Preoperative binaural beats reduce remimazolam dosage and enhance safety in anaesthesia induction: a randomised controlled trial

Abstract Background: Binaural beats, a form of auditory stimulation, reduce anxiety and anaesthetic requirements through brainwave entrainment. Remimazolam offers advantages in terms of rapid onset and offset of action and hemodynamic stability. However, the optimal remimazolam dose for anaesthesia induction remains unclear and there are concerns regarding variability in response and potential side effects at higher doses. This study investigated the effects of preoperative binaural beats on the remimazolam dose required for loss of consciousness (LoC) during general anaesthesia induction. Methods: In this randomised, prospective, single centre study, 72 patients undergoing general anaesthesia were allocated to two groups: the binaural sound (B group) or the control group. The B group listened to binaural sounds (1-Hz frequency difference) for 30 min preoperatively, while the control group did not. Results: The B group required a significantly lower remimazolam dose for LoC (15.0 ± 3.6 vs. 17.7 ± 4.5 mg, P=0.006) and achieved LoC faster (140 ± 29 vs. 168 ± 47 s, P=0.003) than the control group. The incidence of hypotension was lower in the B group than in the control group (6 vs. 28%, P=0.024). Electroencephalography spectral analysis revealed no significant between-group differences. Conclusion: Binaural beats significantly reduced the remimazolam dose required for LoC and shortened the time to LoC, while reducing the incidence of hypotension during anaesthesia induction. Binaural beats are an effective, non-invasive method of enhancing efficiency and safety in anaesthesia induction when using remimazolam infusion. Trial Registration: This study was registered at ClinicalTrials.gov (NCT06099977; November 1, 2023).