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The sounds of music in the operating room
Abstract
Little information is available about the effect of music on the operating room (OR) staff.
The objective of this study was to evaluate the perception of the influence of music on physicians and nurses working in the OR.
A questionnaire was designed and 250 copies were distributed to the doctors and nurses working in the OR at three hospitals. One hundred and seventy-one returned the completed questionnaire and were included in this study.
63% of the participants listen to music on a regular basis in the OR. Classical music is the most requested (58%) and most of the responders do not choose the type of music according to the type of the procedure. In our study, the nurses were more likely to listen to music and the willingness is higher among the female responders. The desired volume is lower as age increases and 78.9% of the participants claimed that music in the OR makes them calmer and more efficient.
According to our study, music has a positive effect on the staff working in the operating rooms.
... 2,3 Background music is one way in which the OT environment is commonly modified, being played in 67-80% of OTs globally. [4][5][6][7][8][9] While noise is widely considered to be negatively impactful, music is seen by many to be a favourable part of the theatre environment, in particular calmness, stress and mood. [4][5][6][9][10][11] However, controversy remains with particular concern regarding its distracting effects. ...
... [4][5][6][7][8][9] While noise is widely considered to be negatively impactful, music is seen by many to be a favourable part of the theatre environment, in particular calmness, stress and mood. [4][5][6][9][10][11] However, controversy remains with particular concern regarding its distracting effects. 5,[8][9][10] In the literature, there are few objective physiological and psychological stress studies in the OT environment through the lens of music. ...
... [4][5][6][9][10][11] However, controversy remains with particular concern regarding its distracting effects. 5,[8][9][10] In the literature, there are few objective physiological and psychological stress studies in the OT environment through the lens of music. 10 One interventional music study has been conducted within the OT with surgeon and patient stress as an outcome, though in this case no physiological measurements were recorded in the surgeons. ...
Objective
The experience of stress is common among surgeons while working in the operating theatre (OT). Understanding and finding ways to mitigate this stress is important for optimizing surgical quality and maintaining clinician wellbeing. In this pilot study, we tested the feasibility and reported the outcomes of measuring the effect of background music on intra‐operative surgeon stress in the clinical environment.
Methods
The effect of Music on the Operating Surgeon: A pilot Randomized crossover Trial (the MOSART study) was conducted over a 9‐month period in a single‐centre. Vascular and general surgeons acting as primary operators (POs) performing elective, general anaesthetic operations were included. The intervention was surgeon‐selected music, and the control was the absence of music. Outcome measures were feasibility (recruitment rate, practicability, and completeness of data), heart rate variability (HRV) indices, the Six‐Item State–Trait Anxiety Inventory (STAI‐6), and the Surgical Task‐load Index (SURG‐TLX).
Results
Five POs performed 74 eligible randomized cases. The protocol was well tolerated, and no cases were abandoned. Data was incomplete in 8% of cases. The overall mean (SD) operative SURG‐TLX score was 48 (±22). Mean HR increased and RMSSD decreased significantly from baseline, suggesting reduced parasympathetic activity while operating. The presence of intra‐operative music was not found to affect the psychological or physiological outcomes.
Conclusions
A music interventional study of this nature is feasible in the operating theatre environment, though no difference was found between in the music and non‐music conditions. Follow‐up research in a simulated environment with intensive physiological monitoring could be considered.
... Finding meaningful ways to mitigate workplace stress and improve occupational ergonomics is thus imperative to maintaining service quality and patient satisfaction. Music is one way in which surgeons can alter their operating environment, it is therefore not surprising to find that it is played in 67-98 % of operating theatres throughout the world [4][5][6][7]. While it is clear that excess noise is deleterious to the surgical team [8][9][10][11][12][13], many clinicians found music to be a generally favourable part of the theatre environment [4,[14][15][16], with music being seen as improving calmness [6], stress [17,18], mood, and surgeons' and overall team performance [4,5,16]. ...
... Music is one way in which surgeons can alter their operating environment, it is therefore not surprising to find that it is played in 67-98 % of operating theatres throughout the world [4][5][6][7]. While it is clear that excess noise is deleterious to the surgical team [8][9][10][11][12][13], many clinicians found music to be a generally favourable part of the theatre environment [4,[14][15][16], with music being seen as improving calmness [6], stress [17,18], mood, and surgeons' and overall team performance [4,5,16]. There is little objective evidence to demonstrate an effect of music on surgeon stress, and only few heterogenous studies on health professionals' perceptions [16]. ...
... This paper represents one of the largest cohorts of surgeons and surgical residents surveyed on the topic of intra-operative music [5,16]. In this study, in line with international experiences, it was demonstrated that music was commonly played [4,6,7], and found to be widely viewed as enjoyable in the OT environment. There was a perceived positive effect on elements of the SURG-TLX such as mental fatigue and anxiety [4,14,15]. ...
Background
Surgery is a stressful exercise, and the experience of occupational stress may have impacts on surgical performance, and surgeon well-being. Music is played in operating theatres (OTs) throughout the world, and while it may improve surgical performance, and reduce clinician stress within the OT, concerns exist over its distracting and noise-creating properties.
Methods
In this prospective observational study, between May to August 2022, Vascular, General and Paediatric surgeons and registrars in Australia and Aotearoa New Zealand (AoNZ) responded to a survey investigating the way they use music, and their perceptions and attitudes towards its effect on the OT environment. Binomial logistic regression and Chi squared tests of association were performed, accepting p < 0.05 as significant.
Results
In this cohort of 120 surgeons, 45 % were vascular specialists, 30 % were female and 59 % were consultant surgeons. The most commonly preferred music genres were easy listening and pop. Over 75 % of surgeons enjoyed having music in their OTs with the majority reporting it improved their temperament, how mentally fatiguing a procedure felt and how anxious or stressed they felt. Vascular surgeons were more likely to believe music had a positive influence on communication than their general and paediatric surgery colleagues (p < 0.01). Registrars had significantly higher odds of believing music had a positive effect on their temperament, and how stressed and anxious they felt when operating, when compared to consultants (p < 0.05).
Conclusions
This study provides a window into the surgeons' use of and attitudes towards intra-operative background music and its effect on stress and cognitive load in Australia and AoNZ. While overall, music is viewed positively by this cohort, there was some difference seen across specialties and level of experience. Further subjective and objective data in this field may provide useful information to guide hospital policy and inform pathways for clinician wellbeing.
... Music can be ubiquitously heard emanating from operating theatres (OTs) throughout the world. [1][2][3] Commonplace as it is, there is disagreement in the literature regarding the benefits or harms of music in this setting. 1,2,4 Surgery can be a stressful exercise that warrants expert execution of both technical and non-technical skills (such as communication, teamwork and rapid decision making) under pressure. ...
... [1][2][3] Commonplace as it is, there is disagreement in the literature regarding the benefits or harms of music in this setting. 1,2,4 Surgery can be a stressful exercise that warrants expert execution of both technical and non-technical skills (such as communication, teamwork and rapid decision making) under pressure. The feeling of stress and managing its flow-on effect on performance is one that unites all surgeons in their experience. ...
... The feeling of stress and managing its flow-on effect on performance is one that unites all surgeons in their experience. 5 While it is clear that noise is deleterious to the surgical team, 6-12 many clinicians found music to be a generally favourable part of the theatre environment, 3,12,13 with music being seen as reducing stress, 14,15 and improving calmness, 1 mood, and surgeons' and overall team performance. 3 Following a seminal paper by Rauscher et al. on the "Mozart effect", there is interest in the interaction between music and task performance. ...
Abstract
BACKGROUND:Music is played in operating theatres (OTs) throughout the world, though controversy around its use exists. While some clinicians may find background music favourable to the theatre mood and a way to augment surgical performance, there is concern raised over its distracting and noise-creating properties.
METHODS:In this prospective observational study, between August and December 2021, 110 surgeons and registrars in South Africa responded to a survey investigating the way they use music, and their perceptions and attitudes towards its effect on the OT environment.
RESULTS:In this cohort, 66% were male, 29% were consultants and the most common age range was 30–39 years old. Eighty per cent of respondents reported that music was played at least “sometimes”, with 74% reporting that they enjoyed it. Easy Listening was the most played and preferred genre followed by Top 40/Billboard hits. Overwhelmingly, respondents reported that background music in the OT improved temperament, focus, mood, and performance, though over a quarter felt it worsened communication. Thirty-one per cent of respondents reported that the choice of music depended on the type of operation, and 70% would turn music down or off during crises. Those who enjoyed music in their spare time were significantly more likely to enjoy music in the OT and perceive it positively.
CONCLUSION:This study provides a window into the surgeons’ use of and attitudes to intraoperative music in South Africa. While overall, music is viewed positively by this cohort, some concerns remain regarding communication and distractedness. Further interventional and qualitative studies would be useful.
... Many scientists have investigated the therapeutic effect of music on patients before, during and after surgical procedures of different kinds. It generally proves to be useful: (a) for reducing anxiety and pain levels, (b) during the recovery period [3,51,52], and (c) for encouraging people to commit to routine and necessary preventive care [53]. In the field of dentistry, a systematic review concluded that music intervention was effective in reducing anxiety and pain in children undergoing dental procedures and in adults undergoing medical procedures [13,50,54,55]. ...
... Music influenced communications positively between staff as reflected by 63% of the responders, and 77% reported that music made them calmer and more efficient. Those who refused to listen to music during surgery indicated that it might interfere in extended and complicated procedures as well as in emergency procedures [51]. ...
... In terms of the type of music proposed, a study concluded that the anxiolytic and pain-reducing effects are not restricted to one specific type of music [3]. For example, classical music was preferred by 58% of the responders [51]. A meta-analysis concluded that there is a small but statistically significant beneficial effect of listening to Mozart on task performance [60]. ...
Sound is inextricably linked to the human senses and is therefore directly related to the general health of the individual. The aim of the present study is to collect data on the effect of two dimensions of sound, music, and noise from an emotional and functional point of view in the dental office and to perform a thorough review of the relevant literature. We collected articles from the databases PubMed and Google Scholar through keywords that were related to noise and music in healthcare. Important information was also extracted from articles on the web and official websites. Screening of the relevant literature was performed according to accuracy and reliability of the methodology tested. A total of 261 articles were associated to sound and music in healthcare. Ninety-six of them were the most well documented and were thus included in our article. Most of the articles associate noise with negative emotions and a negative impact on performance, while music is associated with positive emotions ranging from emotional state to therapeutic approaches. Few results were found regarding ways to reduce noise in a health facility. If there is a difficulty to find effective methods of reducing the daily noise-inducing sounds in the dental office, we must focus on ways to incorporate music into it as a means of relaxation and therapy.
... The feeling of stress, and managing its flow-on effects to performance, is one that unites all surgeons in their experience 1 . Music can be one way in which surgeons can alter their operating environment, and it is perhaps not surprising to find that it is played commonly in operating theatres (OTs) throughout the world [2][3][4] . Though commonplace, there is disagreement in the literature regarding the perceptions of the benefits or harms that music can have in this context. ...
... While it is clear that noise is deleterious to the surgical team 5-10 , many clinicians find music to be a generally favourable part of the theatre environment 4,11,12 , with music being seen as improving calmness 2 , stress 13,14 , mood, and surgeon and overall team performance 4 . However, respondents' opinions differed when it came to the distracting effect of music 11,13 , particularly at times of critical situations [2][3][4]11 -factors that may affect performance, increase the feeling of difficulty, or stress 15 . Communication is another contentious area, where several studies report no effect or a positive influence with music 2,4,14,16 , though others found a reduction in auditory speech perception 10,17 and an increase in repeated request rate 18 . ...
... However, respondents' opinions differed when it came to the distracting effect of music 11,13 , particularly at times of critical situations [2][3][4]11 -factors that may affect performance, increase the feeling of difficulty, or stress 15 . Communication is another contentious area, where several studies report no effect or a positive influence with music 2,4,14,16 , though others found a reduction in auditory speech perception 10,17 and an increase in repeated request rate 18 . ...
Background:
Despite the ubiquitous sounds of music playing in operating theatres (OTs) around the world, the effect that music has on intraoperative clinician stress is ill-defined. In the present scoping review the aim was to map the available evidence for the effect of background music in the OT on the experience of stress in the operating surgeon.
Methods:
The present review was conducted in accordance with the PRISMA Protocols for Scoping Reviews. Using Embase, MEDLINE, and the Cochrane databases, peer-reviewed research studies reporting the effect of intraoperative background music on an outcome measure of clinician stress or respondent perceptions on this effect were included.
Results:
A total of 4342 studies were screened and 15 studies met the inclusion criteria, of which 10 were interventional studies, and five were observational survey-based studies. Of the 10 interventional studies, four showed reduced anxiety and mental workload scores with music, although only two demonstrated a significant improvement in a physiological outcome. The survey-based studies generally reported a positive perception among surgeons and theatre staff towards the effect of music on OT stress.
Conclusion:
While there is generally a positive perception towards intraoperative music and surgeon stress, there are few objective physiological and psychological data to support this. Studies were varied in their design. The present review can be used to guide future experimental, observational, and mixed-method research on this topic.
... After Rauscher et al. first demonstrated beneficial effects on spatial task performance, the so-called Mozart effect [3], diverse evidence pro or contra music was published approximately in equal parts ever since [4]. The majority of surgeons listen to some music in operating theaters worldwide [5][6][7][8]. According to an online survey including surgeons and nurses from more than 50 countries, rock music (49%) and pop music (48%) are the most popular genres, followed by classical music (43%) [7]. ...
... According to an online survey including surgeons and nurses from more than 50 countries, rock music (49%) and pop music (48%) are the most popular genres, followed by classical music (43%) [7]. Questionnaires assessing the subjective perception of music showed that 78.9% of the surgeons felt music to be calming, and they were convinced that it would enable them to carry out their work more efficiently [5]. Classical music has been shown to affect experienced surgeons positively, as heart rate, blood pressure, and muscle tension were reduced while the accuracy of performing surgical tasks was improved [9]. ...
... One of the most frequently investigated music types was classical music (e.g., Mozart's piano sonatas), probably because 92% of surgeons chose classical music in 1994 [10]. Classical music was shown to be related to lower autonomic function and reactivity [10], higher speed and accuracy of task performance [5,10,27,28], and less muscle effort and less muscle fatigue [27]. Music preferences seem to have changed in the last decades. ...
Purpose
Music is often played in operating theaters. In the literature, the effects of music on surgeons are controversial. We aimed to investigate the effect of different music genres and amplitudes on laparoscopic performance.
Methods
Novice surgeons underwent a proficiency-based laparoscopic training curriculum. Participants were required to perform these tasks under three conditions: no music, with music in medium volume (45–50 dB) and in high volume (65–70 dB). Soft rock by the Beatles and hard rock by AC/DC were played. Task performance was evaluated by analyzing speed and accuracy.
Results
With soft rock in medium volume, participants were faster in peg transfer (60.3 vs. 56.7 s, P = 0.012) and more accurate in suture with intracorporeal knot (79.2 vs. 54.0, P = 0.011) compared to without music. The total score was improved (383.4 vs. 337.9, P = 0.0076) by enhancing accuracy (79.5 vs. 54.0, P = 0.011). This positive effect was lost if the soft rock was played in high volume. With hard rock in medium volume, participants were faster performing precision cutting (139.4 vs. 235.8, P = 0.0009) compared to without music. Both balloon preparation and precision cutting were performed more rapidly (227.3 vs. 181.4, P = 0.003, 139.4 vs. 114.0, P < 0.0001) and the accuracy was maintained. Hard rock in high volume also resulted in increased speed (366.7 vs. 295.5, P < 0.0001) compared to without music. Thereby, the total scores of participants were enhanced (516.5 vs. 437.1, P = 0.002).
Conclusion
Our data reveal that the effect of music on laparoscopic performance might depend on the combination of music genre and amplitude. A generally well-accepted music genre in the right volume could improve the performance of novice surgeons during laparoscopic surgeries.
Trial Registration
DRKS00026759, register date: 18.10.2021 (retrospectively registered).
... Music has a long-standing place in the operating theatre. Staff from all over the world have reported listening to music during surgical procedures [1][2][3]. Several studies have illustrated the anxiolytic and pain relief effects of music on patients [4][5][6][7]. Nonetheless, limited studies have investigated the role of music during Ear Nose and Throat (ENT) surgical procedures. ...
... The authors showed that patients experienced less discomfort during this surgical procedure and suggested that music could minimise anxiety and pain in similar ENT procedures. A study by Ullmann et al. illustrated that the majority of theatre staff reported that music enhances communication and efficiency between staff, and reduces anxiety [2]. Nonetheless, no study has yet assessed the influence of music on paediatric ENT theatre staff. ...
... Concerning the type of music, we found that FM Radio was the most popular one. On the contrary, similar studies evaluating the effects of music on theatre staff found that classical music, Jazz, and Easy Listening were the most preferred ones [2,12,13]. Cultural differences might play a role as the studies were conducted in different countries (Israel, Nigeria, New Zealand) [2,12,13]. ...
Background
Music has a long-standing place in the operating theatre. Nonetheless, limited studies have investigated the role of music during Ear Nose and Throat (ENT) surgical procedures.AimsTo evaluate the benefits of background music on ENT theatre staff.MethodsA 10-question survey was distributed to ENT theatre staff over a four week period.ResultsA total of 36 ENT theatre staff responded to the survey, a response rate of 86%. Most participants (61%) enjoyed the calming effect of background music in ENT surgery. The majority of participants responded that music did not affect their communication with other staff (69%), and improved their concentration (61%). Most respondents agreed that music can produce a sense of comfort for the patients (69%), and reduce anxiety before anaesthesia (75%).Conclusions
Background music can have a calming effect on staff in paediatric elective ENT surgery. This is a decision to be made by the surgical team with direct patient care and, if there is any concern about communication and distraction, then it is to be avoided.
... Music has a long-standing place in the operating theatre. Staff from all over the world have reported listening to music during surgical procedures [1][2][3]. Several studies have illustrated the anxiolytic and pain relief effects of music on patients [4][5][6][7]. Nonetheless, limited studies have investigated the role of music during Ear Nose and Throat (ENT) surgical procedures. ...
... The authors showed that patients experienced less discomfort during this surgical procedure and suggested that music could minimise anxiety and pain in similar ENT procedures. A study by Ullmann et al. illustrated that the majority of theatre staff reported that music enhances communication and efficiency between staff, and reduces anxiety [2]. Nonetheless, no study has yet assessed the influence of music on paediatric ENT theatre staff. ...
... Concerning the type of music, we found that FM Radio was the most popular one. On the contrary, similar studies evaluating the effects of music on theatre staff found that classical music, Jazz, and Easy Listening were the most preferred ones [2,12,13]. Cultural differences might play a role as the studies were conducted in different countries (Israel, Nigeria, New Zealand) [2,12,13]. ...
Objective
To assess the effect of Episcissors-60 upon obstetric anal sphincter injuries (OASIS) reduction in nulliparous women
Study Design: Independent literature search for relevant studies was performed up to 30th May 2021 on five databases: Embase (OVID), MEDLINE (R) (OVID), CAB Abstracts (OVID), ClinicalTrials.gov, and Google Scholar. The primary outcome was to assess OASIS events prior and after Epi-60 implementation in clinical practice in natural births (NB), whilst secondary outcomes included overall operative vaginal delivery (OVD) %/spontaneous vaginal deliveries (SVD) % deliveries, episiotomy rates and operator satisfaction. All included studies (retrospective, prospective and time-series) examined the effect of Episcissors-60 implementation upon observed OASIS %.
Results
A total of 14027 nulliparous females were included in the meta-analysis. Overall, study heterogeneity was high at I²: 79% with collectively fair quality of studies, as assessed by the Newcastle-Ottawa scale. Overall, this analysis highlights significant differences of OASIS events that might suggest their implementation as standard practice [RD -0.02, 95% CI -0.03 to 0.00; P = 0.03].
Conclusion
The present analysis highlights significant differences of OASIS events pre- and post- Epi-60, that may suggest Episcissors-60 implementation as standard practice. Nonetheless, to ensure data integrity, well reported observational studies and robust randomized controlled trials (RCTs) are required prior to introduction of Epi-60 as standard episiotomy technique in clinical practice.
... It enhances mental theater are critical, taxing the brain function; hence, there should be a good coordination and communication among surgeons, anesthesiologists, and other health-care staff. [6] Intrusive background noise in the operating theater can be distracting, jeopardizing communication leading to a perceived increase in stress. According to the WHO, the noise in operating theaters must not increase beyond 30 dB (A), comparable to whispering inaudibly in a library. ...
... Obnoxious noise levels ringing from our devices while carrying out the surgical procedure may violate the norms set by the Occupational Safety and Health Administration and National Institute for Occupational Safety and Health (NIOSH) recommendation for hearing safety. [6] The aim of this survey was to obtain information on the perspective of the surgeons and anesthesiologists regarding noise in the operating theater and its impact on their working. The key objective of this survey was to identify whether noise can lead to an increase in the level of stress and human errors, tracing the area of the operating theater that emanates the loudest noise, impact of noise and music while working, and finally, whether noise can lead to hearing impairment. ...
... Contrary to this, there are studies that highlight the beneficial effects of music which includes calming effect on individuals in the operating room by decreasing the anxiety and stress while multitasking. [6] Weldon et al. conducted a study on music and communication in the operating theater and suggested that the choice of music should be decided by the entire staff and ought to be played low in the background. [14] Number of people in operating room A study by Shital et al. analyzed the operating room human traffic as a cause of surgical site infection. ...
Background and aims:
Noise is often considered as an undesirable sound. Excess noise is a health threat that deteriorates one's concentration and communication. Noise in the operating theater can be disturbing, impairs communication, and can lead to stress. The aim of this survey was to assimilate information about the perspective of surgeons and anesthesiologists regarding noise in the operating theater and whether it affects their work atmosphere.
Methods:
A questionnaire consisting of 15 closed-ended questions excluding one open-ended question was given to surgeons from various specialties and anesthesiologists. The subjective response were analyzed and documented. Data analysis was done using descriptive statistics. Association was found out using Chi-square test.
Results:
We collected a total of 290 responses, of which 87.6% (n = 254) considered noise to increase the stress level and deteriorates the quality of teamwork (83.8%, n = 243). Noise affects communication among the staff (86.2%, n = 250) and decreases their concentration level (85.5%, n = 248) which could be harmful in view of the patient's safety. 87.9% (n = 255) of the participants were in favor of limiting the number of people in the operating theater. Nonetheless, 73% (n = 211) considered music has a calming effect and were in favor of music in the operating theater.
Conclusion:
Noise in the operating theater can have distressing effects on surgeons, jeopardizing the patient's safety. However, a flip side to this is that music is considered to have a calming and soothing effect decreasing the anxiety and stress levels.
... 27 Self-reported distraction by noise seems to be more present in surgeons (39 and 43% of main and assisting surgeons) when compared with anesthesiologists (16%). 10 Perception and attitude toward playing music in the OR Ten studies evaluated the perception by and attitude of the OR staff on playing music in the OR through cross-sectional surveys (1751 participants) ( Table 2), [29][30][31][32][33][34][35][36][37][38] with an additional three studies assessing its effect on auditory perception and communication (24 participants). 11,39,40 The prevalence of music in the OR was assessed in seven studies (1486 participants), with music being played during a majority of surgical procedures in hospitals around the world. ...
... 11,39,40 The prevalence of music in the OR was assessed in seven studies (1486 participants), with music being played during a majority of surgical procedures in hospitals around the world. [29][30][31]33,35,37,38 In general, the majority enjoyed music in the OR with positive approval rates varying between 60% and 90% (eight studies, 1057 participants). [29][30][31][32][34][35][36]38 In six studies (949 participants), [29][30][31]34,35,38 individual performance or concentration was subjectively either improved or unaffected by music according to most surgeons, anesthetists, and OR nurses surveyed. ...
... Music was not deemed to be distracting in general, 34,38 but opinions differed in regard to critical situations when a problem was encountered. 29,31,[35][36][37] Communication was regarded to be either unaffected or positively influenced by music by approximately 60% of respondents (911 participants). 30,31,35,37,38 In contrast, two studies that, respectively, evaluated 15 surgeons and four physicians acting as an OR team reported a significant reduction in the correct rate of auditory speech perception in a simulated setting, when music was added. ...
Background: Environmental noise pollution is regarded as a general stressor. Noise levels frequently exceed recommended noise levels by the World Health Organization in hospitals , especially in the operation room. The aim of this systematic review was to assess the effects of noise pollution on patient outcome and performance by operation room staff. In addition, the perception and attitude toward playing music in the operation room, which can increase noise levels, were assessed as well.
Materials and methods: A systematic literature search of the databases Embase, Medline Ovid, and Cochrane from date of database inception until October 16 th , 2020 using the exhaustive literature search method was performed. Prospective studies evaluating the effect of noise on the patient, surgeons, anesthesiologists, nurses, and other operation room staff, or perception and attitude toward playing music in the operation room, were included. This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines and was registered with PROSPERO (ID: 208282).
Results: The literature search generated 4758 articles, and 22 prospective studies (3507 participants) were included. Three of the four studies that investigated the effect of noise on patient outcome reported a significant reduction of complication rate in surgical patients, when noise levels were lower. Six studies assessed the effect of noise in the operation room on the staff (1383 participants). Over half of the surveyed staff found noise levels to be a disturbing stressor and negatively impact performance. Although music increased decibel levels in the operation room, most surveyed staff was positively predisposed toward playing music during surgery, believing it to improve both individual and team performance. In general, music was not considered to be distracting or impairing communication.
Conclusions: Higher noise levels seem to have a negative effect on patient outcome and adversely affect performance by members in the operation room. Further research is needed to assess whether this knowledge can benefit patient outcome and surgical performance. Notably, attitude of surgical team members toward music during surgery is generally regarded favorable.
... Music, with its benefits, is significantly used in operating rooms worldwide to positively modify the environment where surgeons and the entire healthcare staff operate [11,19,20]. However, the literature is not yet unanimous on the benefits that music can have in these contexts. ...
... In addition, some believe that music may "mask" alarms [24]. Conversely, other studies argue that music is generally a favorable part of the operating room environment [10,25,26], as it seems to improve calmness [19], stress autonomic reactivity [24,27], mood, and the performance of the surgeon and the entire assistive team [11,25]. Recent systematic reviews have highlighted that background music can improve the accuracy and speed of surgical interventions [9], reducing mental workload [28]. ...
Background: Music evokes positive emotions and reduces stress and anxiety. Operating Room (OR) staff face various challenges which can lead to high levels of stress. The aim of the study is to assess whether listening to music during intraoperative phases improves the work environment by reducing anxiety and stress in the entire surgical team. Methods. A prospective observational study was conducted from February to September 2023, involving medical personnel, nursing staff, and nursing students. They were divided into two groups: Group 1 with music during surgical procedures, and Group 2 without music. Participants were administered two validated instruments: the Zung Anxiety Self-Assessment Scale (SAS) to measure anxiety, and the Positive and Negative Affect Schedule to assess emotions generating stress. Additional items were included for demographics, job satisfaction, and the organization method. Results. Music did not impact anxiety but increased positive emotions while reducing negative ones. Music had an ancillary effect, highlighting the need for significant organizational interventions aimed at increasing operator satisfaction, including voluntary rather than mandatory assignments for nursing staff. Conclusions. Music appears to reduce stress in the intraoperative team when supported by a positive work environment in which assigned operators have chosen to work in the OR.
... Music, with its benefits, is significantly used in operating rooms worldwide to positively modify the environment where surgeons and the entire healthcare staff operate [11,19,20]. However, the literature is not yet unanimous on the benefits that music can have in these contexts. ...
... In addition, some believe that music may "mask" alarms [25]. Conversely, other studies argue that music is generally a favorable part of the operating room environment [10,26,27], as it seems to improve calmness [19], stress autonomic reactivity [25,28], mood, and the performance of the surgeon and the entire assistive team [11,26]. Recent systematic reviews have highlighted that background music can improve the accuracy and speed of surgical interventions [9], reducing mental workload [29]. ...
Background:
Music evokes positive emotions and reduces stress and anxiety. Operating room (OR) staff face various challenges which can lead to high levels of stress. The aim of the study is to assess whether listening to music during intraoperative phases improves the work environment by reducing anxiety and stress in the entire surgical team.
Methods:
A prospective observational study was conducted from February to September 2023, involving medical personnel, nursing staff, and nursing students. They were divided into two groups: Group 1 with music during surgical procedures, and Group 2 without music. Participants were administered two validated instruments: the Zung Anxiety Self-Assessment Scale (SAS) to measure anxiety, and the Positive and Negative Affect Schedule to assess emotions generating stress. Additional items were included for demographics, job satisfaction, and the organization method.
Results:
Music did not impact anxiety, but increased positive emotions while reducing negative ones. Music had an ancillary effect, highlighting the need for significant organizational interventions aimed at increasing operator satisfaction, including offering voluntary instead of mandatory assignments to nursing staff.
Conclusions:
Music appears to reduce stress in the intraoperative team when supported by a positive work environment in which assigned operators have chosen to work in the OR.
... Effects: Ulmann in his study found that 63% of the participants listened to music on a regular basis in operation rooms [6]. Hawksworth in a study established that 26% of his study population felt music hampered their communication with other staff in the operating ...
... Various studies suggested that instrumental music was the most sought after type of music; followed by FM radio, Hindi ghazal, English country, English classical and Hindi classical in that order. Ulmann., et al. found classical music as the most preferred type of music [6]. ...
Music is commonly played in operation theatres and has shown to diminish stress of the surgical team along with reducing the patient's anxiety before surgery. Music during surgical procedures can prevent distraction, minimize annoyance, reduce stress and diminish the anxiety of patients, staff and users. Most Surgeons like to play soft, low volume, instrumental music to combat long hours of standing while performing complex, skillful and dexterous surgical procedures. They probably want to keep their cool and make the patient undergoing surgery at ease by playing their favorite music in the highly tensed and perplexing operating room environment. Music also must be having a role to play in making the long, routine, planned, monotonous surgical procedures interesting and enthralling.
... Strong scientific evidence shows that it can reduce stress and anxiety for both surgical teams and their patients, and, in some cases, it even increases patients' tolerance of pain. [1][2][3][4][5] Just as importantly, however, it must be determined whether playing music has an impact on the actual surgical outcomes. At the moment of writing, 14 original articles 2,6-18 and 3 systematic reviews [19][20][21] on the topic had been published. ...
... 1,2,[6][7][8][9][10][11][12][13][14]16,[19][20][21] Coupled with strong existing evidence that music reduces stress in surgical teams, playing music of the surgeon's choice can be a safe, simple, and cost-effective way to do so. [1][2][3] In fact, our study not only shows that playing music shortened operating times, but also that playing faster music shortened operating times even further. Contrary to the British, Swiss, and American studies mentioned earlier, 15,17,18 fast-tempo music did not distract the surgeon or result in poorer communication between surgical team members. ...
Background:
The effect of playing background music on surgical outcomes has been controversial. This prospective case-control study aims to evaluate the impact of music tempo in general surgical settings.
Study design:
Six hundred consecutive patients with nonmetastatic breast cancer receiving breast cancer surgery have been recruited since April 2017. Patients were then assigned to 3 arms in consecutive order. The surgeon operated without music in study arm A; the surgeon operated with slow music in study arm B; and in study arm C, the surgeon operated with fast background music. Patients' clinical records were reviewed by an independent blinded assessor.
Results:
Baseline demographic data were comparable among the 3 study arms. Seven (3.5%) patients from study arm A developed minor complications (Clavien-Dindo class I and II); none developed major complications (Clavien-Dindo class III or above). Six (3.0%) patients from study arm B and C, respectively (slow/fast music groups), developed minor complications; none developed a major complication. Mean blood loss was also similar among the 3 study arms (5.1, 5.1, and 5.2 mL, respectively; p > 0.05). Operating time was significantly shorter in study arm C: 115 minutes (90-145), compared with 125 minutes (100-160) in study arm A (p < 0.0001) and 120 minutes (95-155) in study arm B (p = 0.0024). After a median follow-up of 40 months (3-56), 40 months (3-56), and 39.5 months (3-56), the local recurrence rates were 1.5%, 1%, and 1%, respectively (p > 0.05).
Conclusion:
Playing music in the operating room is safe in general surgical settings in experienced hands.
... And for those who felt otherwise, impairment of the ability to detect alarm/sounds from theatre machines, possible loss of concentration, loss of ability to hear and listen to one another were their major concerns. These findings are in consonance with the reports from previous studies which raised issues about the use of music in operating theatre [49]- [51]. The potential effect of interference of music with personnel communication has been reported, with a call for discussions on guidance [49]- [51]. ...
... These findings are in consonance with the reports from previous studies which raised issues about the use of music in operating theatre [49]- [51]. The potential effect of interference of music with personnel communication has been reported, with a call for discussions on guidance [49]- [51]. Interference of loud music with sound of patient breathing and monitors used in the theatre is another issue of concern especially to the anesthetist [52], [53]. ...
Aim: To determine the opinion of operating theatre users on the role of operating theatre background music on theatre users and patients in tertiary health care facilities in Port Harcourt. Background: The relationship between music and health has been described by researchers. Music has been used in several hospital settings with effects which some consider beneficial and others harmful. Materials and Methods: This cross-sectional descriptive study was carried out among theatre users from March to June 2020 in two multispecialty tertiary healthcare facilities in Port Harcourt Nigeria. Using the convenience sampling method, data collected with pretested semi-structured questionnaires were analyzed using the Statistical Package for the Social Sciences (SPSS) version 20.0. Results: One hundred and twenty-one (82.9%) respondents asserted to knowledge of relationship between music and stress hormone. 97 (66.4%) agreed that music has positive effect on workers in the operating theatre. One hundred and seventeen (80.1%) respondents were of the opinion that background music in the operating theatre is not a distraction, while 22 (15.1%) respondents felt otherwise. One hundred and forty-four (98.8%) respondents agreed to usefulness of background music while at work. High proportion of respondents who lack knowledge of the relationship between stress hormone and music had no preference for operating theatre background music and the relationship was statistically significant (P<0.05). Conclusion: Operating theatre background music is useful as opined by the majority of operating theatre staff, though its preference is low among those with less knowledge of the positive relationship between such music and stress hormones.
... Besides possible positive effects on patients, also the medical personnel may profit from music in their working environment. In a questionnaire-based study among surgical staff comprising physicians as well as nurses, a majority reported regular use of music as a mean to reduce stress [7]. Another cross-sectional prospective study among healthcare professionals showed that music helps to improve concentration while soothing anxiety of the patient by "producing a sense of familiarity in a strange environment" [8]. ...
... This seems comparable to the results of another study examining healthcare providers' musical preferences and views of music in the ambulatory operating room where attending physicians showed significantly lower music enjoyment scores than nurses [13]. Another study Fig. 2 a Impact of music on respondents during CS and b presumed impact on patients during CS showed that the willingness to listen to music is higher among female healthcare professionals than among their male colleagues [7]. As the proportion of male respondents is significantly higher in the obstetricians group, this might also influence their behaviour when it comes to recommendations. ...
Purpose
Evidence abounds about the beneficial effects of music on patients and healthcare professionals for many medical indications. This study aimed to evaluate the dissemination and use of music in the obstetrical setting.
Methods
Invitations to an online survey were sent to physicians and midwives of all obstetrics departments in Germany. The survey gathered descriptive data as well as information about the personal relation to music and the use of it during vaginal birth (VB) and caesarean section (CS) and whether data about positive or negative effects of music were known to the participant.
Results
In total, there were 293 respondents. The 47% that had the means to play music during CS stated that music was played in 15% of the cases. Most respondents have the means to play music during VB (97%). Music is played in 38% of VB. Regardless of the mode of delivery, music was estimated to be positive for team communication and patient communication. It was also deemed calming and mood lifting on the respondents. Regarding the patient, music during CS and VB was rated as being positive on all scales. Listening to music was recommended more often during VB (66%) than CS (38%).
Conclusions
Although healthcare professionals are mostly aware of the beneficial effects of music in obstetrics, our study shows that music plays a more important role during VB than during CS in Germanys obstetrical wards. There is a lack of equipment to play music in operation theatres where CS take place.
... Our study did not find significant differences in perspectives on music among the professional groups, except for one question where nurses were more cautious about music in the operating room. Similar to our findings, other studies have reported that nurses tend to be more cautious than doctors about listening to music in the operating room, and women generally have a more positive attitude towards music than men (14). Additionally, our study found a negative correlation between increased professional experience and positive views on music, aligning with Hawksworth et al. (15) findings that older anesthesiologists felt music distracted them. ...
... Başka bir çalışmada ilahi söylemek, müzik dinlemek, şarkı sözü yazmak ve vurmalı çalgıları çalmanın hemşirelerin tükenmişlik seviyelerini azalttığını ve ruhsal sağlıklarını geliştirdiği görülmüştür (Finnerty et al., 2022). Ameliyathanede çalışan hemşire ve doktorlarla yapılan bir çalışmada, çoğunluğunu hemşirelerin oluşturduğu katılımcıların %78.9'u ameliyat sırasında müzik dinlemenin ruhsal sağlıklarını iyileştirdiğini ifade etmişlerdir (Ullmann et al., 2008). Müdahale grubundaki hemşirelere farkındalık temelli nefes ve müzik terapi uygulanan bir çalışmada hemşirelerin psikolojik iyi oluş puan ortalamalarının arttığı belirlenerek hemşirelerin ruh sağlığına iyi geldiği bulunmuştur (Yıldırım ve Yıldız, 2022). ...
Amaç: Bu araştırmanın amacı hemşirelerin ruh sağlığını geliştirme düzeyleri ve ilişkili faktörlerin incelenmesidir. Yöntem: Tanımlayıcı tipte olan bu araştırma bir vakıf üniversitesi hastanesinde çalışan 223 hemşire üzerinde gerçekleştirildi. Araştırma verileri “Hemşire Tanıtıcı Bilgi Formu” ve “Ruh Sağlığını Geliştirme Ölçeği” kullanılarak toplandı. Araştırmada elde edilen veriler bilgisayar ortamında SPSS 22.0 istatistik programı aracılığıyla değerlendirildi. Verilerin analizinde frekans, yüzde, ortalama, standart sapma, bağımsız gruplar t-testi, tek yönlü varyans analizi (Anova) ve post hoc (Tukey, LSD) analizleri kullanıldı. Bulgular: Hemşirelerin “Ruh Sağlığını Geliştirme Ölçeği” nden 187.9±25.7puan aldığı ve ruh sağlığını geliştirmek için girişimlerde bulunanların (x=190.9±25.3), hiçbir şey yapmayanlara (x=180.8±25.3) göre, ruh sağlığını geliştirme ölçeği puanı anlamlı düzeyde yüksek bulunmuştur (t=2.760; p=0.006
... Upon request, surgeons, anesthesiologists, and anesthetists may choose either to refrain from listening to music altogether during surgery or to opt for a specific genre. A comparison with studies conducted in Israel (Ullmann et al. 2008), the United Kingdom (Weldon et al. 2015), the United States (Butler 2022), Pakistan (Ahmad 2017), and New Zealand (Narayanan & Gray 2018) reveals that the decision to play music during surgical procedures is most commonly determined by the operating surgeons. ...
Listening to music during surgery is a widespread phe-nomenon in healthcare institutions globally. Music can have both positive and negative impacts on the stressful and challenging surgical process. Scientific studies by Kahloul et al. (2017), Zybartaite and Gedrime (2021), and Ahmad (2017) confirm that music is an effective and eco-nomical tool to reduce stress. According to Boghadady and Kvist (2020), playing classical music at a moderate volume can enhance the speed and accuracy of surgical tasks. However, it’s important to acknowledge that music may hinder communication and concentration (Naraya-nan & Gray 2018; Weldon et al. 2015; Shambo, Umad-hay & Pedoto 2015), and contribute to time inefficiencies arising from the selection of music types (Sarla 2022). This qualitative study, conducted through semi-structured interviews, aimed to analyze how music influences te-amwork during the perioperative stages. The study antici-pates contributing to patient safety, work efficiency, team satisfaction, and cost reduction in the healthcare system Results and conclusions: All participants had a positive view of listening to music during surgery, with prefe-rences varying across perioperative stages. Anesthesio-logists and operating room nurses often choose the type of music, while sometimes no specific team member is assigned to this role. Steady rhythm genres don’t dis-rupt communication and can alleviate emotional tension. High-rhythm genres may increase tension and fatigue, disrupting concentration. Fast-paced genres can improve mood, and different genres don’t necessarily affect surgi-cal duration. Slow-tempo genres may reduce emotional fatigue. High music volume can impair communication and concentration. An ideal music source in operating theaters should be compact, easily disinfected, and sim-ple to control.
... 31 Music is not only beneficial to the well-being of patients, but also shows positive effects on activities and services of medical staff. 32 Music therapy can be integrated in medical practice, complementing medical treatments, which makes it relevant and interesting for medical education. 33 Music therapy combines medicine with music and psychology, 34 which offers an insight into an area that is both scientifically and clinically relevant. ...
OBJECTIVES
Music therapy has been proven as a safe and well-established intervention in healthcare to relieve symptoms and improve quality of life. While music therapy is already established in several settings to supplement medical care, there is a lack of integration in the field of medical education.
METHODS
We report on the implementation and evaluation of a teaching concept for a five-day-intensive-course on music therapy. The course was offered as an elective course for medical students at the University Duisburg-Essen. At the end of the course, students filled out a free text questionnaire to assess the students’ perception of the course, and additionally answered standardized questions by the structured EVALuna online evaluation tool of the University of Duisburg-Essen.
RESULTS
All students (N = 35) who participated in the music therapy course between September 2019 and March 2023 completed the questionnaires and N = 21 students filled out the EVALuna. Most students (89%) chose the course because of their interest in alternative and supportive therapy options to improve patients’ well-being. About 46% had previous musical experience and passion and fun with music and 37% of the students were interested in the interdisciplinary academic subject that combined music and medicine. EVALuna online evaluation reflected high satisfaction with the course.
CONCLUSION
Due to the well-proven effectiveness and evidence of music therapy as well as the positive perception of medical students, music therapy should be further established in medical care and medical education.
... It is hypothesized that music has positive effects on performance, teamwork, concentration, and stress [7]. In clinical practice, it has seen that music played in the operating room is mostly selected by the senior surgeon or the team [8] [9]. Whether music is useful or harmful in the operating room is still a controversial question. ...
... Music has been used in medical treatment to reduce pain and anxiety [1]. Music, which is commonly played in operating rooms during surgical procedures, has a positive effect on the surgical team [2] considering that not only the patient but also the surgeon may feel tense and stressed. Surgeons' stress can negatively affect their skills [3], which can have adverse consequences for the patients. ...
Background:
Music has been used to reduce stress and improve task performance during medical therapy.
Aim:
To assess the effects of music on colonoscopy performance outcomes.
Methods:
We retrospectively reviewed patients who underwent colonoscopy performed by four endoscopists with popular music. Colonoscopy performance outcomes, such as insertion time, adenoma detection rate (ADR), and polyp detection rate (PDR), were compared between the music and non-music groups. To reduce selection bias, propensity score matching was used.
Results:
After one-to-one propensity score matching, 169 colonoscopies were selected from each group. No significant differences in insertion time (4.97 vs 5.17 min, P = 0.795) and ADR (39.1% vs 46.2%, P = 0.226) were found between the two groups. Subgroup analysis showed that the insertion time (3.6 vs 3.8 min, P = 0.852) and ADR (51.1% vs 44.7%, P = 0.488) did not significantly differ between the two groups in experts. However, in trainees, PDR (46.9% vs 66.7%, P = 0.016) and ADR (25.9% vs 47.6%, P = 0.006) were significantly lower in the music than in the non-music group.
Conclusion:
The current study found that listening to music during colonoscopy did not affect procedure performance. Moreover, it suggested that music may distract trainees from appropriately detecting adenomas and polyps.
... There are benefits to distractions in the OR as well such as improving team relationships, reducing stress via music (Allen & Blascovich, 1994;Kyrillos & Caissie, 2017;Siu et al., 2010;Ullmann et al., 2008). However, as nurse participants also mentioned, loud music can hinder communication (Weldon et al., 2015). ...
Distractions can interfere with surgical tasks and may negatively impact task performance, surgery duration, and mood of surgical team members. A mixed-methods study was conducted to examine the prevalence and potential effects of distractions during general surgery, in particular during the surgical procedure and post-operative counts. An audio-video recording platform named the OR BlackBox® was used to record data from 40 surgical cases, which was in turn coded by multiple raters. Supporting qualitative data was collected through interviews with four OR staff members. The audio-video data revealed that distractions occurred on the average about every three minutes during the surgical procedure, and most frequently observed effect was distracted members not noticing other members’ requests. Twenty-nine of the cases had at least one changeover during the surgical procedure whereas overall four changeovers occurred during post-operative counts; in one of these cases the count was repeated, resulting in a delay of almost 15 minutes. Other distractions (OR traffic, communication, and others) were frequent both during the surgical procedure (M=0.39 per minute per case, SD=0.15) and post-operative counts (M=0.75 per minute per case, SD=0.44). The interviews were preliminary in nature and provided additional insights on the effects of OR distractions and potential mitigation strategies to inform future OR distraction research.
... Music is commonly allowed during surgery in many operating theatres worldwide. Surgical staff has reported that music can reduce stress and increase efficiency [1][2][3][4]. Several studies have examined the impact of background music on surgical performance [5][6][7]. ...
Background
Acoustic conditions in the operating room have different impacts on surgeon’s performance. Their effects on the performance of surgical teams are not well documented. We investigated if laparoscopic teams operating under pleasant acoustic conditions would perform better than under noisy conditions.
Methods
We recruited 114 surgical residents and built 57 two-person teams. Each team was required to perform two laparoscopic tasks (object transportation and collaborative suturing) on a simulation training box under music, neutral, and noisy acoustic conditions. Data were extracted from video recordings of each performance for analysis. Task performance was measured by the duration of time to complete a task and the total number of errors, and objective performance scores. The measures were compared over the three acoustic conditions.
Results
A music environment elicited higher performance scores than a noisy environment for both the object transportation (performance score: 66.3 ± 8.6 vs. 57.6 ± 11.2; p < 0.001) and collaborative suturing tasks (78.6 ± 5.4 vs. 67.2 ± 11.1; p < 0.001). Task times in the music and noisy environments was subtracted to produce a music-noisy difference time. Pearson correlation coefficient analysis showed a significant negative relationship between the team experience score and the music-noisy difference time on the object transportation ( r = − 0.246, p = 0.046) and collaborative suturing tasks ( r = − 0.248, p = 0.044).
Conclusions
As to individuals, music enhances the performance of a laparoscopy team while a noisy environment worsens performance. The negative correlation between team experience and music-noisy difference time suggests that laparoscopy teams composed of experienced surgeons are less likely affected by an acoustic distraction than the noisy teams. Team resistance to acoustic distraction may lead to a new way for assessing team skills.
... In the research in healthcare, most researchers regard soundscape as a means of reducing noise. [11][12] Improving the soundscape can relieve stress for patients, increase patience and work enthusiasm for medical staff, and enhance the comfort of the hospital environment. [13] Some studies have proved that soundscape as a non-pharmacological intervention can positively affect people suffering from diseases in recent years. ...
... In the research in healthcare, most researchers regard soundscape as a means of reducing noise. [11][12] Improving the soundscape can relieve stress for patients, increase patience and work enthusiasm for medical staff, and enhance the comfort of the hospital environment. [13] Some studies have proved that soundscape as a non-pharmacological intervention can positively affect people suffering from diseases in recent years. ...
... In line with these early findings, questionnaire studies assessed the subjectively perceived effects of music listening at work. In one study, it was reported that 63 percent of physicians and nurses like to listen to music in the operation room (Ullmann et al., 2008). A recent study (Haake, 2011) explored music listening habits of employees who select their individual music during work. ...
Recent findings suggest that music listening plays an important role in affect and arousal modulation. Individuals use music to enhance their well-being and counteract negative affect in numerous everyday situations. We investigated whether listening to preferred, non-preferred, or no music altered affect, arousal, psychological and physical health, and stress. Thirty police officers participated in the study. After a baseline assessment, participants were divided into three experimental groups: Group 1 listened to their preferred music; Group 2 listened to their non-preferred music; and Group 3 did not listen to any music. The manipulation was maintained over a period of 7 days. At the end of each day, participants filled out questionnaires concerning their current affect, arousal, psychological and physical health, and stress. Results indicate that the no music group showed significant decreases in affect and psychological and physical health, and significant increases in stress levels compared with the other groups. In contrast, no statistical differences were observed between the non-preferred music group and the preferred music group. We conclude that not listening to any music might be followed by discomfort. We recommend music listening in everyday life for supporting health.
... The World Health Organization (WHO) recommends nighttime noise levels in hospitals not exceed 30 dB [8], yet studies have found the average nighttime levels are range from 42-60 dB while daytime levels range from 57-72 dB [9,10]. The overall noise level in hospital settings, including the OR, can be detrimental to both patient recovery and clinician performance [11][12][13]. ...
In high-consequence industries such as health care, auditory alarms are an important aspect of an informatics system that monitors patients and alerts providers attending to multiple concurrent tasks. Alarms levels are unnecessarily high and alarm signals are uninformative. In a laboratory-based task setting, we studied 25 anesthesiology residents’ responses to auditory alarms in a multitasking paradigm comprised of three tasks: patient monitoring, speech perception/intelligibility, and visual vigilance. These tasks were in the presence of background noise plus/minus music, which served as an attention-diverting stimulus. Alarms signified clinical decompensation and were either conventional alarms or a novel informative auditory icon alarm. Both alarms were presented at four different levels. Task performance (accuracy and response times) were analyzed using logistic and linear mixed-effects regression. Salient findings were 1), the icon alarm had similar performance to the conventional alarm at a +2 dB signal-to-noise-ratio (SNR) (accuracy: OR 1.21 (95% CI 0.88, 1.67), response time: 0.04 s at 2 dB (95% CI: –0.16, 0.24), which is a much lower level than current clinical environments; 2) the icon alarm was associated with 27% greater odds (95% CI: 18%, 37%) of correctly addressing the vigilance task, regardless of alarm SNR, suggesting crossmodal/multisensory multitasking benefits; and 3) compared to the conventional alarm, the icon alarm was associated with an absolute improvement in speech perception of 4% in the presence of an attention-diverting auditory stimulus (p = 0.031). These findings suggest that auditory icons can provide multitasking benefits in cognitively demanding clinical environments.
... Music is commonly allowed during surgery in many operating theatres worldwide. Surgical staff has reported that music can reduce stress and increase e ciency [1][2][3][4]. Several studies have examined the impact of background music on surgical performance [5][6][7]. ...
BACKGROUND: Music and noise have different impacts on individuals in the operating room. Their effects on the performance of surgical teams in simulated environments are not well documented. We investigated if laparoscopic teams operating under favorable acoustic conditions would perform better than under noisy conditions.
METHODS: We recruited 114 surgical residents and built 57 two-person teams. Each team was required to perform two laparoscopic tasks (object transportation and collaborative suturing) on a simulation training box under musical, neutral, and noisy acoustic conditions. Data were extracted from video recordings of each performance for analysis. Task performance was measured by the duration of time to complete a task and the total number of errors, and objective performance scores. The measures were compared over the three acoustic conditions.
RESULTS: A musical environment elicited higher performance scores than a noisy environment for both the object transportation (performance score: 66.3 ± 8.6 vs. 57.6 ± 11.2; p < 0.001) and collaborative suturing tasks (78.6 ± 5.4 vs. 67.2 ± 11.1; p < 0.001). Task times in the musical and noisy environments was subtracted to produce a musical-noisy difference time. Pearson correlation coefficient analysis showed a significant negative relationship between the team experience score and the musical-noisy difference time on the object transportation (r = -0.246, p = 0.046) and collaborative suturing tasks (r = -0.248, p = 0.044).
CONCLUSIONS: As to individuals, music enhances the performance of a laparoscopy team while noise worsens performance. The negative correlation between team experience and musical-noisy difference time suggests that laparoscopy teams composed of experienced surgeons are less likely affected by an acoustic distraction than novice teams. Team resistance to acoustic distraction may lead to a new way for assessing team skills.
... Here, music is being played in the background for the purpose of entertaining surgical staff, which must be distinguished from music being played in the preoperative setting to reduce anxiety among patients before surgery [18]. The decision as to whether music will be played in the OR or the kind of music that is chosen is predominantly the privilege of the senior surgeon [19]. The effect of music in this specific occupational setting is difficult to quantify. ...
Background
The influence of music on the performance of surgical procedures such as laparoscopy is controversial and methodologically difficult to quantify. Here, outcome measurements using laparoscopic box training tools under standardized conditions might offer a feasible approach. To date, the effect of music exposure at different sound pressure levels (SPL) on outcome has not been evaluated systematically for laparoscopic novices.
Methods
Between May 2017 and October 2018, n = 87 students (49 males, 38 females) from Heidelberg University Medical School performed three different laparoscopy exercises using the “Luebecker Toolbox” that were repeated twice under standardized conditions. Time was recorded for each run. All students were randomly assigned to four groups exposed to the same music compilation but at different SPLs (50–80 dB), an acoustically shielded (earplug) group, or a control group (no intervention).
Results
Best absolute performance was shown under exposure to 70 dB in all three exercises (a, b, c) with mean performance time of 121, 142, and 115 s ( p < 0.05 for a and c). For the control group mean performance times were 157, 144, and 150 s, respectively. In the earplug group, no significant difference in performance was found compared to the control group ( p > 0.05) except for exercise (a) ( p = 0.011).
Conclusion
Music exposure seems to have beneficial effects on training performance. In comparison to the control group, significantly better results were reached at 70 dB SPL, while exposure to lower (50 or 60 dB) or higher (80 dB) SPL as well as under acoustic shielding did not influence performance.
... One study on the music preferences of physicians and nurses working in the OR at three hospitals in Israel revealed that 45% of participants preferred classical music and that fewer preferred folk music (29.8%), rock (12.3%), jazz (10.5%), or blues (9.4%) played in the OR. 3 Cultural differences might be relevant because by contrast, in a hospital setting in Nigeria, the majority of the OR staff Correspondence: Inquiries to: Fabian Riedel, MD Heidelberg University Hospital Department of Gynecology and Obstetrics Im Neuenheimer Feld 440 D-69120 Heidelberg, Germany Phone: 0049 06221 56-37366; e-mail: fabian.riedel@med. uni-heidelberg.de ...
Purpose
Whether and how music influences the performance of surgical procedures such as laparoscopy is unclear and can be feasibly determined using laparoscopic box training tools under standardized conditions. The aim of this prospective study is to evaluate the effect of different genres of music on the performance of laparoscopic novices.
Methods
Between May 2018 and December 2018, n = 82 students (38 male, 44 female) from Heidelberg University Medical School performed 3 different laparoscopic exercises (A, B, C) from the “Luebecker Toolbox” with 2 repetitions each under standardized conditions. Time was recorded for each exercise. The students were assigned either to one of four groups, each of which was exposed to a compilation of music from 1 genre (hip hop, classical, rock, or mixed radio music), or to a fifth, control group, without exposure to music. The music was played at a constant sound pressure level of 70 decibels . Each group was compared with the others using a t-test for independent samples.
Results
Exposure to music generally led to better performance compared with the control group. Compared with exposure to mixed radio music or to rock, significantly better performance could be demonstrated for exposure to classical music in Exercise B, with an average exposure time of 127 s needed (± 21.4; p < 0.05). No significant differences could be demonstrated for Exercise A, though for classical music, best performance was possible with 120 s (±17.3) of exposure. In Exercise C, hip hop triggered significantly better performance than rock or radio music (p < 0.05).
Conclusions
At an sound pressure level of 70 decibels, exposure to classical music or hip hop appears to have beneficial effects on training performance for surgical novices under standardized conditions.
... Other similar studies obtained from the literature review have reported mean noise levels in operating rooms to differ between 55 dB and 80 dB. 2,[23][24][25][26][27] The results of the study are similar to the literature. Surgical procedures performed, the tools used and the number of employees are standard in all operating room environments, which might explain similar results. ...
Background
The study was conducted to assess operating room noise levels and to investigate its effects on medical staff.
Methods
Single‐blind study. This study was conducted with 92 medical staff working in 11 operating rooms of a university hospital. Data was collected using a personal information form and sound level measuring devices. Sound measurements were made 3 days a week in the morning and in the afternoon, twice a day and lasted 15 min each. Mean values of the measurements in each room were collected and recommended maximum values for operating rooms (35 dB during daytime) by the World Health Organization were set as a reference point.
Results
The highest noise level was measured in orthopaedic (67.5 dB), and the lowest in gynaecology room (55.5 dB). Daily mean noise level of all operating rooms was 60.90 dB. Noise disturbance score measured with Visual Analogue Scale was 6.66 ± 1.84. Of the medical staff, 84.8% were physiologically, 93.5% psychologically, and 82.6% both physiologically and psychologically affected. Of those affected physiologically, 51.1% experienced fatigue, and 33.7% headache, and of those affected psychologically, 43.5% experienced inattentiveness, 34.8% agitation and 15.2% restlessness. Only 4.34% reported not being affected by the noise.
Conclusion
Operating room noise levels were higher than normal limits set by the World Health Organization, which affected the medical staff both physiologically and psychologically. Since experienced negativities may reduce medical staff's motivation and increase error making, making arrangements to control noise levels is recommended.
I will explore what Sports Psychology has to offer because it deals with the reactions and responses to stress and their effect on performance under pressure but also how to prepare to perform at your best. There is an increasing interest in applying Sports Psychology techniques to healthcare (Sandars et al. Sandars et al., Med Teach 44:71–78, 2022). Surgery involves making many decisions, often under pressure, often with uncertain outcomes, in an ever-changing surgical environment, and this results in a degree of stress felt in the body and the mind. Some stress can be helpful but too much can result in a failure to perform or even ‘Catastrophe’. Pressure can come externally from the need to deliver high volumes, complexity of cases, complications, theatre environment, bureaucracy and the team as well as internally with the fear of failure ranking highly. I will explore ‘failure’ in ‘Part II’. Character traits and personality might also play a role although and I will explore these in ‘Part III’.
Bei medizinischen Operationen wird häufig Musik gehört, wobei keine Richtlinien für diese
Musik bestehen. In der aktuellen Literatur befassen sich nur wenige Untersuchungen mit
Einflussfaktoren des medizinischen Behandlungspersonals auf die Einstellung zu perioperativem
Musikkonsum. Ein besseres Verständnis dieser Zusammenhänge könnte das Arbeitsumfeld
des Operationssaals (OP) sowie letztlich auch die Teamdynamik des Behandlungspersonals
verbessern. In dieser Untersuchung wurde eine Onlinebefragung mit medizinischem
Behandlungspersonal in OPs beziehungsweise Katheterlaboren (N = 119) durchgeführt. Daten
zur Einstellung und zu musikalischen Vorlieben im OP wurden anhand standardisierter Fragebögen
sowie neu formulierter Items erhoben. Als Ergebnis konnten die bisherige Erfahrung
mit Musik im OP und die antizipierte Übereinstimmung der gewünschten Musik mit den Vorlieben
anderer Personen als signifikante Prädiktoren für die Bereitschaft zu perioperativem
Musikkonsum identifiziert werden. Weiterhin stellte sich ein Alterseffekt heraus: Je jünger
das Behandlungspersonal ist, desto höher die Bereitschaft zum perioperativem Musikhören.
Außerdem zeigte pflegerisches Personal eine höhere Bereitschaft im Vergleich zu ärztlichem
Personal. Der individuelle Musikgeschmack hängt mit dem gewünschten musikalischen
Genre im Operationssaal zusammen. Die Ergebnisse dieser Untersuchung bekräftigen die
Bedeutung der Musikauswahl für das Behandlungspersonal. Weiterhin konnte durch den
Alterseffekt sowie das Konstrukt der antizipierten Übereinstimmung der gewünschten Musik
im OP der bisherige Forschungsstand um neue Perspektiven ergänzt werden.
Snake bites accounts for a less common yet significant morbidity and mortality among farmers, plantation workers and those outdoor labour workers, especially in those countries with heavy greeneries and forestry – Malaysia is one example (1). Statistically about 5 million people per year are bitten by snakes and approximately 0.02% - approximately 100,000 develops complication or sequelae from the bites (1). Bites from these venomous snakes can cause local and systemic envenomation that can lead to a life-threatening medical crisis (2). These snakes are prevalent in many tropical and subtropical countries. Malaysian data and literature on the snakebites and epidemiology is scarce. Snake bite incidences are not notifiable diseases in Malaysia however a quantitative data is available in the Malaysian Health Informative Centre (2).
Dysplasia Epiphysealis Hemimelica (DEH) is a rare skeletal developmental disorder involving epiphyses of long bones. It primarily emerges during childhood and is characterised by an osteocartilaginous overgrowth involving epiphyses of long bones. Although the exact aetiology of DEH remains elusive, it can be treated conservatively or surgically via excision or corrective osteotomies, depending on the patient's clinical presentation. Radiological imaging must be carried out before surgery to prevent expected intraoperative complications if the patient is planned for surgical intervention. We are reporting a case of an 8-year-old child who presented with left knee pain with imaging demonstrating a DEH. The patient then underwent surgery. The patient had a rapid recovery following several rehabilitation sessions, and no recurrence was reported at the follow-up. The surgical outcome of DEH is unpredictable and largely dependent on several factors. Surgical options should be offered only to those with impacted symptoms.
High stress may diminish a surgeon’s performance in the operating room (OR). Music is perceived to reduce stress in the OR, however the psycho-physiological effects of music on intra-operative stress in inexperienced and experienced operators is incompletely understood. The effect of music on the psychological (Six-Item State-Trait Anxiety Inventory [STAI-6] and Surgical Taskload Index [SURG-TLX]) and physiological responses (e.g., heart rate variability) was determined to a simulated surgical task (carotid patch-angioplasty) in 15 medical students (MS) and 12 vascular surgeons (VS) under stressing conditions in a randomised crossover design. Music did not affect the speed or accuracy of the simulated surgical stress task performance. While the surgical task increased SURG-TLX scores from baseline to control (D32 [22–42]; mean difference [95% confidence interval]) and to music (D30 [20–40]), and increased STAI-6 scores in both conditions, there was no difference between music and control. The surgical task also increased heart rate (peak D5.1bpm [3.0-7.1] vs. baseline p < 0.0001) and cardiac sympathetic nervous system activity (SNS index), and reduced parasympathetic (PNS index) nervous system activity, with the latter two exacerbated by music (SNS: 0.14 [0.004–0.27], p = 0.042; PNS: -0.11 [-0.22 - -0.008], p = 0.032). The more experienced group performed faster and more accurately than the inexperienced group, but there were no psychological or physiological differences in their responses to music. Despite previous research identifying generally positive surgeon perceptions of music on the intra-operative experience of stress, herein, background music failed to improve surgical task performance or attenuate subjective ratings of task load and anxiety, and physiological arousal.
In the area of dental healthcare services, where patients and professionals deal with multiple auditory stimuli, this cross-sectional study reports on the intricate dynamics of sound preferences, noise obstacles, and the profound impact of music on anxiety reduction within dental office set-tings. The sample comprises of 134 dental patients, primarily females (56.7%), with varying age groups, education levels, and therapy durations in the university clinics of the department of Dentistry, National and Kapodistrian University of Athens and four private dental offices at the metropolitan area of Athens, Greece. Notably, 92.5% of the participants report no hearing loss, and 56.7% exhibit some level of noise sensitivity. The study reveals a moderate to good perceived health status (M=3.84, SD=0.95) among participants, with low perceived noise disturbance in university dental clinics. Preferences for instrumental music, foreign pop, and classical music are prominent during waiting times. Potential irritations include impersonal treatment (44%) and staff behavior (41.8%). Music player usage within the settings of the dental clinic involves radios (49.3%) and headphones (41.0%). Correlations and predictors indicate associations between health status, music preferences, and noise disturbances. More specifically, visiting the university dental clinics (β = .300, p = .005) as well as younger age (β = .300, p = .034) were significant predictors of better perceived health status. Clearer perception of external sounds while using the music player (β = .190, p = .039) was a significant predictor of better perceived health status, while poorer health was predicted by the preference of Greek folk songs (β = -.200, p = .030). Also, the use of smartphones for playing music was related to poorer health (β = -.370, p < .001). Following, younger age (β = -.270, p = .015), lower education (β = -.210, p = .035), higher noise sensitivity (β = .190, p = .027), as well as feelings of anxiety and nervousness due to ambient noise from people and machines (β = .510, p = .027) were significant predictors of noise disturbance from machines. Also, visiting private clinics (β = .240, p = .018), preferences of specific playlist (β = .310, p = .012), no music (β = .280, p = .016) and use of smartphones to play music (β = .230, p = .029) were significant predictors of noise disturbance from patients or staff. Finally, the preference of listening to a specific playlist was related to better health status (r = .190, p < .05). Findings aim to optimize eco-soundscapes in dental offices, con-tributing to enhanced patient well-being. The research underscores the potential of music inter-ventions to alleviate dental anxiety and improve the overall dental experience and quality care.
This chapter focuses on the array of technologies and technical objects within an operating unit, showing their essential role in the performance of everyday activities, and thus how organizational and work practices ‘materialize’ through different artifacts and technologies. From an interpretative point of view, the chapter proposes the metaphor of ‘flirtation’ to catch one of the main characteristics of everyday work in the operating room. That is, the unpredictable yet intimate relationship that arises between actors and technical objects in the operating room.
Finally, the chapter makes a point regarding the presence, the use, and the interferences of two ‘mundane’ technologies common to find in the operating room and which served as a background to the flow of activities: the radio and the smartphone.
Background
Music is part of operating room (OR) culture; however, some personnel may perceive music as a distraction.
Methods
A single institution survey of surgeons (SURG), anesthesia (ANES), and nursing (NURS) regarding attitudes on music in the OR.
Results
There were 222 responses (67% response rate) agreeing that music in the OR should be allowed (91%), is calming (75%), and helps with focus (63%). Most did not feel music was distracting (63%) or unsafe (80%). SURG were more likely to state that surgeons should decide (46.7%) if music should be played, whereas ANES and NURS (81%) were more likely to feel decisions should be made collaboratively (P < .001).
Conclusion
Most OR personnel feel positively towards music. Surgeons were more likely to believe the decision to play music should be the surgeon’s choice. The majority of OR staff agreed with collaborative decision-making, aligning with creating a safe OR culture.
Music is commonly played in the operating rooms and contributes to overall noise level. High noise levels in the operating room, often surpassing the National Institute for Occupational Safety and Health recommendations, affect clinician communication and vigilance. This study's primary aim was to reduce clinician response time to alarms to improve quality of care to patients undergoing general anesthesia. The aim of this quality improvement project was to reduce clinician response time to vital sign alarms with the tested intervention of the CanaryBox device to modulate music volume in the OR by August of 2021. Utilizing improvement science methods including the Model of Improvement and tested interventions via the Plan-Do-Study-Act cycles, we utilized the CanaryBox in the pediatric orthopedic operating rooms at Monroe Carell Jr. Children's Hospital at Vanderbilt. This device modulates music volume according to the severity of patient vital sign deviations. Timestamps of onset and response to patient vital alarms, recorded by the Philips IntelliVue Information Center system, were collected for 12 control (pre-intervention) and 58 intervention (with the CanaryBox) cases. Median and average response times were calculated for pre- and post-intervention cases. There was an associated decrease (improvement) in average clinician alarm response times from 30.2 seconds in pre-intervention cases to 23.6 seconds with CanaryBox intervention cases. Improved clinician response times with implementation of the CanaryBox imply less distraction due to unnecessary noise levels at critical periods. This improved vigilance and decreased response time indicate clinicians provide higher levels of patient care when the CanaryBox is modulating music volume.
Objective
To determine the effect of music and surgeon-directed questions on suturing speed.
Study design
Randomized observational study.
Sample population
Fifty-five faculty veterinarians, residents, interns, and fourth-year veterinary students.
Methods
Experience, gender, and favorable and unfavorable music choices were self-declared by participants. Each person performed four timed suture trials, which required them to complete a simple 10 cm continuous suture pattern on a model. The initial trial served as practice and did not include music or questions. The order of the three remaining trials was randomized, and consisted of one trial each with favorable music, unfavorable music, and required the participant to answer 2 questions. Trial duration was compared using a mixed effects linear model. Influence of gender and experience on participants’ categorical responses to 2 different questions was evaluated using a Pearson χ² test and Fisher's exact test, respectively. Stratified analysis was used to evaluate further the effect of experience and gender.
Results
Question trials were on average 8.1 s longer than favorable music trials (P = .008), with no notable difference found between unfavorable and favorable music or unfavorable music and question trials. Experience (P = .021) and gender (P = .033) influenced participants’ response to question 1 but not question 2 (P = .267 and P = .839, respectively).
Conclusion
Listening to favorable music, rather than answering questions, may result in decreased closure times. This influence was greater for less experienced individuals and less experienced male veterinarians and veterinary students.
Clinical significance
The absence of questions may increase suturing speed, particularly for minimally experienced surgeons or when instruction is taking place in a surgical laboratory setting.
Introduction
Music is commonly played in operating theatres throughout the world though its use remains controversial. There is growing literature supporting the notion that playing background music can improve a surgeon’s task performance and reduce performance stress. We present findings from our survey of surgeons about their perceptions of the effect of intra-operative music on their stress levels.
Methodology
Surgeons and registrars from three different specialties – general, vascular, and paediatric surgery – in a single tertiary centre were surveyed on their views on the effect of music in theatre. Two instruments were used to assess parameters of stress: the modified 6-point state trait anxiety inventory (STAI-6) and the surgical task load index (SURG-TLX).
Results
There were 35 respondents across the three surgical specialties (78% response rate). Pop and “easy listening” were the most popular genres. A majority felt music improved their temperament (75%) and perceived stress (63%). 59% of respondents reported no to low perceived anxiety with music, compared with 31% reporting moderate and 9% high anxiety based on STAI-6 parameters. Regarding SURG-TLX parameters and music, respondents overall perceived feeling less anxious, rushed and mentally fatigued though more distracted.
Conclusions
Music is generally thought to have positive subjective effects on the theatre environment with regards to anxiety levels, temperament, perceived stress, and parameters within the surgical task load index. This is counterbalanced by a smaller group of respondents who felt that music can impair communication and increase distraction within theatre. Music used appropriately may reduce perceptions of stress in theatre.
Music has traditionally been part of the culture of many operating room theatres around the world with a purported myriad of benefits to the patient, surgeon, and other staff. However, hospital noise levels have risen all around the world, and the operating room is no exception. While certain noises are unavoidable in the operating room, playing music is optional. Thus, as we continue efforts to improve surgical care, the decision to play music must be weighed against its potential as a further source of disturbance. The purpose of this article is to review sources of distractions in the OR, discuss the potential pros and cons of music, for both health care personnel as well as patients, and to delve into studies analyzing the effect of music on surgical trainees, as learners may be particularly vulnerable to noise. This review provides guidance as to how to optimize the OR environment so as to enhance teamwork and communication. We feel that the decision of whether to play music in the operating should be a shared decision between all operating room personnel, with more research needed to form a basis on how to improve operating room communication regarding noise pollution and music.
This study was designed to determine whether music (M), or music in combination with therapeutic suggestions (M/TS) could improve the postoperative recovery in the immediate postoperative in daycare surgery.
One-hundred and eighty-two unpremedicated patients who underwent varicose vein or open inguinal hernia repair surgery under general anaesthesia were randomly assigned to (a). listening to music (b). music in combination with therapeutic suggestions or (c). blank tape in the immediate postoperative period. The surgical technique, anaesthesia and postoperative analgesia were standardized. Analgesia, the total requirement of morphine, nausea, fatigue, well-being, anxiety, headache, urinary problems, heart rate and oxygen saturation were studied as outcome variables.
Pain intensity (VAS) was significantly lower (P = 0.002) in the M (2.1), and the M/TS (1.9) group compared with the control group (2.9) and a higher oxygen saturation in M (99.2%) and M/TS (99.2%) group compared with the control (98.0%), P < 0.001, were found. No differences were noted in the other outcome variables.
This controlled study has demonstrated that music with or without therapeutic suggestions in the early postoperative period has a beneficial effect on patients' experience of analgesia. Although statistically significant, the improvement in analgesia is modest in this group of patients with low overall pain levels.
Music played to staff in the operating theatre is thought to improve surgeons’ concentration but its effects on other theatre staff are unknown. We surveyed 200 anaesthetists to determine the prevalence of music playing in the operating theatre and anaesthetists’ attitudes to it. The response rate was 72% and of these 72% (104) worked in a theatre where music was played regularly. Around 26% of the sample felt that music reduced their vigilance and impaired their communication with other staff while 11.5% felt that music might distract their attention from alarms. Fifty-one per cent felt that music was distracting when a problem was encountered during the anaesthetic.
Management of pain is a primary concern in the treatment of burn patients. The intent of this study was to test the efficacy of music-based imagery and musical alternate engagement in assisting burn patients in managing their pain and anxiety during debridement. Twenty-five patients, 7 years of age and older, who were admitted to the Comprehensive Burn Care Center were enrolled in the study, which used a repeated-measures design with subjects serving as their own control. Subjects were randomly assigned to 1 of 2 groups. Those placed in Group A received music therapy intervention during their first dressing change, and no music therapy on the following day. Group B received no music therapy intervention during their first dressing change and music therapy during their next dressing, on the following day. Data were collected at 4 intervals in the medical procedure; in the patient's room before transfer to the treatment room, in the treatment room during debridement, in the treatment room after debridement, and upon returning to the patient's room. The measurements taken were pulse, patients' self-report of pain, patients' self-report of anxiety, and the nurse's observation of patients' tension. There was a significant reduction in the self-reporting of pain in those who received music therapy in contrast to those who did not receive music therapy (P < .03). Music therapy is a valuable noninvasive intervention for the treatment of pain after burn injury.
Music is frequently played in operating theatres, but may prove distracting to anaesthetists. We undertook a laboratory-based study of the effects of music on the psychomotor performance of 12 anaesthetic trainees. Using part of the computer-based PsychE psychomotor evaluation programme, we were unable to demonstrate any effect of self-chosen music, silence, white noise or classical music on their performance in these tests.
Sound levels during a typical major operation were measured to identify the main sources of noise in the operating theatre. Although overall sound levels were within the recommended levels for a satisfactory working environment, loud intermittent noises of up to 108 dB were emitted from sources such as suckers, "intercoms", and alarms on anaesthetic monitoring devices. The noisiest time was usually during the preparation period of the operation; during surgery, noise levels were much higher than levels of normal speech between staff. Preferred speech interference levels were often exceeded which made communication difficult and sometimes impossible. Communication and concentration were also disrupted by unnecessary background conversation.
To determine the effects of surgeon-selected and experimenter-selected music on performance and autonomic responses of surgeons during a standard laboratory psychological stressor.
Within-subjects laboratory experiment.
Hospital psychophysiology laboratory.
A total of 50 male surgeons aged 31 to 61 years, who reported that they typically listen to music during surgery, volunteered for the study.
Cardiac responses, hemodynamic measures, electrodermal autonomic responses, task speed, and accuracy.
Autonomic reactivity for all physiological measures was significantly less in the surgeon-selected music condition than in the experimenter-selected music condition, which in turn was significantly less than in the no-music control condition. Likewise, speed and accuracy of task performance were significantly better in the surgeon-selected music condition than in the experimenter-selected music condition, which was also significantly better than the no-music control condition.
Surgeon-selected music was associated with reduced autonomic reactivity and improved performance of a stressful nonsurgical laboratory task in study participants.
Music played to staff in the operating theatre is thought to improve surgeons' concentration but its effects on other theatre staff are unknown. We surveyed 200 anaesthetists to determine the prevalence of music playing in the operating theatre and anaesthetists' attitudes to it. The response rate was 72% and of these 72% (104) worked in a theatre where music was played regularly. Around 26% of the sample felt that music reduced their vigilance and impaired their communication with other staff while 11.5% felt that music might distract their attention from alarms. Fifty-one per cent felt that music was distracting when a problem was encountered during the anaesthetic.
Exposure to noise in a critical care unit may trigger a response by the sympathetic nervous system, thereby increasing cardiovascular work in patients recovering from cardiac surgery.
To investigate the effects of a music intervention given twice on the first postoperative day on noise annoyance, heart rate, and arterial blood pressure in subjects with high (n = 22) and low (n = 18) sensitivity to noise.
A prospective, quasi-experimental, repeated-measures design was used. Based on results of power analysis, the sample size was 40. Subjects were recruited preoperatively, and their sensitivity to noise was assessed. On the first postoperative day, repeated-measures data were collected on levels of noise annoyance and physiological variables during 15 minutes of baseline and 15 minutes of music intervention on two occasions. Subjects completed a follow-up questionnaire regarding their perceptions of the noise in the critical care unit and the music intervention.
Repeated-measures analysis of variance showed that subjects had lower levels of noise annoyance during music intervention than at baseline. Heart rate and systolic blood pressure decreased during the music intervention compared with baseline. Diastolic blood pressure decreased during the music intervention from baseline during time 2, but not time 1. Subjects with high baseline scores of noise sensitivity preoperatively had higher baseline levels of noise annoyance in the critical care unit the first postoperative day. Subjects rated the music intervention as highly enjoyable regardless of their baseline noise sensitivity or noise annoyance.
Results of this study support the idea that noise annoyance is a highly individual phenomenon, influenced by a transaction of personal and environmental factors. Use of a music intervention with cardiac surgery patients during the first postoperative day decreased noise annoyance, heart rate, and systolic blood pressure, regardless of the subject's noise sensitivity.
Management of pain is a primary concern in the treatment of burn patients. The intent of this study was to test the efficacy of music-based imagery and musical alternate engagement in assisting burn patients in managing their pain and anxiety during debridement. Twenty-five patients, 7 years of age and older, who were admitted to the Comprehensive Burn Care Center were enrolled in the study, which used a repeated-measures design with subjects serving as their own control. Subjects were randomly assigned to 1 of 2 groups. Those placed in Group A received music therapy intervention during their first dressing change, and no music therapy on the following day. Group B received no music therapy intervention during their first dressing change and music therapy during their next dressing, on the following day. Data were collected at 4 intervals in the medical procedure; in the patient's room before transfer to the treatment room, in the treatment room during debridement, in the treatment room after debridement, and upon returning to the patient's room. The measurements taken were pulse, patients' self-report of pain, patients' self-report of anxiety, and the nurse's observation of patients' tension. There was a significant reduction in the self-reporting of pain in those who received music therapy in contrast to those who did not receive music therapy (P < .03). Music therapy is a valuable noninvasive intervention for the treatment of pain after burn injury.
Unlabelled:
Ambulatory surgery can create significant anxiety. This prospective study measured whether music can influence anxiety and perioperative sedative requirements in outpatients undergoing surgery with spinal anesthesia. We also evaluated the correlation between two anxiety measures, the State-Trait Anxiety Inventory test (STAI) and the 0- to 10-cm visual analog scale (VAS 0-10), with 0 meaning complete relaxation and 10 the worst feeling of anxiety possible. Fifty unpremedicated patients were randomly assigned to listen to music of their choice via headset during the perioperative period (Group I) or to have no music (Group II). All participants used patient-controlled IV midazolam sedation and underwent repeated evaluations of their anxiety level with the STAI and the VAS 0-10. Midazolam requirements during surgery (Group I, 0.6 +/- 0.7 versus Group II, 1.3 +/- 1.1 mg; P < 0.05) and for the whole perioperative period (Group I, 1.2 +/- 1.3 versus Group II, 2.5 +/- 2.0 mg; P < 0.05) were smaller in patients listening to music. Anxiety levels, measured with STAI or VAS 0-10, were similar in both groups. The Spearman's coefficient values between STAI and VAS 0-10 ranged from 0.532 to 0.687. We conclude that patients listening to music require less midazolam to achieve a similar degree of relaxation as controls and that measures of anxiety obtained from the STAI and the VAS 0-10 are positively, but only moderately, correlated.
Implications:
It is possible to decrease sedative requirements during surgery under spinal anesthesia by allowing patients to listen to music to reduce their anxiety.
Unlabelled:
Music may decrease the anxiety experienced by patients before surgery. Previous studies of this issue were hindered with multiple methodological problems. In this investigation, we examined this hypothesis while using a rigorous study design and objective outcome measures. Adult patients undergoing anesthesia and surgery were randomly assigned to two study groups. Subjects in Group 1 (n = 48) listened to a 30-min patient-selected music session, and subjects in Group 2 (n = 45) received no intervention. By using self-report validated behavioral (State-Trait Anxiety Inventory) and physiological measures of anxiety (heart rate, blood pressure, and electrodermal activity and serum cortisol, epinephrine, and norepinephrine), patients were evaluated before, during, and after administration of the intervention. We found that after intervention, subjects in the Music group reported significantly lower anxiety levels as compared with the Control group (F(1,91) = 15.4, P = 0.001). That is, the postintervention anxiety level of subjects in the Music group decreased by 16% as compared with the preintervention level, whereas the anxiety level of the Control group did not change significantly. Two-way repeated-measures analysis of variance performed for the electrodermal activity, blood pressure, heart rate, cortisol, and catecholamine data demonstrated no group difference and no time x group interaction (P = not significant). In conclusion, under the conditions of this study, patients who listened to music before surgery reported lower levels of state anxiety. Physiological outcomes did not differ, however, between the two study groups.
Implications:
Patients who listen to music of their choice during the preoperative period report less anxiety.
Music and preopera-tive anxiety: a randomized controlled study1489—94. The sounds of music in the operating room
- Wang Sm
- L Kulkarni
- J Dolev
- Kain
- Zn
Wang SM, Kulkarni L, Dolev J, Kain ZN. Music and preopera-tive anxiety: a randomized controlled study. Anesth Analg 2002;94:1489—94. The sounds of music in the operating room
Music and preoperative anxiety: a randomized controlled study
- Wang