Music in the operating theatre

Music in the operating theatre'The poets did well to conjoin Music and Medicine in Apollo; because the office of medicine is but to tune this curious harp of man's body and to reduce it to harmony'.(Sir Francis Bacon, in The Advancement oflearning, Book 11, 1605)Noise levels in operating theatres often exceed acceptable limits', and there is justifiable concern that this may increase stress levels for staff and produce increased anxiety for conscious patients.Efficiency and safety may also be compromised because the noise levels frequently make reliable communication impossible'.It might therefore be assumed that any additional noise in an operating theatre produced by playing music would be highly undesirable.Paradoxically, appropriately selected music may actually decrease the stress levels of staff and conscious patients in the operating theatre, and may significantly improve the efficiency of those who work in this environment.The anxiolytic effects of music on patients before, during and after surgery have long been recognized and are well documented2.Not only is anxiety reduced but tolerance to pain is increased when music is played3.A number of studies have clearly demonstrated the therapeutic efficacy of music, based on physiological responses to it in a variety of situations4.Even anaesthetized patients appear to benefit, with reduced analgesia requirements when appropriate music is played during surgery5.For a patient undergoing surgery under local anaesthesia, the unfamiliar and often very loud noises occurring in an operating theatre can provoke great anxiety, as can overheard conversations between staff members.One of the important and frequently overlooked benefits of music for patients is to provide 'masking' of these worrying sounds, particularly conversation.Similar considerations apply to the patient awaiting surgery in an anaesthetic room adjacent to an operating theatre, where music may be even more important as a means of masking the intrusive, sometimes terrifying, noises emanating from the operating theatre itself.These noises are often clearly audible through doors which may be partly open or which may provide little sound attenuation even when fully closed.Whereas most studies have been undertaken to assess the effects of music on patients, little attention has been paid to its effects on operating theatre staff.However, in other situations a great deal is known about the beneficial effects of appropriately selected music on the speed and accuracy with which difficult or stressful tasks are performed, and on psychophysiological responses generally6z7.Rauscher et d 8 , for example, found that the performance of spatial tasks was considerably enhanced when preceded by a Mozart sonata, compared with the performance after a period of silence.Objective measurements of the performance and stress levels of surgeons, anaesthetists, nurses and technicians working in operating theatres with and without music are difficult to obtain.However, the effects of music on surgeons performing challenging tasks in a research laboratory setting were documented in a recent study9.Fifty surgeons were required to perform complex mental arithmetic under three sets of conditions: (1) with no music; (2) while investigatorselected music was played; and ( 3 ) while the surgeon's preferred choice of music was played.The investigator-selected music was Pachelbel's Canon in D, an instrumental piece often used in commercially available 'stress-reduction' tapes.The speed and accuracy of task performance were recorded, and physiological parameters reflecting stress levels measured.Both speed and accuracy were significantly greater when surgeon-selected music was played than under the other two conditions ( P < 0.0001).Physiological parameters reflecting stress levels were consistently highest in the no-mubic situation, next highest when experimenterselected music was played and lowest when surgeon-selected music was played No specific category of surgeon-selected music was consistently associated with favourable physiological responses and improved task performance in this study.It (P < 0.02).