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AANS Neurosurgeon | Volume 28, Number 3, 2019

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The Sound of a Neurosurgical Operating Room

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While the resident closed the miniscule lumbar incision following a synovial cyst removal, the surgeon asked me if I knew the song playing on the OR speaker. He was surprised when I said “1979” by the Smashing Pumpkins. Last year, I observed a triple coronary artery bypass that I almost mistook for a 70’s rock concert. In near perfect synchrony, the sternum was bisected as Lynyrd Skynyrd’s “Free Bird” hit the famous guitar rift.

The Rock and Roll Hall of Fame. Taken by Cleveland photographer Michael Weil, PhD.

Having grown up in Cleveland, home of the Rock and Roll Hall of Fame, and with rock music emanating from my radio, I happened to be very familiar with the playlist accompanying these two operations. In fact, I would often listen to Free Bird’s legendary 9-minute buildup, as my personal dial-in before a lacrosse pre-game huddle.

Many surgeons utilize music in the OR to heighten focus and improve performance. According to Dr. Boockvar, vice chair, department of neurosurgery at Lenox Hill Hospital and director of the Brain Tumor Center and the Pituitary/Neuroendocrine Center at Lenox Hill and the New York Head and Neck Institute in Manhattan, music is integral to his success. “I always say operating is a sport, it’s the same preparation as an athlete.” His locker room is the operating room and music gets him into the rhythm of a case.

Dr. John Boockvar, professor of neurosurgery at the Zucker School of Medicine at Hofstra/Northwell performing an endoscopic pituitary tumor removal.

Spotify recently polled over 700 surgeons and found that nearly 90% listen to music in the OR, with 49% reporting Rock regularly appears on their playlists.1 A research study found that surgeons who listened to their preferred music intraoperatively were able to complete procedures faster and with higher quality repairs.2

“Makes us a bit happier dealing with the difficulties of surgery.”

Part of music’s allure is that it can be readily  adjusted to match the setting of each case. Being a child of the 80s, Susan Durham, MD, FAANS, chief of neurosurgery at the University of Vermont Medical Center, listens to artists such as The Cure, Duran Duran, Motley Crue, Def Leppard and Led Zeppelin to liven long, difficult cases. She adjusts the music based on the complexity of the case, noting that there are times where music is not appropriate. Particularly in the case of an unforeseen complication – the music is immediately stopped.

The top 5 genres among a poll of 28 neurosurgeons.

There is a potential downside, however; blunting the senses may interfere with communication among the team. Ann Stroink, MD, FAANS, believes music “can be a distracting interference” and might affect patient care. Research has confirmed that the surgeon’s auditory processing is worse with background music and higher intraoperative sound levels are associated with increased rates of infection.3,4

“Definitely improves outcomes, there is a better response in everyone’s work in the OR.”

Dr. Susan Durham, Chief of Neurosurgery at UVM Medical Center attending a Def Leopard Concert.

Despite differing preferences among neurosurgeons, they may be able to agree on music’s benefit during one increasingly common procedure; the awake craniotomy. The naturally high anxiety surrounding awake craniotomies impacts preoperative cognitive assessments and reduces intraoperative participation.5,6 These two elements are crucial for an optimal resection.

“Patients are at ease when they hear their favorite tunes.”

As a patient, music may provide comfort during this vulnerable time in one’s life, including the time just before surgery and also during specific surgical interventions where general anesthesia is not possible. Research has shown that patients who listened to music during their awake craniotomies had lower anxiety, heart rate, systolic and diastolic blood pressure.7 Dr. Boockvar believes that by providing patients the opportunity to choose the music, he is giving them an “iota of control” in a situation where they otherwise have none.

Results from a poll of 28 practicing neurosurgeons. The more years in practice, the less likely the neurosurgeons were to perform awake craniotomies and to let the patient choose their own music during the procedure.

Music and surgery go hand in hand, with its familiarity providing stress relief and its background effect improving performance. Some may argue these effects are not without sequalae. The benefits to patients, however, are loud and clear. By virtue of having awake patients, neurosurgery has a unique opportunity to give patients the immeasurable benefit of choosing their own playlist.

In 1944, before any major research on music, surgeons of the Duke department of plastic surgery installed a portable radio in their operating and dressing room. During local or spinal sedation, a cushioned headset was given to the patient to “direct the attention of patient from himself to the music”.8

The author would like to thank Dr. Susan Durham, chief of neurosurgery at the University of Vermont Medical Center for her contributions to this article.

References

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1. Spotify and Figure 1 team up to hear what surgeons are playing in the OR. (n.d.). Retrieved from https://figure1.com/blog/surgical-soundtracks/.

2. Lies, S. R., & Zhang, A. Y. (2015). Prospective Randomized Study of the Effect of Music on the Efficiency of Surgical Closures. Aesthetic Surgery Journal35(7), 858–863. doi: 10.1093/asj/sju161

3. Way, T. J., Long, A., Weihing, J., Ritchie, R., Jones, R., Bush, M., & Shinn, J. B. (2013). Effect of Noise on Auditory Processing in the Operating Room. Journal of the American College of Surgeons216(5), 933–938. doi: 10.1016/j.jamcollsurg.2012.12.048

4. Kurmann, A., Peter, M., Tschan, F., Mühlemann, K., Candinas, D., & Beldi, G. (2011). Adverse effect of noise in the operating theatre on surgical-site infection. British Journal of Surgery98(7), 1021–1025. doi: 10.1002/bjs.7496

5. Santini, B., Talacchi, A., Casagrande, F., Casartelli, M., Savazzi, S., Procaccio, F., & Gerosa, M. (2012). Eligibility Criteria and Psychological Profiles in Patient Candidates for Awake Craniotomy. Journal of Neurosurgical Anesthesiology24(3), 209–216. doi: 10.1097/ana.0b013e3182464aec

6. Ruis, C., Wajer, I. H., Robe, P., & Zandvoort, M. V. (2017). Anxiety in the preoperative phase of awake brain tumor surgery. Clinical Neurology and Neurosurgery157, 7–10. doi: 10.1016/j.clineuro.2017.03.018

7. Wu, P. Y., Huang, M.-L., Lee, W.-P., Wang, C., & Shih, W.-M. (2017). Effects of music listening on anxiety and physiological responses in patients undergoing awake craniotomy. Complementary Therapies in Medicine32, 56–60. doi: 10.1016/j.ctim.2017.03.007

8. Pickrell, K. L., Metzger, J. T., Wilde, N. J., Broadbent, T. R., & Edwards, B. F. The use and therapeutic value of music in the hospital and operating room. Plastic Reconstruction Surgery 1946. 1950;6(2):142-152.

Leave a Reply

Philip Minella M.D. | December 16, 2019 at 1:30 pm

I practiced neurosurgery for over 35 years ,training in the late 70s.I’ve experienced rooms with and without music.I’ve seen neurosurgeons play music so loud you could hear it in the adjacent rooms.I used appropriately toned music mostly for the personnel in the room to keep them happy.I feel it can definitely interfere with communication in the OR and lead to mistakes and infections.
I think appropriately volumes music is OK.I personally prefer quiet.

Benjamin Gelber MD | December 16, 2019 at 6:48 pm

I am an amateur violinist, organist and pianist. I always have classical music playing during surgery. This in no way detracts from concentration or quality of surgery. In addition, the OR staff who are not musically inclined, become familiar with Bach, Beethoven, Brahms, Tchaikovsky, etc, whom they might otherwise never experience.