The Choices and Challenges Associated with Music in the Operating Room

Erin Sherer, Ed.D, PA-C, RD

AASPA President Elect


Article originally printed in Sutureline: Sep/Oct 2015 p. 16

 

Working in any hospital environment can be stressful, but the operating room carries with it a special mix of chaos and quiet. Practitioners (and, honestly, all of us) spend a good deal of time searching for ways to still the storm and regain some control over the environment around us. A traditional means has been the use of music—indeed, of all kinds—to calm nerves. The operating room is no exception, and many surgeons use music in the operating room to help them focus at the task at hand. And while this practice is well represented in movies and on television, many operating rooms are now actually equipped with docking stations and surround sound symptoms that encourage the incorporation of music into procedures.


While current data suggests music is played during surgery 53% to 72% of the time worldwide,1 you might be surprised to learn that listening to music during medical procedures has been common practice for millennia. According to one article in the British Medical Journal, harp playing priests and other musicians have accompanied medicinal procedures as early as 4000 BC.2  More (relatively) recently, another report published in the early 1900s by an American surgeon reported that using the phonograph in the operating room provided a means of calming and distracting the patient from the horror of the situation.3


While the days of harp playing priests and phonographs are behind us, the calming effects of present-day stereo systems work for both operating room staff as well as for patients.4  For those cases that involve long operating room hours, music can put less pressure on those practitioners working alongside one another to participate in “small talk” and can allow them to just focus on what they are doing. One study went so far as to suggest that relaxing music played at a beat of approximately 60-80 beats per minute was more calming to patients than receiving the pre-anxiolytic medication midazolam.5


Another recent study, however, suggested that music played during surgery could be a potential safety hazard instead.1  That study, published in the Journal of Advanced Nursing, concluded that listening to music during surgery (and curtailing small talk) could interfere with team communication. In the study, which was performed in the United Kingdom, video recordings from 20 different surgeries were reviewed. Researchers found that when music was playing, operating room staff had difficulty hearing one another. Requests for instruments were five times more likely to be repeated in the surgeries that had music in the background. The researchers suggested that this could lead to both an increased length of surgery as well as heightened tensions among operating room staff members due to frustration associated with ineffective communication. Based on their study, they found that each repeated request could add from 4 to 68 seconds to the total operation time.


Authors in the study also found that (perhaps unsurprisingly) the surgeon selected the music the majority of the time. While the surgeon may be performing the most complex portion of the procedure, if the other staff in the room have little to no voice in even this type of decision, that lack of control or perceived respect can add additional tension to an already stressful environment. And while some may perceive music as a pleasant addition to the operating room, not everyone on the team may feel this way. Data suggest that in particular, nurses found music to be distracting.2


The World Health Organization (WHO) recommends that noise levels in the operating room should not exceed 30 decibels.6  Recent studies indicate that between music, machine noises, chatter, and instruments in the operating room, decibel levels are often much higher than that.7  But while the use of music in the operating room may increases the overall volume of the environment, there will always be background noise in the operating room; used judiciously and with an eye towards overall volume, the use of music can sometimes help mask some of the mechanical sounds that would otherwise be disruptive.


As music in the operating room is a common practice that has been in place for thousands of years, it is unlikely that this single study will change anything in the immediate future. However, it does indicate a need for further research to explore the impact on length of surgeries and any adverse effects that could be associated to the use of operating room music.

 

References:

  1. Weldon S-M., Korkiakangas T., Bezemer J. & Kneebone R. (2015) Music and communication in the operating theatre. Journal of Advanced Nursing 00(0), 000–000. doi: 10.1111/jan.12744
  2. Bosanquet D, et al. Making Music in the Operating Theatre. BMJ British medical journal (Impact Factor: 16.3). 12/2014; 349(1):7436. DOI: 10.1136/bmj.g7436
  3. Kane E. (1914) Phonograph in operating-room. Journal of the American Medical Association 62(23), 1829.
  4. Ullmann Y., Fodor L., Schwarzberg I., Carmi N., Ullmann A. & Ramon Y. (2008) The sounds of music in the operating room. Injury 39,592–597.
  5. Bringman H, Giesecke K, Thorne A, Bringman S. Relaxing Music as pre-medication before surgery:a randomised controlled trial. Acta Anaesthesiol Scand 2009;53:759-64.
  6. Concha-Barrientos M., Campbell-Lendrum D. & Steenland K. (2004) Occupational Noise: Assessing the Burden of Disease from Work-related Hearing Impairment at National and Local Levels. WHO Environmental Burden of Disease Series. World Health Organisation, Geneva.
  7. Way J.T., Long A., Weihing J., Ritchie R., Jones R., Bush M. & Shinn J.B. (2013) Effect of Noise on Auditory Processing in the Operating Room. The American College of Surgeons 216, 933–938.
  8. Gregoire, C. Why Surgeons Listen To Music In The Operating Room -- And How It Could Help You. Accessed online on August 20, 2015 at: http://www.huffingtonpost.com/2014/12/11/music-surgery_n_6310842.html