A substantial body of evidence indicates that a significant proportion of patients undergoing general surgery experience anxiety. 1, 2, 3 Preoperative anxiety can arise from various factors, such as concerns about surgical outcomes, fear of the procedure itself, apprehension regarding loss of independence, and fear of mortality.4,5 Anxiety has far-reaching negative consequences, including compromised immune function, delayed wound healing, prolonged hospitalization,6 diminished patient satisfaction,7 and increased healthcare costs.8 Fortunately, anxiety is a treatable and preventable condition.9 While benzodiazepines are commonly employed for anxiety management due to their efficacy,10 their short duration of action and associated side effects, such as hypotension, respiratory depression, nausea, drowsiness, and allergic reactions, have limited their utility.11,12

Recently, complementary and alternative therapies have garnered attention as relatively effective, safe, non-invasive, and cost-efficient approaches.10,11 Various complementary and alternative therapies have been explored, including acupuncture, acupressure, yoga, homeopathy, aromatherapy, music therapy, reflexology, and chiropractic.13, 14, 15 Among these modalities, aromatherapy and music therapy have gained popularity for their sedative effects.8,16 Aromatherapy is a widely utilized complementary and alternative therapy.5,17 This non-invasive and cost-effective approach involves the application of essential oils extracted from medicinal plants.18 Among these plants, rosemary (Salvia Rosmarinus Schleid) is a commonly employed herb in aromatherapy.20 It belongs to the Lamiaceae family, commonly known as the mint family, and is indigenous to the Mediterranean region.21 Rosemary essential oil comprises more than 16 compounds, including camphor, cineole, alpha-pinene, camphene, and α-terpineol.22 The Food and Drug Administration (FDA) has classified rosemary as generally safe.23 The anxiolytic properties of rosemary essential oil can be attributed to the presence of monoterpenes,24 such as 1,8-Cineole, which has demonstrated anxiolytic effects in human studies.25 1,8-Cineole is thought to reduce anxiety by interacting with the benzodiazepine site of the GABAA receptor.26

Music therapy is another modality within the realm of complementary and alternative medicine that offers a safe and cost-effective approach to alleviate anxiety in surgical patients.27, 28, 29, 30, 31 Music exerts its anxiety-reducing effects by facilitating endorphin secretion and diminishing amygdala activity.30, 31 Moreover, music induces relaxation by suppressing the sympathetic system while activating the parasympathetic system.28

Numerous studies have explored the impact of music therapy and aromatherapy on anxiety levels in surgical patients, yielding varying outcomes. Some studies have reported equivalent efficacy between music therapy and aromatherapy.29,32 Conversely, one study found aromatherapy to be more effective than music therapy,8 while another study indicated a greater impact of music therapy compared to aromatherapy.33,34 However, a study demonstrated that the simultaneous use of aromatherapy and music therapy did not effectively reduce anxiety,16 and another study suggested that aromatherapy had no discernible effect on anxiety.35

Rosemary has a rich historical background in traditional medicine, but recent studies have begun exploring its potential role in modern medicine.36 In light of the inconsistent findings reported in previous studies and the limitations inherent in their methodologies, this present study aims to fill the gap in the literature by examining the effects of aromatherapy, music therapy, and their combination on anxiety levels among patients undergoing general surgery. Specifically, this study seeks to address the following research questions: (1) What is the impact of aromatherapy on anxiety levels in general surgery patients? (2) What is the influence of music therapy on anxiety levels in general surgery patients? and (3) What is the effect of combined aromatherapy and music therapy on anxiety levels in general surgery patients?