575778

research-article2015
JFM0010.1177/1098612X15575778Journal of Feline Medicine and SurgeryMira et al

Original Article

Journal of Feline Medicine and Surgery

Influence of music and its genres 2016, Vol. 18(2) 150­–159

© ISFM and AAFP 2015
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DOI: 10.1177/1098612X15575778

diameter variations in cats under jfms.com

general anaesthesia: contribution

to promoting patient safety

Filipa Mira1, Alexandra Costa1, Eva Mendes1,

Pedro Azevedo1 and L Miguel Carreira1,2,3

Abstract
Objectives  The aims of the study were to recognise if there is any auditory sensory stimuli processing in cats under
general anaesthesia, and to evaluate changes in respiratory rate (RR) and pupillary diameter (PD) in anaesthetised
patients exposed to different music genres, while relating this to the depth of anaesthesia.
Methods  A sample of 12 cats submitted for elective ovariohysterectomy was exposed to 2 min excerpts of three
different music genres (classical [CM], pop [PM] and heavy metal [HM]) at three points during surgery (T1 =
coeliotomy; T2 = ligature placement and transection of the ovarian pedicle; T3 = ligature placement and transection
of the uterine body). A multiparametric medical monitor was used to measure the RR, and a digital calliper was
used for PD measurement. Music was delivered through headphones, which fully covered the patient’s ears.
P values   <0.05 were considered to be statistically significant.   
Results  Statistically significant differences between stimuli conditions for all surgical points were obtained for RR
(T1, P = 0.03; T2, P = 0.00; T3, P = 0.00) and for PD (T1, P = 0.03; T2, P = 0.04; T3, P = 0.00). Most individuals
exhibited lower values for RR and PD when exposed to CM, intermediate values to PM and higher values to HM.
Conclusions and relevance  The results suggest that cats under general anaesthesia are likely to perform auditory
sensory stimuli processing. The exposure to music induces RR and PD variations modulated by the genre of music
and is associated with autonomic nervous system activity. The use of music in the surgical theatre may contribute
to allowing a reduced anaesthetic dose, minimising undesirable side effects and thus promoting patient safety.

Accepted: 9 February 2015

Introduction
In cognitive science, music is one of the most intriguing
and eccentric components of human culture, being appar-
ently universal.1 In a non-consensual way, music can be
defined as the art of organising sound in a temporal dimen-
sion according to such properties as melody, harmony,
rhythm and tone in order to produce a continuous, unified
and evocative composition.2,3 Regardless of its definition, it
is widely accepted that music has different physiological
and psychological effects on the individual.4–16
Sound waves correspond to longitudinal vibrations
of molecules present in the external environment, char-
acterised by alternate phases of compression and rare-
faction.17 These waves are captured by the pinna and
travel along the external auditory canal to the tympanic
membrane, causing its vibration; the displacement of
1Anjos of Assis Veterinary Medicine Center (CMVAA), Barreiro,
Portugal
2Faculty of Veterinary Medicine, University of Lisbon, Lisbon,
Portugal
3Interdisciplinary Centre of Research in Animal Health (CIISA),
Faculty of Veterinary Medicine, University of Lisbon, Portugal
Corresponding author:
L Miguel Carreira PhD, MSc, DTO, Pst-Grd, DMD, DVM,
Department of Surgery, Faculty of Veterinary Medicine,
University of Lisbon, 1300 Lisbon, Portugal
Email: miguelcarreira@fmv.ulisboa.pt
Mira et al 151

this membrane leads to the sequential oscillation of the

middle ear ossicles, with consequent stimulation of the
oval window.18,19 This causes the displacement of peri-
lymphatic vestibular fluid, creating pressure waves that
travel through the liquid medium of the vestibular scale
and the tympanic scale, as the two scales communicate
with each other, and are transmitted to the basilar mem-
brane. The oscillation of the basilar membrane leads to
distortion of the stereocilia, with consequent changes in
their membrane potential and neurotransmitter release
to afferent bipolar neurons,20 which carry the nerve
impulses to the spiral ganglion.19 Subsequently, the spi-
ral ganglion axons leave the inner ear through the inter-
nal acoustic meatus and establish synapses in the
cochlear nucleus of the medulla oblongata (Figure 1).21
From this point on, the auditory information is passed
over several other processing centres, such as the supe-
rior olivary complex, the lateral lemniscus, the inferior
colliculus and the medial geniculate body, culminating
in the auditory cortex (Figure 2).23
In non-human animal species, music appears to be a
useful tool in terms of welfare, leading to a decrease in
stress and anxiety.24–27 In a surgical context, there is evi-
dence that pre-, intra- or postoperative exposure to musi-
cal stimuli is beneficial for the patient, leading to a
reduction of perceived pain, anxiety and stress, as well as
to a decrease in anaesthetic and analgesic require-
ments.28–41 Several studies in children have reported these
findings, and according to the study of Hatem et  al,33
music can even modulate the vital signs in the periopera-
tive period. This is particularly important in children,
owing to their frequent non-cooperative nature in a sur-
gery/anaesthesia context. The effects of music on pain
reduction are explained by the gate control theory of pain,
with music acting to modulate the painful stimuli. Brain
imaging studies have shown activity in the auditory path-
way, auditory cortex and limbic system in response to
music and its ability to reduce stress neurohormonal Figure 1  The auditory pathway – from the source of sound
markers, heart rate, blood pressure and ventilation, espe- waves through the external ear to information transmission
in the cochlear nucleus (adapted from Patestas and
cially music with a slow rhythm.10,42 The addition of non-
Gartner18)
pharmacological agents such as music is assumed to be
very important in medical and surgical scenarios.
Clinical assessment of the depth of anaesthesia may 2.4–3.6 kg), submitted for elective ovariohysterectomy
be achieved by measuring the respiratory rate (RR) in surgery. All individuals were of apparent good health,
spontaneously breathing subjects, and the pupillary with no signs of neurological or hearing disorders –
diameter (PD).16,43–45 We aimed to investigate whether conditions that might interfere with the legitimacy of the
there is any auditory sensory stimuli processing in cats results. All females with signs of oestrus and with ocular
under general anaesthesia, and to evaluate changes in pathology not allowing the collection of accurate data
RR and PD in cats exposed to different music genres, concerning PD were excluded from the sample. For the
relating this to the depth of anaesthesia. study, permission from the ethical committee and signed
consent forms from the owners were obtained.
Materials and methods After achieving an adequate and stable anaesthetic
The study was conducted on a sample of 12 female cats, of plane, repeated measurements of RR and PD were
domestic breed, with an average age of 9 months (range undertaken at three different surgical times (T1 = coeli-
6–12 months) and an average body weight of 3.0 kg (range otomy; T2 = ligature placement and transection of the
152 Journal of Feline Medicine and Surgery 18(2)
Figure 2  Major ascending auditory pathways (adapted from Mountain22)
ovarian pedicle; T3 = ligature placement and transection
of the uterine body). For each of these surgical time
points, patients were first assessed in a silent scenario as
a self-control (CT) and then exposed to three different
genres of music: classical music (CM), ‘Adagio For
Strings (Opus 11)’ by Samuel Barber; pop music (PM),
‘Torn’ by Natalie Imbruglia; and heavy metal (HM),
‘Thunderstruck’ by AC/DC. Musical stimulation was
performed for 2 mins for each genre.
The study design for T1 was division of the linea alba
into four segments, to be incised under CT and different
musical genres; for T2 the study design involved one
ovary being surgically worked on under CT and one genre
of music, and the other ovary under the remaining two
genres. A total of 8 mins was spent on the task. The order
of music exposure was not always the same, and data
records were blind for the sequence of music presented for
each patient (three different sequences were considered,
eg, A, B, C). Music was delivered via headphones that fully
covered the patient’s ears. An MP3 player set to deliver
<80 decibels (measured and confirmed using the Benetech
Digital LCD Sound Noise Level Meter device) was used at
a loudness level of 4 (out of a maximum of 12) in all
patients. Two recordings were made   for each genre for
each of the studied parameters, and only the arithmetic
mean was considered for statistical analysis. The surgical
procedure was performed by the same surgeon, using the
same surgical technique, and data collection was executed
by the same operator, with recourse to a multiparametric
monitor (NT MP1000; Mekics Corporation). PD was
evaluated by direct measurement using a digital calliper
(SXG-model 110, Dongguan Hust Tony Instruments Co)
always in the right eye.
All patients were catheterised via the cephalic vein
after topical application of bupivacaine gel 5%, and
received a continuous intravenous fluid therapy with
saline (5 ml/kg/h NaCl 0.9%). Ketamine (7.5 mg/kg IM)
with dexmedetomidine (0.08 mg/kg IM) was used for
anaesthetic induction, and isoflurane for the mainte-
nance of anaesthesia. A presurgical protocol with amoxi-
cillin + clavulanic acid (8.75 mg/kg IM), meloxicam (0.3
mg/kg SC), atropine (0.02 mg/kg SC) and buprenor-
phine (0.02 mg/kg IM) was used for all patients. The
action of dexmedetomidine was reversed at the end of
the surgical procedure with atipamezole (10 IU/patient
IM). Statistical analysis was performed with Microsoft
Excel and IBM SPSS Statistics. Shapiro–Wilk, repeated
measures ANOVA, and Friedman and Wilcoxon signed-
rank were used, and   P <0.05 was considered to be
significant.
Results
We recorded the RR and PD values throughout the study;
the results are shown in Tables 1–5.
Mira et al 153

Most individuals exhibited lower RR values when
exposed to CM, intermediate RR values to PM and higher
RR values to HM at all surgical time points. The Shapiro–
Wilk test supports the normality of the obtained data for
all stimuli conditions, with the exception of HM at T1 (P =
0.04), which was considered irrelevant given the strength
of repeated measures ANOVA; CT at T2 (P = 0.028); and
CT (P = 0.033), PM (P = 0.006) and HM (P = 0.014) at T3.
ANOVA results for T1, and Friedman’s test results for T2
and T3 exhibited differences in RR between genres, and
CT was statistically significant for all three surgical time
points (T1, P = 0.03; T2, P = 0.00; and T3, P = 0.00). The
results of pairwise comparisons between genres, per-
formed with the post-hoc Bonferroni test for T1 and the
Wilcoxon signed-rank test (with Bonferroni correction)
for T2 and T3, were statistically significantly different
between the following pairs: HM/CM at T1 (P = 0.00),
HM/PM at T2 (P = 0.00), HM/CM at T2 (P = 0.00), CM/
CT at T3 (P = 0.01) and HM/PM at T3 (P = 0.00) (Figure 3).
For PD, at all surgical time points, a higher percentage
of individuals manifested lower PD values when
exposed to CM, intermediate values to PM and higher
values to HM. The Shapiro–Wilk normality test suggests
the normality of the collected data, with the exception of
CM at T1, the significance value of which was slightly
lower than the established threshold (P = 0.04) and for
CT in T2 (P = 0.03). The application of the repeated
measures ANOVA test led to statistically significant dif-
ferences being obtained between stimuli conditions for
all surgical time points (T1, P = 0.03; T2, P = 0.04; T3,
P = 0.00). In terms of pairwise comparisons, statistically
significant differences were observed between the fol-
lowing pairs: PM/HM at T1 (P = 0.00); HM/PM at T2
(P = 0.00); HM/CM at T2 (P = 0.00); and at T3 for CT/
PM (P = 0.00), CT/CM (P = 0.00), CT/HM (P = 0.002),
PM/HM (P = 0.000) and CM/HM (P = 0.000) (Figure 4).
Discussion
The autonomic nervous system (ANS) is involved in the
control of vegetative functions, which include the res-
piratory and heart rates, body temperature, and pupil
constriction and dilation. In human medicine, the con-
cept that general anaesthesia leads to complete aliena-
tion towards external events is rejected by many
published studies that support the existence of auditory
stimuli processing in patients under general anaesthe-
sia.48–50 Studies on humans concluded that music influ-
ences ANS activity differently, depending not only on
the sex of the individual, but also on the rhythmic struc-
ture to which the patient is exposed.10,51–54 The measures
of the anaesthetic effect represent normal physiological
responses, which can be quantified, and these are used
in clinical practice as possible clinical measures of the
depth of anaesthesia. The RR in spontaneously breath-
ing subjects and PD are examples of this.43–45
Our results support these observations for both
parameters studied, as the recorded variations showed
similar trends over all the considered surgical time points
(T1, T2 and T3) in the individuals. In fact, recorded varia-
tions in RR and PD can be assumed to be a consequence
of the exposure to distinct music genres, with the major-
ity of the patients presenting lower mean RR and PD

Table 1  Descriptive statistics of the respiratory rates (RR) and pupil diameters (PD), according to music genre and
surgical time point. All patients received atropine before the surgical time points and therefore a discrete mydriasis was
always expected for all individuals

Parameter n St* Phys Surgical time points

  T1 T2 T3  

  CT PM CM HM CT PM CM HM CT PM CM HM

RR 12 Max 40† 23.00 22.00 22.00 24.00 23.00 27.00 25.00 31.00 24.00 24.00 21.00 32.00
  Min 16† 11.00  8.00  8.00  9.00 11.00 10.00  9.00 11.00 12.00 10.00  9.00 11.00
  xˉ 20† 16.58 14.67 13.75 15.50 16.16 16.00 15.17 18.25 16.58 14.33 13.33 17.25
  SD –  4.23  5.09  5.03  5.37  4.70  5.03  4.63  6.52  4.39  4.64  3.89  6.94
PD 12 Max – 11.10 10.90 10.80 11.10 11.00 11.10 11.00 11.10 11.10 11.00 10.90 11.20
  Min –  9.80  8.80  8.70  9.00  9.00  9.80  9.70 10.00 10.00  9.80  9.70 10.10
  xˉ 10.1‡ 10.40 10.12 10.08 10.28 10.30 10.33 10.32 10.55 10.55 10.41 10.33 10.63
  SD 0.5‡  0.42  0.73  0.76  0.69  0.67  0.45  0.46  0.38  0.36  0.38  0.37  0.37

*Data mean (x ˉ ) and dispersion (SD) measures obtained in a 95% confidence interval, presenting the minimum (min) and maximum (max)
values at the three surgical time points considered
†The physiological respiratory rate range data from Reece46 (Copyright 2004 by Cornell University)
‡The physiological pupil diameter range data from Wilkie and Latimer47

St = statistics; Phys = physiological values; CT = control; T1 = coeliotomy; T2 = ligature placement and transection of the ovarian pedicle;
T3 = ligature placement and transection of the uterine body; PM = pop music; CM = classical music; HM = heavy metal
154 Journal of Feline Medicine and Surgery 18(2)

Table 2  Shapiro–Wilk test results for respiratory rate (RR) and pupillary diameter (PD) organised according to music
genre and surgical time point

Surgical time point Parameter Music genre Statistic Degrees of freedom P value

T1 RR Control 0.909 12 0.208

  Pop 0.880 12 0.088
  Classical 0.879 12 0.084
  Heavy metal 0.859 12 0.047
  PD Control 0.930 12 0.378
  Pop 0.895 12 0.137
  Classical 0.860 12 0.049
  Heavy metal 0.910 12 0.213
T2 RR Control 0.841 12 0.028
  Pop 0.905 12 0.184
  Classical 0.916 12 0.258
  Heavy metal 0.869 12 0.064
  PD Control 0.848 12 0.035
  Pop 0.923 12 0.311
  Classical 0.913 12 0.233
  Heavy metal 0.886 12 0.105
T3 RR Control 0.847 12 0.033
  Pop 0.783 12 0.006
  Classical 0.863 12 0.053
  Heavy metal 0.814 12 0.014
  PD Control 0.929 12 0.369
  Pop 0.958 12 0.760
  Classical 0.977 12 0.970
  Heavy metal 0.940 12 0.496

Values in bold indicate statistical significance

T1 = coeliotomy; T2 = ligature placement and transection of the ovarian pedicle; T3 = ligature placement and transection of the uterine body

Table 3  Repeated measures ANOVA and Friedman’s test results for respiratory rate (RR) and pupillary diameter (PD),
according to surgical time point

Parameter Surgical ANOVA Friedman test

time point

  Significance Degrees of F P value Eta partial χ2 Degrees of P value

(Mauchly test) freedom square freedom

RR T1 0.00 1.20  5.26 0.03 0.32 – – –

  T2 – – – – – 17.85 3 0.00
  T3 – – – – – 17.54 3 0.00
PD T1 0.00 1.44  4.75 0.03 0.30 – – –
  T2 – – – – –  8.25 3 0.04
  T3 0.39 3 70.02 0.00 0.86 – – –

Values in bold indicate statistical significance

T1 = coeliotomy; T2 = ligature placement and transection of the ovarian pedicle; T3 = ligature placement and transection of the uterine body

values when exposed to CM, intermediate values to PM
and higher values to HM. By recording these variations it
is possible to conclude that, even under general anaesthe-
sia, cats are able to process and differentiate auditory
stimuli, and that different rhythms or genres can influ-
ence these two physiological parameters, which are
under ANS control.16,55,56 The study results reveal a
relationship between the different music genres and the
clinical signs of anaesthesia depth in the surgical patients
as exhibited by the RR and PD variations.
General anaesthetics are potent activity depressants
of the ANS, affecting upregulation of cardiac and res-
piratory functions, and therefore presenting a relatively
narrow margin of safety with a borderline between
Mira et al 155

Table 4  Descriptive statistics of respiratory rate (RR), according to music genre and surgical time point

Surgical time point Pairs of genres ANOVA Wilcoxon test

  Mean difference SE P value Z Asymptotic significance

(two-tailed)

T1 CT PM 1.917 0.988 0.471 – –

  CM 2.833 1.021 0.109 – –
  HM 1.083 1.033 1.000 – –
  PM CT –1.917 0.988 0.471 – –
  CM 0.917 0.288 0.052 – –
  HM –0.833 0.297 0.103 – –
  CM CT –2.833 1.021 0.109 – –
  PM –0.917 0.288 0.052 – –
  HM –1.750 0.250 0.000 – –
  HM CT –1.083 1.033 1.000 – –
  PM 0.833 0.297 0.103 – –
  CM 1.750 0.250 0.000 – –
T2 PM CT – – – –0.211 0.833
  CM CT – – – –1.086 0.277
  HM CT – – – –1.788 0.074
  CM PM – – – –2.058 0.040
  HM PM – – – –3.020 0.003
  HM CM – – – –2.952 0.003
T3 PM CT – – – –2.361 0.018
  CM CT – – – –2.442 0.015
  HM CT – – – –0.409 0.683
  CM PM – – – –0.952 0.341
  HM PM – – – –3.165 0.002
  HM CM – – – –2.047 0.041

Values in bold indicate statistical significance (P <0.017, Bonferroni)

T1 = coeliotomy; T2 = ligature placement and transection of the ovarian pedicle; T3 = ligature placement and transection of the uterine body;
CT = control; PM = pop music; CM = classical music; HM = heavy metal

Figure 3  Mean respiratory rate (RR) according to the music
genre and surgical time points considered
cpm = cycles per min; T1 = coeliotomy; T2 = ligature
placement and transection of the ovarian pedicle;
T3 = ligature placement and transection of the uterine body
Figure 4  Mean pupillary diameter (PD) according to the
music genre and surgical time points considered
T1 = coeliotomy; T2 = ligature placement and transection of
the ovarian pedicle; T3 = ligature placement and transection
of the uterine body
156 Journal of Feline Medicine and Surgery 18(2)

Table 5  Descriptive statistics of pupillary diameter (PD), according to music genre and surgical time point

Surgical time point Pairs of genres ANOVA Wilcoxon test

  Mean difference SE P value Z Asymptotic

significance

T1 CT PM 0.292 0.125 0.239 – –

  CM 0.333 0.142 0.229 – –
  HM 0.133 0.121 1.000 – –
  PM CT –0.292 0.125 0.239 – –
  CM 0.042 0.058 1.000 – –
  HM –0.158 0.034 0.004 – –
  CM CT –0.333 0.142 0.229 – –
  PM –0.042 0.058 1.000 – –
  HM –0.200 0.064 0.058 – –
  HM CT –0.133 0.121 1.000 – –
  PM 0.158 0.034 0.004 – –
  CM 0.200 0.064 0.058 – –
T2 PM CT – – – –0.134 0.894
  CM CT – – – –0.059 0.953
  HM CT – – – –1.688 0.091
  CM PM – – – –0.882 0.378
  HM PM – – – –2.902 0.004
  HM CM – – – –2.602 0.009

T3 CT PM 0.408 0.040 0.000 – –

  CM 0.483 0.042 0.000 – –
  HM 0.192 0.038 0.002 – –
  PM CT –0.408 0.040 0.000 – –
  CM 0.075 0.025 0.072 – –
  HM –0.217 0.032 0.000 – –
  CM CT –0.483 0.042 0.000 – –
  PM –0.075 0.025 0.072 – –
  HM –0.292 0.042 0.000 – –
  HM CT –0.192 0.038 0.002 – –
  PM 0.217 0.032 0.000 – –
  CM 0.292 0.042 0.000 – –

Values in bold indicate statistical significance (P <0.017, Bonferroni)

T1 = coeliotomy; T2 = ligature placement and transection of the ovarian pedicle; T3 = ligature placement and transection of the uterine body;
CT = control; PM = pop music; CM = classical music; HM = heavy metal

therapeutic, toxic or even lethal doses.57 Almost all
anaesthetic drugs cause a dose-dependent reduction in
RR and/or tidal volume, reflecting the patient’s
depressed ventilatory function, which is why RR is a
good indicator of anaesthesia depth. Considering the
side effects of anaesthetics on respiration, it is important
to search for new approaches to the anaesthetised
patient, with the aim of reducing the anaesthetic dose.
Music can influence RR through the activity of the
parasympathetic nervous system,58 decreasing tissue
oxygen consumption.59 In our study, RR data recording
was started only after the patients achieved a stable level
of anaesthesia. Patient exposure to different musical gen-
res was the newly introduced stimulus; therefore, we
think that the registered variations in RR may be derived
from the processed musical stimulus at all surgical time
points considered (T1, P = 0.034; T2, P = 0.000; and T3,
P = 0.001). According to our results, patients under the
same surgical stimulus and hearing CM presented a
lower RR (8 cycles per min [cpm]), and those hearing
HM presented the highest values (32 cpm). Moreover,
the lowest dispersion of data was obtained with CM (12
cpm) and the highest with HM (21 cpm), both in T3. The
results are in accordance with the studies of Kogan et al
conducted in dogs,26 where it was concluded that CM
can be associated with a more relaxed state, and HM
with higher stress and anxiety.
PD measurement is also used as an indicator of the
depth of anaesthesia.60 In cats, the pupil occupies an
area that varies between approximately 120 mm2 and
Mira et al 157
<1 mm2, corresponding to a range of values at least
10-fold greater than those displayed by humans.61 PD
adjustment is achieved by the smooth muscle activity
of the iris,62 which, when stimulated by the parasympa-
thetic ANS, promotes contraction, decreasing PD (mio-
sis); in contrast, the sympathetic ANS causes an increase
in PD (mydriasis).55,63 All patients received atropine
before surgery and therefore a discrete mydriasis was
always expected for all individuals. Nevertheless, it
was possible to record some variations in PD in all
patients at all surgical time points under the influence
of different musical genres, revealing statistically sig-
nificant differences between stimuli conditions for all
surgical time points (T1, P = 0.033; T2, P = 0.041; and
T3, P = 0.000). According to our results, most of the
patients showed greater PD at all surgical time points
as a result of exposure to HM, which is related to an
increase in sympathetic activity, indicating a more
stressful situation. This is in contrast to their exposure
to CM and PM, where the miosis values were greater
and therefore associated with an increase of the para-
sympathetic activity.
Conclusions
The results of this study suggest that cats under general
anaesthesia are likely to perform auditory sensory stim-
uli processing, and that this stimulation induces changes
in two physiological parameters that are under the con-
trol of the ANS, RR and PD, depending on the music
genre to which a patient is exposed. This work has impli-
cations for the anaesthetic and surgical environments of
cats. Use of certain music genres in the surgical theatre
may contribute to a decrease in the anaesthetic dose
required, reducing undesirable side effects of anaesthetic
agents and thus promoting patient safety.
Acknowledgements  We thank CIISA, the Interdisciplinary
Centre of Research in Animal Health, Faculty of Veterinary
Medicine of Lisbon, University of Lisbon, Portugal; and the
Anjos of Assis Veterinary Medicine Center, Barreiro, Portugal.
Conflict of interest  The authors do not have any potential
conflicts of interest to declare.
Funding  This research received no specific grant from any fund-
ing agency in the public, commercial or not-for-profit sectors.
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