Spinning Medical Records
The benefits of intraoperative music for both surgeons and patients
The fact that hospitals and medical arenas harbor stress for both medical professionals and
patients alike is not a novel concept. Doctors and nurses often work long shifts with minimal
sleep, performing procedures that countless hours of schooling and training have qualified them
for; and patients may spend anywhere from a few hours to a few weeks surrounded by unfamiliar
faces, awaiting procedures and test results, many of which have uncertain, but critical outcomes.
In order to reduce the stress associated with medical environments, hospitals have recently
turned to the use of alternative therapy treatments including therapy dogs, massage therapists,
and meditation rooms for patients and staff. A therapeutic intervention that is not so novel,
however, is the use of music to ameliorate patients’ anxiety and pain both before and after
medical procedures. Surgeon Evan O’neill Kane, who first introduced music as medical therapy
in 1914, would play it via a phonograph in the operating room before anesthetizing his patients.
Kane believed the music had a calming effect, and was more effective than simply talking to his
patients before the procedure (Moore, 2011). Today, many doctors still hold this same opinion
(****this statement is a little too general); in a recent article published by Akron Children’s
Hospital (Akron, Ohio), Music in the OR: What Music Does your Surgeon Listen to?, Dr. Ananth
Murphy, director of pediatric plastic surgery, stated, “Listening to music in the operating room
keeps the stress level low and everyone is in a good mood.” (Schueler, 2014).
While much evidence exists about the therapeutic benefits of music for the patient both preoperatively and post-operatively, less research has been done regarding the benefits of music for
surgeons and patients during surgery. The studies that have been conducted however, suggest
that music has a significantly larger physiological benefit than simply “relieving stress” as Dr.
Ananth Murphy speculated. For the surgeon, listening to music while operating can both
increase surgical performance, and lower vital signs; and for the patient, music during surgery
causes a decrease in sedative requirements while under anesthesia, as well as a decrease in vital
signs. The idea that music in the operating room is beneficial to both the patient and the surgeon
is of great importance as it is both parties that contribute to the health and healing of the patient
(*** confusing – consider rewording this sentence).
Music and The Surgeon
For surgeons, music has been shown to reduce autonomic responses both during a stressinducing serial number task, and robot assisted laparoscopic surgery.
The stress inducing serial number task was employed as a stressor under the presumption that
performing surgery is also a meticulous, stress-inducing task that requires a great deal of
cognitive function (Allen & Blascovich, 1994). In the task, fifty male surgeons who regularly
listen to music in the operating room, were asked to count backwards aloud in increments of
thirteen from a specified five digit starting value (ex. 45683, 45670, 45657….). The music was
varied between subjects such that each surgeon performed the task three separate times: once
with no music, once with investigator-selected music, and once with self-selected music. All
autonomic responses - skin conductance, diastolic and systolic blood pressures, and pulse - were
taken before (***before what? before surgery?), and two minutes prior to the serial number task
(Allen & Blascovich, 1994). The presence of music, either self-selected or investigator selected
led to a decrease in all measured autonomic responses; further, all autonomic responses were the
lowest when the music was self-selected by the surgeon, than when the music was selected by
the investigator (Allen & Blascovich, 1994). The surgeons’ speed and accuracy on the serial
number task was also measured in all three conditions, producing the same trend in results as the
measured autonomic responses. The surgeons performed the task more quickly (***is there a
percentage available to represent how many surgeons performed the task more quickly?), and
with a greater degree of accuracy in both music conditions compared to the condition with no
music at all; and again speed and accuracy were the best in the self-selected music condition
(Allen & Blascovich, 1994).
The implications of the study are twofold. Not only does it suggest that during a stressful task
surgeons are more relaxed physiologically when listening to music as compared to silence, but it
also suggests that this greater sense of relaxation promotes speed and accuracy of the task. It is
not merely the presence of music of any kind, however, that induces these changes. The type of
music being played is also an important consideration in that self-selected music yielded the best
results. Thus, the most optimal condition for performing a surgical procedure would be in an
operating room with music that the surgeons themselves selected. Nonetheless, it cannot be
assumed that the stress involved in performing a serial number task and that involved in
performing an actual surgery are comparable; for one, surgery confers a much larger risk for
inaccuracy than does a serial number task, and it could be argued that the serial number task is
solely a measure of cognitive ability, whereas surgery involves a great deal of fine motor ability
as well.
In accordance with this previous research suggesting that music can enhance surgeons’
performance, Siu et al, conducted a study on the effects of music during an actual robot-assisted
laparoscopic surgery. Four types of music – jazz, classical, hip-hop, or Jamaican – were played
based on the surgeons’ personal preferences while they performed two surgical tasks. The first
task, suture tying, required tying two intracorporeal knots with a surgical suture; and the second
task, mesh alignment, required surgeons to gently manipulate mesh and align it on a platform
(Siu et al, 2010). In this case, physiological responses were not measured, but the time of task
completion, the total distance traveled by the surgeon’s hand, and muscle fatigue was recorded.
Once again, the tasks were both completed more quickly when music was played, and the total
distance traveled by the surgeon’s hand was also less in the presence of music. Interestingly, less
muscle effort, which therefore led to a reduction in muscle fatigue, was also recorded in the
hands of the surgeon in the music condition (***how was muscle efforts/fatigue measured?) (Siu
et al, 2010). This difference, however, was again prevalent only if the music selected was of
preference to the surgeon; if the music was not of the surgeon’s liking, its effects were
diminished (Siu et al, 2010).
This study demonstrates that the presence of music in the operating room can lead to an increase
in surgical performance by three measures: reduced muscle fatigue, total task time, and distance
traveled by the surgeon’s hand. It is unlikely that music directly influenced muscle fatigue, but
more likely that it contributed to a reduction in the total task time, and that the distance traveled
by the surgeon’s hand led to a decrease in fatigue.
The health of the patient, though, is not solely based on the performance of the surgeon alone.
Although often under anesthetics, the patient plays a vital role in the success of a surgery, and
the recovery thereafter. (***Try to add in a little more here as a transition)
Music and the Patient
The effects of music on a patient undergoing surgery have been studied less extensively than its
effects pre- and post-operatively; still, evidence does exist that suggests its benefits to be very
similar to those experienced by the surgeon.
In Hawaii, a retrospective case series involving 203 patients who underwent ophthalmologic
procedures, measured the effects of live classical piano music on patients’ mean arterial blood
pressure, heart rate, and respiratory rate (Camara et al, 2008). These vital signs were measured in
the preoperative holding area, and again during the surgical procedure for patients who were
both exposed to the live classical piano music, and those who were not. For patients who did not
experience the live piano music, blood pressure, heart rate, and respiratory rate all increased
during surgery as compared to when they were in the pre-operative holding area; on average,
blood pressure increased by 5mmHg, heart rate increased by 5 beats per minute, and respiratory
rate increased by 4.5 breaths per minute (Camara et al, 2008). Conversely, exposure to live
classical piano music caused a decrease in all three vital signs measured: blood pressure
decreased by a whopping 21mmHg, heart rate decreased by 5 beats per minute, and respiratory
rate decreased by 4 breaths per minute (Camara et al, 2008).
While having a live pianist in the operating room may not be possible under all circumstances,
the study demonstrates the beneficial effect that classical music has on patients undergoing
surgery. It functions to reduce the patients’ vital signs not only in comparison to the preoperative holding area, but also significantly in comparison to the intraoperative no music
condition (***This sentence could use some rewording. Maybe try sometime like: “Music
reduces the patients’ vital signs in comparison to the pre-operative holding area, as well as in
comparision to the intraoperative no music control”).
It has also been shown that listening to music while undergoing surgery results in a decrease in
the sedative requirements of a patient undergoing a surgical procedure with regional anesthesia.
The conditions of one such study included a patient selected music condition and a white noise
condition both administered via headphones, as well as a no headphone condition. The patients
were administered a spinal anesthetic, and were each set up with a pump to deliver 30mg of
propofol (an amnesic agent), as often as every five minutes (Ayoub et al, 2005). The patients’
vital signs as well as propofol consumption were recorded once every five minutes. In the music
condition, roughly 78% of patients required no propofol at all, and those that did require
propofol consumed .004mg on average. Only 28% of patients in the white noise condition
required no propofol, and those that did consumed .014mg on average; finally, 36% of patients in
the no headphone condition did not consume any propofol, and those that did consumed .012mg
on average (Ayoub et al, 2005).
The inclusion of a white noise condition in this study is of particular importance; it eliminates the
possibility that a decrease in sedative requirements is due to a reduction in sensory input from the
operating room noise and environment, rather than to music itself. While the operating room can
be particularly noisy, the results of the study clearly suggest that music confers a reduction in the
consumption of sedatives by patients more so than simply blocking operating room ambient
noise via white noise.
Although it is evident that music has physiological benefits for both the patient and the surgeon,
objective measurements are not the only aspect that needs to be considered to determine music’s
overall effectiveness in the operating room. If a surgeon hates music for example, it likely would
increase rather than decrease his/her blood pressure and heart rate, and similarly if the patient is
particularly sensitive to all types of noise, music’s supposed physiological benefits would likely
be unseen. Thus, the perception of music in the operating room by both patients and surgeons is
also of particular importance; in a single surgery, both parties need to support the use of music in
the operating room in order for its intervention to be considered therapeutic.
Perception of Music by Patients and Surgeons
In order to assess the perception of music on the operating room staff, a study conducted at Tel
Aviv University administered a survey to 81 surgeons across fifteen specialties regarding their
opinion on music’s influence in the operating room during surgery (Ullmann et al, 2008). Of the
eighty-one participants, 63% regularly listen to music in the operating room, and the most
common music preferred was classical (Ullmann et al, 2008). The volume of music preferred by
99% of surgeons was low or medium, and the length of each surgical procedure/number of
procedures performed per day had no effect on the willingness of the surgeon to listen to music
as he/she performed (Ullmann et al, 2008). Finally, although one of the concerns regarding
music in the operating room is an inhibition in the communication among the operating room
staff, 63% reported music as having a positive influence on staff communication, namely
because it calmed staff members (Ullmann et al, 2008). In accordance with the physiological
benefits of music then, the perception of music by the operating room staff is equally as positive.
The perception of music by the patient was assessed similarly, via an attitudinal scale and a postsurgery extensive interview process. Of the patients interviewed, 75% reported feeling happy
while listening to music during surgery, even if the music was not of their exact taste (as long as
it was somewhat similar), (Stevens, 1990). According to the helpfulness scale administered by
the investigators, 45% of patients considered music to be excellently helpful as a support
mechanism, and some focused more specifically on the use of music as aid in relaxation. One
patient reported, “It was relaxing. It god rid of a lot of my stress. I was rather distraught
beforehand and the music certainly settled me down”; other patients focused on music’s direct
intervention in pain management reporting, “ there was some pain at first and so the nurse
directed me to listen to the music so I did and didn’t feel a thing then.” (Stevens, 1990). While
the patients may find the music to be psychologically beneficial for different reasons, the
important thing is that the majority of those surveyed both supported and enjoyed the therapeutic
use of music in the operating room during surgery.
Soundtrack Selection
Hospitals can be extremely depersonalizing environments, and establishing a true bond between
patient and surgeon is more often a wishful experience than a reality. Perhaps then, music could
also function to establish a bond between the patient and the surgeon – a bond that can transcend
verbal communication, and be carried into the operating room and last the duration of the
procedure. Listening to music encourages avenues of emotional responses like identification,
association, imagination, and the sharing of experiences and thoughts through an artistic
medium, and could serve to non-verbally ally the patient and the surgeon (Moris & Linos, 2013).
The positive effects of music however, are usually only seen for the patent if the music is patient
selected, and for the surgeon if the music is surgeon selected. Is it possible then, to satisfy both
parties? If the benefits of intraoperative music are so pronounced, then perhaps a discussion of
the type of music to be played should be included between the patient and the surgeon in the preoperative consultation appointments. The surgeon and the patient could collaborate their
preferences, and collectively build a play-list such that both parties are equally as satisfied on the
day of the surgery. As the use of music in the operating room must become increasingly more
prevalent, its use must be acknowledged. Then, not only will the surgeon and the patient each
maximally benefit from the use of music, but they can also establish a “musical bond” in creating
a joint playlist prior to their intimate, shared experience during the surgery itself. Physical health
and well-being are not solely measured physiologically, and the benefits of music during surgery
shouldn’t be either; its perceived relaxing and therapeutic effects are also of critical importance,
and any means that will enhance these effects should be employed. The use of music within the
operating room should therefore be of common practice under the condition that the surgeon and
the patient are both involved in the music selection process; thereby extending the shared
experience of music listening and its therapeutic benefits into the surgery room.
Melissa,
Great job! I really enjoyed reading your paper. You brought up a lot of great points and had
some solid evidence to back it up. The soundtrack selection is a good idea, but I can’t help but
wonder whether that would be an unproductive use of time. It strikes me as the playback theater
segment during which we questioned whether patients were simply saying that the playback
matched their emotions. What if patients feel an obligation to agree with the surgeon about their
preferred music yet do not actually enjoy that music and have to go through a long procedure
while listening to music that they don’t actually like? Seems like it might end up backfiring.
Nevertheless, it could potentially work. My other edits are mostly grammatical and I pointed out
a few places that could use some rewording. Content wise, it was engaging and very interesting
to read.
~Maria
References:
Allen, K., & Blascovich, J. (1994). Effects of music on cardiovascular reactivity among
surgeons. Jama, 272(11), 882-884.
Ayoub, C. M., Rizk, L. B., Yaacoub, C. I., Gaal, D., & Kain, Z. N. (2005). Music and ambient
operating room noise in patients undergoing spinal anesthesia. Anesthesia & Analgesia, 100(5),
1316-1319.
Camara, J. G., Ruszkowski, J. M., & Worak, S. R. (2008). The effect of live classical piano
music on the vital signs of patients undergoing ophthalmic surgery. The Medscape Journal of
Medicine, 10(6), 149.
Moris, D. N., & Linos, D. (2013). Music meets surgery: two sides to the art of “healing”.
Surgical endoscopy, 27(3), 719-723.
Siu, K. C., Suh, I. H., Mukherjee, M., Oleynikov, D., & Stergiou, N. (2010). The effect of music
on robot-assisted laparoscopic surgical performance. Surgical innovation, 17(4), 306-311.
Schueler, Laurie. "Music in the OR: What Music Does Your Surgeon Listen To?" Inside
Children's. Akron Children's Hospital, 14 Aug. 2013. Web. 27 May 2014.
Moore, Kimberly Sena. “Musical Analgesia: How Music Helps Pain” Your Musical Self.
Psychology Today, 19 May. 2011. Web. 27 May 2014.
Stevens, K. (1990). Patients' perceptions of music during surgery. Journal of Advanced Nursing,
15(9), 1045-1051.
Ullmann, Y., Fodor, L., Schwarzberg, I., Carmi, N., Ullmann, A., & Ramon, Y. (2008). The
sounds of music in the operating room. Injury, 39(5), 592-597.