Music is part of our lives and can make us feel different emotions. It can make us feel happy, sad, courageous, depressed, unstoppable, chained, free, and so on. Music is a good way to transmit ideas (and a reason for being arrested), set people free, start a revolution, and change a government. Music has unlimited powers.
In medicine, there are some effects we can get from music. Music can increase patients' threshold of pain and reduce anxiety. Some say that the anxiolytic effect that music has on a patient is higher than orally administered midazolam. Music can also prevent patients from getting stress-induced tachycardia and high blood pressure. On the other hand, how about music in the operating room? What is the effect music has on the surgeon and his performance?
The effect of music in the operating room is not unanimous. Some defend music as relaxing and improving performance, while others say it is distracting. I believe it may be a personal option, but some effects it has on our body are not optional. I found a systematic review published in 2020 in the International Journal of Surgery by Michael El Boghdady et al. from the UK trying to answer some questions about playing music in the operating room.
What are the positive effects of playing music in the operating room?
Listening to classical music was associated with an increase in surgical memory consolidation and improvement in the performance of a surgical task - Mozart Effect
Laparoscopic training tasks were improved with music
Authors state that "the Mozart effect is debated as a momentary positive effect of cognitive improvement on surgical performance in forms of decreased anxiety and stress, increased speed and accuracy, as well as improved acquisition of technical skills of novice surgeons"
Note that these results were found in a small number of high-quality publications, and some ideas were found for plastic surgery
What are the negative effects of playing music in the operating room?
It is associated with hard communication with a significantly higher number of repeated requests during surgery, leading to increased tension and anxiety due to unproductive communication (91% of repeated requests occurred in operating rooms with music on)
Associated with increased operation time
Noise volume during surgery is associated with surgical site infection (SSI), probably because of the lack of concentration during surgery
Does the type of music influence the effect it has on the surgical team?
These effects were noted with classical, calm, slow, and low-volume music
Rock music increases heart rate; Heavy-metal music or techno-sounds can cause stress and/or life-threatening arrhythmia; Techno-sounds promote changes in the neuroendocrine system of subjects, and fast music activates the noradrenergic system more than slow and calm music.
Dr. Michael El Boghdady et al. conclude that the positive effect of music in the operation room overrides the negative effects. However, they present to the readers some ideas I believe are crucial for our decision about playing music while doing surgical tasks.
The World Health Organization (WHO) recommends that a 30dB noise level should not be exceeded in the operating room. Having in mind that a normal conversation has 50-65 dB, we can conclude that the WHO recommends a quiet environment in the operation room. Well... in my daily practice in Portugal, it is hard to have a quiet environment while doing surgery, so it is necessary to ask for silence sometimes. Noise causes misunderstandings and bad communication between the surgical team members, the anesthesiologist, and the entire operation room staff. This lack of communication causes frustration, and consequently, all staff raise their voices to be heard, and the noise level in the operation room increases. As the authors state, music can be a reason for this. Surgeons must not forget that miscommunication is one of the most common causes of medical errors, and it must be considered when playing music in the operating room. Can music and medical errors have medico-legal implications? I believe it is hard to answer, and it depends on the type of music as well as the volume.
A final idea shared by the authors and that I would like to leave you is that "more musically educated persons are more selective in their music taste and do not like background music." Unwanted music becomes noise and, in consequence, increases blood pressure and causes anxiety. That is why, if music is to be played in the operating room, the surgeon must be the only music chooser. If the surgeon prefers no music, the entire operating room must accept and respect that desire.
Remember: if you prefer music in the operating room, calm, slow, and classical music should be the only ones to be played so that the Mozart Effect of music can arise. Is this the music you hear in the operating room? That is not my experience while assisting other surgeons...
After reading Micheal El Boghdady et al. work, I will keep my preference of doing surgery without music and with the most silence possible. Maximum concentration and good communication are sacred while doing surgery.
Link to article:
Dr. Carlos Eduardo Costa Almeida
General Surgeon
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