The Effect of Binaural Sound on the Occurrence of Emergence Delirium in Children Undergoing Strabismus Surgery: A Randomized Controlled Trial

BACKGROUND: Binaural beats, which induce brainwave entrainment, have reduced anxiety and sedative use. This study evaluated the effect of binaural beats on emergence delirium (ED) in children undergoing strabismus surgery under general anesthesia. METHODS: This randomized controlled trial included 73 pediatric patients aged 2-7 years receiving binaural beats (n = 36) or noise-canceled silence (n = 37) during general anesthesia. ED was defined as a Pediatric Anesthesia Emergence Delirium (PAED) score > 12 or Watcha score > 2. Primary outcome was the incidence of ED. Secondary outcomes included PAED, Watcha, and Faces Legs Activity Cry Consolability (FLACC) scores in the postanesthesia care unit (PACU), intraoperative electroencephalogram band power differences, and PACU stay duration. RESULTS: The incidence of ED did not significantly differ between groups (38.89% vs. 54.05%; relative risk 1.39 [95% confidence interval (CI), 0.84-2.31]; p = 0.287). However, PAED scores at PACU arrival, at 20 min, and the highest score during PACU stay were significantly lower in the binaural group (median difference -1 [95% CI, -3 to 0]; p = 0.026 at arrival; -4 [95% CI, -4 to 0]; p = 0.035 at 20 min; -1 [95% CI, -3 to 0]; p = 0.048 for the highest score). Watcha and FLACC scores, band powers, and PACU stay duration did not differ significantly between groups. CONCLUSIONS: Binaural beat application during general anesthesia did not significantly reduce the incidence of ED. Exploratory analyses suggested a reduction in maximum PAED score, but this requires further study. TRIAL REGISTRATION: NCT05883280 (registered at http://clinicaltrials.gov (registration number, principal investigator: Jeong-Hwa Seo, registration date: May 22, 2023)).