A view from the coffee room…Mozart or Metallica in the OR

Some 5 years ago, or was it 12 years ago I remember reading on the internet, or maybe it was in some chat forum, well anyway. So, I read a question from patient, that has echoed in my mind all these years. I cannot give you link or reference, so you just must trust me on this. The question was: “I thought my surgeon was fine gentleman, until I was in the OR, and he listened to country and western music. This ruined my experience; why didn’t he listen to classical music? Can I trust him?”

For some reason, in the movies and tv-series, the OR is always portrayed with peculiar lighting – you know,  pitch dark room and only one spotlight to the operating area and classic music playing in the background. And the surgeons and nurses are talking about complex patient cases. Strangely enough in many of these discussions the surgeon and OR nurses seem to talk are about internal medicine patients and cases. We all know that this cannot be further from the truth. On second thoughts, maybe it’s good to keep it this way, to maintain the mystery of OR.  

The idea of using music to relax anxiety in patients is not new. An article published in the year 1950,  states that as early as 1944, a portable radio was installed into plastic surgery operating and dressing rooms.1 The article continues that  after opening the radio, “the comfort and composure of our patients was  apparent immediately, their fears were allayed for minds were diverted and occupied by the music rather than the thought of the operation.”1 WHY don’t we write like this anymore! Nowadays this would be something like: the positive effect of music on the patient´s self-reported negative emotions were noted within an average of 3 minutes (range 0 – 30 minutes), by the Music Before Operation (MBO) Questionnaire (*I made this one up), that patients taking part in the survey completed whilst giving written informed consent before their surgery.

Music in the operating room is very common2, 3 and usually it is the surgeon that decides what to listen to, or not to listen at all. As the saying goes, what is divinely wonderful music for one person, may be unbearable noise for the other. We must remember, that loud music is also a major stressor for nurses in the operating room,4 and I must add for the surgeons reading, probably listening not least favourite music is an even bigger stressor.

Favourite music is not only an individual choices, but also social and age dependent. The music we listened to during our  adolescence  when we felt like the world was our oyster, often remains our favourite music throughout life. Therefore, it is not surprising that US surgeons play lists that are relatively weighty, and include Scorpions Rock You Like a Hurricane, Ted Nugent Just What the Doctor Ordered, The Doors Break on Through, Rolling Stones Paint it Black, Led Zeppelin Whole Lotta Love, Queen We Will Rock You, AC/DC Back in Black and  Metallica Nothing Else Matters.5 As much as I enjoy these landmarks of rock and roll, just like the next surgeon, my taste in music is different.

The Mozart effect refers to a temporary improvement in spatial perception lasting about 10-15 minutes,6 first described by Rauscher in 1993.7 Since then, the effect of the Mozart effect on surgery and surgeons has been well studied. Oomens et al.  review evaluated whether the Mozart effect is real in surgery.8  They concluded, that listening to music, not just Mozart, improved the speed of surgery and shortened the surgical time, improved instrument handling, the quality of surgical intervention, and overall surgical performance. Great, speed is always good, what about other outcomes? Kurmann et al. showed that there is a direct relationship between surgical site infection and the amount of dBs in the operating room.9 The higher the dBs, the more likely the surgical site infection, with an impressive p-value of 0.029. Noise in the OR causes errors and, in particular, increases the possibility of human errors.10 Communication becomes difficult and thus 26% of anaesthetists report that music complicates their work.11 

Weldon et al. studied video recordings of laparoscopic surgeries, some with music playing and others without.12 This study focused on communication, and specifically on requests. The study found that when music was playing, requests had to be repeated several times, up to 5 times more often than without music playing, which caused frustration in the whole team, and  it took from 4 to 68 seconds to repeat the request.

Finally, music in the operating room can help you focus, but music played too loudly can make teamwork difficult and compromise patient safety.  Attention should be paid to choosing music for the duration of the operation, and the best thing would be listening to the opinion of the whole team so that everyone feels comfortable working with you.