Influence of Environment and Noise on Anesthesia Emergence

Emergence from general anesthesia is a complex transition from unconsciousness to wakefulness. During this period, patients gradually regain awareness and begin to respond to what is happening around them. The environment can influence this process. Noise, unfamiliar voices, and other forms of stimulation may be difficult to interpret while the brain is still recovering from anesthesia. In some patients, this may contribute to confusion or agitation. A calm environment with low noise levels and clear and reassuring communication may help support smoother anesthesia emergence.

Noise is a common source of stimulation in the perioperative setting. Operating rooms (ORs) and recovery areas are filled with monitor alarms, equipment sounds, and staff conversations. For a patient emerging from anesthesia, this background noise may be difficult to process and can add to an already disorienting experience. Excessive noise may also increase physiologic stress. Li et al. examined the effects of operating room noise in orthopedic surgical patients and found that reducing noise was associated with lower anxiety and pain. Patients also had lower heart rates and reduced stress hormone levels (1). Although the study did not focus specifically on emergence from general anesthesia, it suggests that noise in the OR environment can affect both psychological and physiologic stress during the perioperative period.

The type of sound a patient hears may be just as important as the overall noise level. During emergence, clear verbal cues can help patients regain orientation as consciousness returns. Lee et al. studied adults recovering from general anesthesia after minimally invasive abdominal surgery. Patients who repeatedly heard reminders about their identity and surroundings had significantly less emergence agitation than those who heard only their names (2). These findings suggest that a quiet environment is not necessarily the same as an orienting one. Reducing unnecessary noise while preserving calm and meaningful communication may contribute to a less disorienting emergence.

Music has been hypothesized to be able to influence patient stress and anxiety while under anesthesia. Fu et al. studied patients who listened to classical music through noise-cancelling headphones while under general anesthesia. Ultimately, the intervention did not significantly improve postoperative pain or reduce the need for pain medication. Other measures of recovery were also similar between the music and control groups (3). These findings suggest that reducing environmental noise and replacing it with pleasant sound does not necessarily lead to better postoperative outcomes. They also highlight that the effect of sound may depend on when it is introduced and whether the patient is able to process it. In this context, meaningful communication during emergence may have a different effect than music played while the patient remains unconscious.

The influence of the sensory environment may be particularly important in children, who can be more susceptible to agitation during anesthesia emergence. Nonpharmacologic approaches have explored whether familiar and calming forms of stimulation can make recovery less distressing. Some studies have reported benefits from interventions that use familiar voices or other forms of sensory support, although the findings have not been consistent across all pediatric populations (4).

Anesthesia emergence should be viewed as both a pharmacologic and sensory process in which the surrounding environment can hinder or help a patient's recovery of awareness and orientation. Reducing unnecessary noise while emphasizing calm verbal communication may create a smoother transition from unconsciousness to awareness. These measures are relatively simple, require no additional medication, and should be used alongside effective pain control, appropriate anesthetic management, and careful observation during early recovery.

References

Li M, Xu A, Chen B. Effects of Operating Room Noise on Anxiety and Pain in Non-General Anaesthesia Orthopaedic Surgery under Seamless Care and Diversified Health Education. Noise Health. 2025;27(127):446-457. doi:10.4103/nah.nah_28_25
Lee S, Sohn JY, Hwang IE, et al. Effect of a repeated verbal reminder of orientation on emergence agitation after general anaesthesia for minimally invasive abdominal surgery: a randomised controlled trial. Br J Anaesth. 2023;130(4):439-445. doi:10.1016/j.bja.2022.12.009
Fu VX, Lagarde SM, Favoccia CT, et al. Intraoperative Music to Promote Patient Outcome (IMPROMPTU): A Double-Blind Randomized Controlled Trial. J Surg Res. 2024;296:291-301. doi:10.1016/j.jss.2024.01.006
Prandeh Afshar P, Dehghan F, Ali ESA, Alnaiem M, Dehghan M. Nonpharmacological Interventions to Prevent Postoperative Delirium and Agitation Among Children: A Systematic Review. J Perianesth Nurs. 2026;41(4):1069-1079. doi:10.1016/j.jopan.2025.12.011