Personalized Music, Dreaming During Propofol Sedation

Dreaming during intravenous propofol sedation is common and may influence how patients remember their perioperative experience. External auditory stimulation can sometimes be processed during sedation and may be incorporated into dream content. Music is a practical auditory intervention because it can be delivered through headphones without interfering with anesthetic care or the surgical workflow. However, it remains unclear whether music itself increases dream recall during propofol sedation, and whether patient-selected music provides additional benefit beyond exposure to music with similar acoustic features.

The modified Brice interview will be administered as soon as the participant has adequately recovered consciousness and is able to communicate in the PACU. Because dream recall may fade over time, the interview will be conducted at the earliest feasible time point after recovery of consciousness and no later than 60 minutes after PACU arrival.

This single-center, parallel-group, three-arm randomized controlled trial will compare three auditory conditions during propofol sedation: preferred music, matched non-preferred music, and silence. Participants assigned to the preferred music group will listen to one personally selected track through closed-back headphones. Participants assigned to the matched non-preferred music group will listen to a pleasant but non-selected track matched to the preferred music by genre family, tempo, and loudness. Participants assigned to the silence control group will wear identical closed-back headphones without music playback. In all groups, the assigned auditory condition will begin shortly before sedative administration and continue until the end of the sedation period.

The study population will consist of adults undergoing elective procedures under spinal anesthesia or peripheral nerve block with intravenous propofol sedation. Propofol sedation will be administered according to a standardized protocol and titrated to a predefined sedation depth using clinical sedation scales, with processed electroencephalographic monitoring recorded when available. Standard intraoperative monitoring will be performed according to institutional anesthetic practice.

The study has two main comparisons. First, the two music groups will be pooled and compared with the silence group to assess whether auditory stimulation increases dream recall. Second, the preferred music group will be compared with the matched non-preferred music group to assess whether personalization improves dream pleasantness among participants who recall dreams. Dream recall and dream pleasantness will be assessed in the post-anesthesia care unit using a standardized, neutral interview after participants meet predefined recovery-readiness criteria.

Additional assessments will include coded dream content, auditory salience, emotional valence, vividness, perceived control within the dream, patient satisfaction, propofol dose, opioid use, hemodynamic variability, recovery time, postoperative pain, postoperative nausea and vomiting, and adverse events. Dream narratives will be coded by blinded assessors using a prespecified codebook. Outcome assessors, content coders, and statisticians will remain blinded to group allocation whenever feasible.

The overall aim is to determine whether structured headphone-based music, particularly patient-preferred music, can improve the subjective quality of propofol sedation while maintaining clinical safety. The findings may inform whether routine music delivery and optional music preference capture should be incorporated into perioperative sedation workflows.

Inclusion criteria

• Adults aged 19 years or older.
• Scheduled to undergo an elective procedure under spinal anesthesia or peripheral nerve block with intravenous propofol sedation.
• American Society of Anesthesiologists physical status I to III.
• Able to provide written informed consent.
• Able to wear closed-back headphones during the study period.
• Able to complete postoperative interviews and study questionnaires.

Exclusion criteria

• Planned general anesthesia.
• Severe hearing impairment that would interfere with the auditory intervention.
• Major psychiatric instability or condition that may interfere with study participation or dream assessment.
• Expected significant intraoperative bleeding.
• Inability to complete the required postoperative interviews or questionnaires.
• Contraindication to propofol or other study sedative agents.
• Refusal or withdrawal of informed consent.