AimsTransoesophageal echocardiography (TEE) is widely used for cardiac assessment and requires moderate sedation due to its semi-invasive nature, carrying potential risks. Music is a non-pharmacological strategy shown to reduce anxiety in various clinical settings. We prospectively investigated whether music could reduce anxiety and/or sedation dosage in patients undergoing TEE.Methods and resultsSixty-three patients (>18 years) referred for TEE were randomized into a music group (n = 31) or control group (n = 32). All completed an anxiety questionnaire and had haemodynamic parameters (blood pressure, heart rate, oxygen saturation) assessed prior to transthoracic echocardiography (TTE). Music was played before TTE and continued throughout TEE in the intervention group. Anxiety and haemodynamic measurements were repeated after TTE, before sedation. Groups were compared for baseline characteristics, anxiety levels, haemodynamic changes, and midazolam dosage. There was no difference between the groups regarding age or sex; control group had more comorbidities. Anxiety levels did not differ between groups at baseline or pre-sedation (P > 0.05). A significant reduction over time was observed only in the music group (P = 0.032 vs. P = 0.069), but group-by-time interaction was not significant (P = 0.347). Regarding anxiety level, it decreased in both groups, more markedly in the music group (P < 0.008 vs. P = 0.04). Diastolic blood pressure also decreased after music exposure (P = 0.024). Midazolam dosage did not differ between groups but was inversely correlated with age.ConclusionAlthough music did not reduce sedation requirements, it significantly decreased anxiety levels and blood pressure; music may be a valuable adjunct to sedation in patients undergoing TEE.