Music therapy combined with anesthesia recovery care boosts anesthesia recovery in colorectal cancer patients undergoing laparoscopic radical resection

Abstract

BACKGROUND

Current standard nursing practices demonstrate limited effectiveness in perioperative colorectal cancer (CRC) management, highlighting the need to explore alternative care strategies that improve clinical outcomes.

AIM

To investigate the impact of music therapy and anesthesia recovery care on anesthesia recovery in patients with CRC undergoing laparoscopic radical resection.

METHODS

One hundred and twenty patients scheduled for elective laparoscopic CRC radical resection at Affiliated Hospital of Jiangnan University from January 2022 to May 2024 were enrolled. The patients were assigned to control (n = 60, receiving standard nursing care) and observation groups (n = 60, receiving music therapy, anesthesia recovery care, and standard nursing care). We comparatively analyzed the time to regain consciousness, extubation time, and length of stay in the postanesthesia care unit; heart rate, systolic blood pressure, and diastolic blood pressure before anesthesia and during recovery; cortisol, aldosterone, norepinephrine, and adrenaline levels before anesthesia and 24 hours postoperatively; Postoperative Quality of Recovery Scale scores; and complication rates between the groups.

RESULTS

The observation group exhibited a significantly shorter time to regain consciousness, extubation time, and postanesthesia care unit stay than the control group (P < 0.05). During the recovery period, heart rate, systolic blood pressure, and diastolic blood pressure significantly increased in both groups compared with preanesthesia levels, with the levels in the observation group being significantly lower than those in the control group (P < 0.05). At 24 hours postoperatively, cortisol, aldosterone, norepinephrine, and adrenaline levels were elevated in both groups compared with preanesthesia levels, with levels in the observation group being significantly lower than those in the control group (P < 0.05). The observation group achieved significantly higher Postoperative Quality of Recovery Scale scores than the control group (P < 0.05). Moreover, the complication rate in the observation group was significantly lower than that in the control group (10.00% vs 40.00%, P < 0.05).

CONCLUSION

Music therapy combined with anesthesia recovery care remarkably boosted the quality of anesthesia recovery in patients undergoing laparoscopic CRC radical resection, mitigated fluctuations in vital signs and stress responses, improved postoperative recovery quality, and reduced complication rates, demonstrating substantial clinical value.

Key Words: Music therapy; Anesthesia recovery care; Laparoscopic radical resection for colorectal cancer; Anesthesia recovery period

Core Tip: This research project examines the impact of music therapy in combination with anesthesia recovery care on colorectal cancer patients undergoing laparoscopic radical resection. A comparison was made between standard nursing care and music therapy plus anesthesia recovery care. Several key outcomes were assessed, including anesthesia recovery quality, vital signs, stress response, postoperative recovery quality, and complications. The combination therapy offered superior clinical benefits, contributing to higher recovery quality, minimized vital sign fluctuations, more effectively mitigated stress responses, better postoperative outcomes, and decreased complication rates in the study population.

INTRODUCTION

Colorectal cancer (CRC), also known as large intestine cancer, are malignancies originating from the epithelium of the large intestine. These malignancies include colon and rectal cancer, with rectal cancer being more prevalent in China[1]. As a common digestive tract malignancy, CRC has high incidence and mortality rates. With societal development and lifestyle changes, CRC incidence is rising and becoming increasingly prevalent among younger individuals, posing a significant threat to human health and quality of life[2]. CRC predominantly affects middle-aged and older adults over 40, with a higher incidence in men. The primary pathological site is the sigmoid–colon–rectum junction. Disease progression leads to symptoms like abdominal pain and hematochezia, gravely affecting patients’ quality of life[3]. Clinically, CRC’s etiology remains unclear. However, it is believed to result from a combination of genetic, dietary, and environmental factors, necessitating heightened clinical attention[4]. Because early-stage CRC has no distinct symptoms, it is easily overlooked, and most patients are in the mid-to-late stages upon hospital visit, complicating clinical treatment. Clinical experience has shown that early detection, diagnosis, and treatment of CRC markedly improves patients’ quality of life. With medical advancements, diagnostic and therapeutic approaches for CRC have evolved, reducing the mortality rate. However, CRC remains a major threat to human life and safety[5]. Laparoscopic radical resection for CRC has emerged as a predominant therapeutic approach in contemporary surgical practice. Its advantages, including minimal trauma, fewer postoperative complications, and quick recovery, have been widely acclaimed among clinicians and patients[6]. However, the procedure necessitates general anesthesia, wherein anesthetic agents can perturb basal metabolic processes, disrupt physiological homeostasis, and elevate perioperative risks. Particularly, these pharmacological interventions frequently precipitate emergence agitation during the postanesthesia recovery phase, potentially compromising surgical outcomes and adversely affecting patient prognosis[7]. Nursing is an effective approach to managing emergence agitation[8]. However, because conventional nursing care often yields limited effectiveness owing to insufficient specificity and proactive engagement, other efficient nursing strategies must be explored. Grounded in psychotherapy theory, music therapy capitalizes on a music’s unique physiological and psychological impact. When administered under professional supervision, it can alleviate or eradicate psychological issues, restore mental and physical well-being, and ultimately achieve objectives like prolonged life, disease prevention, and overall body-mind strengthening[9,10]. Anesthesia recovery care is a novel clinical surgical nursing model tailored for patients under general anesthesia. This approach includes proactive identification and intervention of potential anesthesia-related complications, mitigating rehabilitation impediments associated with anesthetic procedures[11]. Despite these advancements, studies on the synergistic application of music therapy and anesthesia recovery care in postanesthesia recovery are scarce, making it a highly beneficial area for in-depth investigation. Therefore, our study focuses on exploring the impact of this combined approach on patients with CRC undergoing laparoscopic radical resection, aiming to offer clinical insights to improve CRC treatment efficacy.

MATERIALS AND METHODS

General data

In this retrospective study, we enrolled 120 patients with CRC who underwent elective laparoscopic radical surgery at the Affiliated Hospital of Jiangnan University, China, between January 2022 and May 2024. The study participants were assigned to the control or observation group (n = 60 per group). The control group received standard perioperative care, and the observation group received standard care and a combined intervention of music therapy and specialized anesthesia recovery care. The demographic and clinical characteristics, including gender distribution, mean age, body mass index, duration of anesthesia, American Society of Anesthesiologists physical status classification[12], and pathological staging, were comparable between the groups, and there were no statistically significant differences observed (P > 0.05). This homogeneity confirmed the comparability of the groups’ for the purposes of our study. Refer to Table 1 for a detailed comparison of baseline characteristics.

Table 1 Comparative analysis of baseline characteristics between groups, n (%).

Baseline characteristics		Control group (n = 60)	Observation group (n = 60)	t/χ2	P value
Gender	Male	35 (58.33)	33 (55.00)	0.023	0.887
	Female	25 (41.67)	27 (45.00)
Age (year, mean ± SD)		56.80 ± 2.30	57.30 ± 1.96	0.372	0.708
Mean BMI (kg/m2, mean ± SD)		24.28 ± 2.08	24.13 ± 2.01	0.459	0.639
Mean duration of anesthesia (hour, mean ± SD)		3.18 ± 0.32	3.25 ± 0.36	0.814	0.418
ASA classification	I	29 (48.33)	30 (50.00)	0.473	0.492
	II	31 (51.67)	30 (50.00)
Pathological staging	II	35 (58.33)	37 (61.67)	0.454	0.501
	III	25 (41.67)	23 (38.33)

BMI: Body mass index; ASA: American Society of Anesthesiologists.

Inclusion and exclusion criteria

The inclusion criteria were: (1) CRC diagnosis confirmed through imaging examinations, including barium meal X-ray, computed tomography, and magnetic resonance imaging as well as immunohistochemical testing; (2) Meeting the indications for laparoscopic radical surgery; (3) American Society of Anesthesiologists physical status I-II; (4) Undergoing combined intravenous-inhalational general anesthesia, with identical medication protocols and surgeries performed by the same team of surgeons; (5) Normal auditory, cognitive, and psychological functions; and (6) Normal cardiac, hepatic, and renal functions, as confirmed through preoperative assessments.

The exclusion criteria were: (1) Contraindications for laparoscopic radical surgery or inability to tolerate the procedure; (2) Multifocal tumors, recurrent disease, or metastatic cancer; (3) Coagulation disorders; and (4) Women who were pregnant or lactating.

Methods

The control group received standard perioperative care, including preoperative education detailing the surgical procedure, necessary cooperation techniques, and potential risks to ensure adequate psychological preparation. Patients were instructed to fast for 12 hours before the surgery. Standard preoperative preparations included the placement of a nasogastric tube (removed immediately after surgery) and a urinary catheter (removed 48 hours after surgery). Anesthesia induction followed standardized protocols, accompanied by intravenous fluid administration. Vital signs were continuously monitored intraoperatively to ensure patient safety and procedural efficacy. In addition to the standard care described above, the observation group was further given music therapy integrated with anesthesia recovery care.

Music therapy

On day 1 of hospital admission, all patients received a preoperative visit to understand the rationale, objectives, and methodology of music therapy. Additionally, soothing and tranquil music (e.g., Schubert’s Serenade) was selected by professional music therapists, tailoring to each patient’s age, cultural background, and musical preferences. From hospitalization day 2 until a week post-surgery, the patients listened to pre-selected music during two daily 30-minute sessions (at 9:00 am and 8:00 pm) using headphones, with volume maintained gentle (25-30 dB). The music was continuously streamed to create a soothing atmosphere, facilitating emotional relaxation and reducing perioperative anxiety.

Anesthesia recovery care

The observation group was provided with comprehensive preoperative education, which included an overview of laparoscopic radical surgery, anesthesia principles, surgical procedures, possible complications, and postoperative precautions. Specific emphasis was placed on explaining the clinical necessity and importance of indwelling drainage tubes. To mitigate preoperative fear, anxiety, and psychological stress, targeted emotional support such as reassurance and positive reinforcement was provided. Additionally, the operating room temperature was regulated to ensure patient comfort during surgery. All administered fluids, including intravenous fluids and irrigation solutions, were maintained at optimal temperature using specialized fluid warming systems. Furthermore, intraoperative warming strategies, such as thermal blankets and forced-air warming devices, were used to maintain the patient’s core body temperature at about 36.5 °C, thereby minimizing hypothermia risk and the associated complications. Following the surgical procedure, close monitoring of the patient’s postoperative recovery was carried out. Upon arrival in the postanesthesia care unit (PACU), patients were positioned supine without a pillow to mitigate the risk of surgical equipment- or incorrect positioning-induced nerve compression, incisional pressure, or vascular compromise. Regular evaluations were conducted to assess and adjust (if clinically indicated) the tension of restraint straps and the patient’s body alignment, while maintaining rigorous airway patency maintenance to ensure unobstructed respiration. Continuous monitoring of consciousness recovery and vital signs was prioritized for those with pre-existing conditions such as respiratory dysfunction, medication dependence, circulatory impairment, or central nervous system disorders. During postanesthesia recovery, sedatives and analgesics were administered as prescribed to minimize emergence agitation. As the anesthetic effects gradually diminished, the patient gradually regained consciousness and sensory perception, including pain. At this time, tailored sedation and pain-alleviating measures were implemented following the doctor's instructions, including administering injectable analgesics or oral pain relief medications. If necessary, patient-controlled analgesia pumps were utilized to optimize pain management and prevent emergence agitation. In cases where patients experienced upper airway obstruction or respiratory distress due to residual anesthetic effects, which could potentially lead to hypercapnia or hypoxemia and manifest as agitation, restlessness, or headaches, arterial blood gas analysis was conducted to ensure proper respiratory function and mitigate potential recovery-phase complications.

Outcome measures

Anesthesia recovery quality: The time to regain consciousness, extubation time, and PACU length of stay were recorded for both groups to evaluate anesthesia recovery.

Vital signs monitoring: Heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were measured before anesthesia induction and during anesthesia recovery.

Stress response assessment: We collected 6 mL of elbow venous blood samples from the patients in each group before anesthesia administration (fasting) and 24 hours after surgery. The samples were transferred to Eppendorf tubes, allowed to clot at room temperature for 1 hour, and centrifuged at 3000 rpm for 10 minutes using a VM-1400-2KB centrifuge to isolate the serum supernatant. The serum samples were stored at -80 °C until quantification of cortisol (Cor), aldosterone (Ald), norepinephrine (NE), and adrenaline (AD) using radioimmunoassay kits supplied by Beijing Beimian Dongya Biotechnology Institute.

Postoperative recovery quality evaluation: We used the Postoperative Quality of Recovery Scale (PQRS)[13] to assess the recovery quality of patients in both groups. The PQRS includes five recovery domains: Cognitive (25 points), activities of daily living (12 points), emotional (10 points), nociceptive (10 points), and physiologic (27 points). Higher scores indicate superior recovery quality.

Complication incidence: The occurrence of postoperative complications, including arrhythmia, shivering, hypothermia, emergence agitation, and nausea/vomiting, was documented and compared between the groups.

Statistical analysis

Statistical analysis was performed using SPSS v18.0. Continuous variables were expressed as the mean ± SD and compared using the independent samples t-test. Categorical variables were presented as frequencies (n) or percentages (%) and analyzed using the χ² test. The distribution characteristics of continuous data were verified using the Kolmogorov-Smirnov test. Parametric analysis (independent samples t-test) was applied to normally distributed continuous variables, while non-parametric methods (Mann-Whitney U test) were used for variables deviating from normality. P values < 0.05 were considered statistically significant.

RESULTS

Comparison of anesthesia recovery quality between the groups

The observation group exhibited significantly shorter times for regaining consciousness, extubation, and PACU stay than the control group (P < 0.05) (Table 2).

Table 2 Comparison of anesthesia recovery quality between groups, mean ± SD.

Categories	Control group (n = 60)	Observation group (n = 60)	t	P value
Time to regain consciousness	32.83 ± 2.44	23.19 ± 1.73	8.599	0.000
Extubation time	41.83 ± 3.54	33.86 ± 2.60	7.532	0.000
Length of stay in the Postanesthesia care unit	56.83 ± 4.36	40.38 ± 3.18	9.229	0.000

Comparison of vital signs between the groups

There were no significant differences in HR, SBP, or DBP between the groups at baseline (P > 0.05). During the recovery phase, both groups exhibited significant increases in HR, SBP, and DBP. However, the observation group had significantly lower values for these parameters than the control group (P < 0.05) (Table 3).

Table 3 Comparison of vital signs between groups, mean ± SD.

Indicators		Control group (n = 60)	Observation group (n = 60)
HR (beats/minute)	Before anesthesia	72.15 ± 8.25	72.40 ± 8.45
	During the recovery period	77.55 ± 9.50a	87.30 ± 10.40b
SBP (mmHg)	Before anesthesia	130.85 ± 8.35	131.20 ± 9.00
	During the recovery period	139.55 ± 9.80a	151.55 ± 9.25b
DBP (mmHg)	Before anesthesia	82.45 ± 10.75	81.95 ± 9.60
	During the recovery period	85.65 ± 10.05a	95.40 ± 9.60b

^aP < 0.05 vs pre-anesthesia level.

^bP < 0.05 vs control group.

HR: Heart rate; SBP: Systolic blood pressure; DBP: Diastolic blood pressure.

Comparison of stress response between the groups

There were no significant intergroup differences in Cor, Ald, NE, and AD levels at baseline (P > 0.05). At 24 hours postoperatively, both groups exhibited significant elevations in Cor, Ald, NE, and AD levels. However, the observation group demonstrated significantly lower levels of these biomarkers than the control group (P < 0.05) (Table 4).

Table 4 Comparison of stress response between groups, mean ± SD.

Indicators		Control group (n = 60)	Observation group (n = 60)
Cor (nmol/L)	Before anesthesia	163.47 ± 22.69	163.35 ± 22.79
	24 hours postoperative	210.13 ± 26.40a	184.08 ± 21.50b
Ald (pmol/L)	Before anesthesia	122.33 ± 20.57	123.51 ± 22.41
	24 hours postoperative	175.27 ± 23.13a	150.41 ± 25.05b
NE (ng/mL)	Before anesthesia	186.38 ± 13.53	186.03 ± 13.99
	24 hours postoperative	290.38 ± 13.20a	240.31 ± 12.98b
AD (ng/L)	Before anesthesia	150.33 ± 8.27	152.38 ± 9.00
	24 hours postoperative	260.11 ± 9.11a	198.40 ± 10.17b

^aP < 0.05 vs pre-anesthesia level.

^bP < 0.05 vs control group.

Cor: Cortisol; Ald: Aldosterone; NE: Norepinephrine; AD: Adrenaline.

Comparison of postoperative recovery quality between the groups

The observation group achieved significantly higher scores across all PQRS domains compared with the control group (P < 0.05) (Table 5).

Table 5 Comparison of postoperative recovery quality between groups, mean ± SD.

Categories	Control group (n = 60)	Observation group (n = 60)	t	P value
Cognitive	12.57 ± 1.22	21.30 ± 2.30	21.035	0.000
Activities of daily living	7.14 ± 0.89	10.21 ± 1.11	13.007	0.000
Emotional	6.17 ± 0.84	9.14 ± 1.05	13.277	0.000
Nociceptive	4.27 ± 0.73	7.94 ± 0.98	17.967	0.000
Physiologic	15.54 ± 1.41	25.32 ± 2.33	22.155	0.000

Comparison of complication rates between the groups

The observation group had a significantly lower incidence of complications compared with the control group (P < 0.05) (Table 6).

Table 6 Comparison of complication rates between groups, n (%).

Complications	Control group (n = 60)	Observation group (n = 60)	χ2	P value
Arrhythmia	2 (3.33)	0 (0.00)	-	-
Shivering	3 (5.00)	0 (0.00)	-	-
Hypothermia	9 (15.00)	3 (5.00)	-	-
Emergence agitation	5 (8.33)	2 (3.33)	-	-
Nausea/vomiting	5 (8.33)	1 (1.67)	-	-
Total	24 (40.00)	6 (10.00)	7.853	0.000

DISCUSSION

CRC is one of the top three malignancies globally. It predominantly affects the rectum and colon, with rectal cancer being more prevalent. It manifests as abdominal pain, hematochezia, and altered bowel habits. Lifestyle and dietary differences have been suggested to contribute to a lower incidence of CRC in China compared with Western developed nations. Nonetheless, the incidence and mortality rates have followed an upward trajectory since the 1970s, posing a significant threat to public health[14]. Early detection, diagnosis, and intervention are crucial for enhancing the quality of life in patients with CRC. Laparoscopic CRC radical surgery, a minimally invasive technique, ensures complete lesion excision and effective clearance of adjacent tissues and lymph nodes[15]. General anesthesia, induced via intramuscular, intravenous, or inhalation routes, temporarily suppresses central nervous system functions, resulting in a loss of sensation and consciousness. Postoperatively, the anesthetic agents are metabolized and eliminated, leading to the gradual regaining of sensation and consciousness. However, the inherent risks associated with anesthesia impact recovery outcomes, underscoring the importance of meticulous anesthesia recovery care[16]. Music therapy is known to relax muscles and calm the mind. It also engages the nervous and vestibular systems, facilitating the rehabilitation of related bodily functions[17]. Moreover, it offers multidimensional value across artistic, economic, social, and mental health domains, leveraging its clinical benefits through diverse applications. Despite its potential, research examining the effects of integrating music therapy with anesthesia recovery care for patients with CRC undergoing laparoscopic radical surgery during the anesthesia recovery phase is scarce. This study demonstrates that combining music therapy and anesthesia recovery care improves the quality of anesthesia recovery, stabilizes vital signs, mitigates stress responses, accelerates postoperative recuperation, and reduces complication rates.

Living environments and dietary patterns have substantially changed in recent years, resulting in an annual increase in the risk of digestive tract malignancies. CRC is one of the most common digestive tract malignancies, ranking second among all cancers in terms of mortality rate[18]. With the advent of minimally invasive techniques and continuous technological advancements, laparoscopic surgery has been extensively adopted in clinical treatment. However, it necessitates general anesthesia, which may trigger emergence agitation during the recovery phase. Such agitation elevates oxygen consumption, reduces cardiac blood and oxygen supply, and slows the metabolism of anesthetic agents, potentially leading to delayed recovery[19]. Gökçek and Kaydu[20] demonstrated that administering music therapy to patients undergoing septoplasty under general anesthesia significantly reduced sedation agitation scores. In the present study, compared with the control group, the observation group exhibited a markedly shorter time to regain consciousness, extubation time, and length of PACU stay along with a significantly reduced complication rate, such as shivering, hypothermia, and emergence agitation. These findings closely align with those of Gökçek and Kaydu[20], suggesting that integrating music therapy with anesthesia recovery care improves the quality of anesthesia recovery in patients with CRC undergoing laparoscopic radical surgery. This improvement is attributed to the fact that music therapy, a well-established modern discipline originating in the middle-20^th century, utilizes music as an external stimulus to synchronize musical rhythms, psychological states, and muscle activity within a therapeutic framework. Such synchronization stimulates motor potential and promotes physical and mental relaxation[21]. Because the auditory and pain perception centers in the cerebral cortex are anatomically adjacent, harnessing music’s artistic and aesthetic properties stimulates the auditory function of the brain, which, to some extent, inhibits the adjacent pain perception center, reducing the occurrence of related adverse events[22]. This finding also underscores the economic viability of music therapy, demonstrating its capacity to indirectly reduce healthcare costs by mitigating complication risks. The advancement of modern medical models has led to the recent embrace of anesthesia care recovery in clinical practice. This patient-centered approach delivers personalized nursing services throughout the perioperative period, mitigating the adverse effects of anesthetic agents on the body, significantly enhancing recovery quality during anesthesia emergence, and expediting the overall postoperative recovery process. Consequently, it has been widely adopted in perioperative nursing for surgical interventions. A key benefit of anesthesia recovery care is its remarkable ability to alleviate postoperative pain. This is achieved through a two-pronged approach. First, patients are proactively informed about potential adverse events that may occur during the recovery period. Second, appropriate sedative and analgesic medications are administered rationally and promptly after surgery. This deepens patients’ understanding of the recovery process, mentally preparing them for what lies ahead, and substantially reduces the intensity of pain stimuli. Consequently, patients are better equipped to manage their expectations, thereby minimizing physiological and psychological fluctuations, ultimately leading to a notable reduction in the incidence of adverse events[23]. The integration of music therapy with anesthesia recovery care yields synergistic benefits. Anesthesia recovery care offers a comprehensive suite of care services, including in-depth health education, empathetic psychological counseling, meticulous thermal management, proper positional adjustments, judicious administration of sedative and analgesic drugs, and attentive respiratory care during the preoperative, intraoperative, and postoperative stages. The simultaneous administration of music therapy alleviates the negative impacts of anesthetics by influencing the auditory and pain centers and diverting patients’ attention. This holistic approach significantly improves the quality of anesthesia recovery, substantially curtailing the likelihood of adverse events, thereby contributing to more favorable surgical outcomes.

Owing to the dual impact of surgical and anesthetic stress on internal organs and pre-existing psychological vulnerabilities, patients undergoing laparoscopic radical surgery are particularly susceptible to complications, such as emergence agitation and hypothermia during anesthesia recovery. These complications lead to elevated hormone levels and increased HR and blood pressure, triggering stress responses and compromising patients’ ability to tolerate and cope with anesthesia and surgical procedures[24,25]. Kaur et al[26] demonstrated that music therapy stabilizes hemodynamics in patients undergoing orthopedic surgery under spinal anesthesia. Similarly, Xiao et al[27] revealed that patients who listened to soothing music during tension-free hernia repair showed markedly reduced Cor levels compared with those under standard management. In the present study, we observed increased HR, SBP, and DBP during the recovery period and elevated Cor, Ald, NE, and AD levels 24 h after surgery in both groups. However, the observation group, which received a combination of music therapy and anesthesia recovery care, demonstrated a more favorable profile in terms of vital signs, stress response indices, and PQRS scores than the control group. This indicates that combination therapy offers a comparatively superior anesthesia experience for patients with CRC undergoing laparoscopic radical surgery. Our findings align with those of Kaur et al[26] and Xiao et al[27], suggesting that integrating music therapy with anesthesia recovery care stabilizes vital signs, reduces stress responses, and improves postoperative recovery in patients with CRC undergoing laparoscopic radical surgery. The therapeutic benefits of this approach can be attributed to several factors. Music is a unique and powerful form of communication that exerts multifaceted psychological effects on the body, alleviating excessive sympathetic nervous activity, calming emotions, reducing stress responses, and aiding in partially reducing distress, thus indirectly supporting higher patient adherence[28]. Furthermore, music evokes memories, regulates emotions, and exerts therapeutic and physiological-modulating properties. Beyond its therapeutic effects, music therapy fosters social and cultural benefits by cultivating a sense of belonging, shared experiences, and common values among patients. By creating common ground for deeper connections, it helps patients shift their focus away from illness- and treatment-related distress and build meaningful interpersonal engagement. Moreover, it interacts with multiple physiological systems, including the endocrine, circulatory, and respiratory systems, promoting homeostasis characterized by the absence of anxiety and pain and the presence of overall physical and mental well-being. This further demonstrates how music therapy modulates physiological processes to promote mental well-being, which, in turn, mitigates adverse clinical manifestations and negative emotional states, contributing to a more positive recovery experience[29]. The integration of music therapy with anesthesia recovery care has been effectively implemented for orthopedic surgery patients and perioperative breast cancer patients, yielding significant improvements in postoperative pain management and anxiety. Notably, in patients with breast cancer, this combined approach also suppressed serum inflammatory responses[30,31]. Similarly, we hypothesize that this combination therapy may improve clinical outcomes for patients with CRC undergoing comprehensive treatment and pharmacotherapy. However, this potential application requires further empirical validation through rigorous clinical investigations.

Anesthesia recovery care is a specialized and patient-centered approach tailored to the specific needs of anesthetized patients. This comprehensive care model provides a range of interventions, including analgesic management, psychological counseling, comfort-oriented care, continuous vital sign monitoring, and proactive prevention and treatment of adverse reactions, effectively minimizing the incidence of pain-induced, hypoxia-associated, and blood pressure–related agitation, thereby facilitating a smoother and more efficient postoperative recovery process[32].

The music intervention equipment used in this study comprised medical noise-canceling headphones and a portable player. With an affordable price below 2000 yuan per set, it is particularly suitable for primary-level hospitals. Additionally, the combined nursing protocol can be quickly mastered by nursing staff through standardized training (8 hours of theoretical instruction and 4 hours of practical training), as evidenced by a training qualification rate exceeding 95% in our pilot study. To optimize patient acceptance and facilitate the broad application of this combined nursing protocol, we recommend adopting a tiered implementation strategy according to the hospital type. In tertiary hospitals, it is recommended to set up specialized music therapy teams equipped with integrated biofeedback systems. In secondary hospitals, we suggest having anesthesia nurses take the leadership role, using a simplified music library containing three genres with five tracks each. In primary hospitals, implementing natural sound applications would be the most beneficial. Furthermore, to improve regional applicability, we propose developing region-specific music libraries. For instance, adding morin khuur (horsehead fiddle) tracks would increase cultural relevance for Northwest Chinese patients. Additionally, for patients in ethnic minorities, creating bilingual instructional voiceovers can provide valuable dialect support. Several operational hurdles may arise with this protocol, including patient skepticism due to low trust in this combined nursing approach and staff concerns regarding increased workload and doubts regarding treatment efficacy. Upkeep expenses for equipment may also hinder the popularization of this therapy. After a thorough evaluation, we recommend enhancing patient acceptance through preoperative educational videos and integrating headphone sterilization and maintenance procedures into existing medical device management protocols. These measures and interventions are expected to effectively mitigate the identified challenges without compromising protocol effectiveness.

However, several limitations of this study warrant consideration. First, the relatively small sample size might have introduced bias, potentially leading to discrepancies between the observed results and actual clinical outcomes. Second, the lack of long-term follow-up hinders the evaluation of the continued efficacy of combined music therapy and anesthesia recovery care in CRC patients. Hence, future studies should incorporate larger sample sizes and extended follow-up assessments to validate and further explore our findings.

CONCLUSION

Music therapy in combination with anesthesia recovery care demonstrates significant clinical benefits in enhancing anesthesia recovery for CRC patients following laparoscopic radical surgery. It effectively enhances vital sign stability, alleviates stress responses, improves postoperative recovery quality, and lowers complication risks. These findings highlight the clinical utility of this integrated approach, making it a promising strategy worthy of broader adoption and further investigation in surgical care.