomectomy, other gynaecological procedures, cholecystectomy Positive (smooth, comfortable, and rapid recovery, absence of sickness and pain), procedural/ sensory information about course of surgery and recovery; imagery, recommendations for dealing with postoperative events and sensations 33 Blank tape 32 I Mental distress (anxiety)
Pain intensity
Medication (analgesics, antiemetics)
Recovery (mobility, pyrexia, micturation)
Length of procedure
Steinberg et al. (1993) [69] USA Total abdominal hysterectomy or breast reconstruction by transverse rectus abdominus musculocutaneous reconstruction flap Positive (relating to nausea and anxiety) 30 Blank tape 30 I Mental distress (anxiety)
Pain intensity
Medication (analgesics)
Recovery (PONV)
van der Laan et al. (1996) [70] USA Hysterectomy, myomectomy, gynecologic laparotomy Nonspecific affirmative (feelings of relaxation and security) 20 Story of Peter Pan 20 I Mental distress (anxiety)
Pain intensity
Medication (analgesics)
Recovery (nausea)
Length of procedure
Williams et al. (1994) [42] UK Major gynaecological surgery Positive (smooth and uncomplicated progress of surgery, well-being after surgery, absence of sickness) 22 Blank tape 29 I Medication (analgesics)
Recovery (PONV, fluid replacement)
Length of procedure
Physiological parameters (blood loss)
Woo et al. (1987) [71] USA Hysterectomy Positive (rapid recovery) 7 Ocean sounds 7 I Medication (analgesics)
  1. NL Netherlands, I inhalation anesthesia, N neuroleptanesthesia, T intraveneous anesthesia, GA general anesthesia (not specified), PONV postoperative nausea and vomiting; a as reported in primary study