The Differences Between Intraoperative- and Postoperative-Preferred Music Effects on Emergence Delirium in Elderly Patients: A Single-Center, Prospective Randomized Controlled Trial.

Background and Objectives: This study aimed to compare the effects of patient-preferred music delivered intraoperatively versus postoperatively on Emergence Delirium (ED) incidence, severity, and duration, while identifying predictors, to evaluate non-pharmacologic interventions for enhanced anesthetic management. Materials and Methods: In a prospective, single-blind, randomized controlled trial, 360 patients aged ≥ 65 years undergoing elective surgery under general anesthesia were randomized to intraoperative music, postoperative music, or control groups. Participants selected genres played via headphones. Primary outcome was ED incidence (Richmond Agitation-Sedation Scale [RASS] score ≥ +1 within 60 min after extubation); secondary outcomes included severity, duration, visual analogue scale pain scores, satisfaction, and adverse events. Results: Intraoperative music reduced ED incidence (13.8% vs. 28.7% in controls, p < 0.001) and severity (mean RASS 1.3 vs. 1.8, p < 0.01). Postoperative music shortened duration (15.2 vs. 22.5 min, p < 0.01) and pain (mean visual analogue scale 3.0 vs. 4.2, p < 0.01). Both improved satisfaction (p < 0.001). Higher preoperative State-Trait Anxiety Inventory scores predicted ED (odds ratio [OR] 1.06, p = 0.01), with music protective (OR 0.45-0.62). Conclusions: Intraoperative music effectively prevents ED, and postoperative music improves recovery. Integrating patient-preferred music and screening for anxiety may enhance peri-anesthesia care in elderly patients.