Dr. Assagoili said “We trust that the magic of sound, scientifically applied, will contribute in ever greater measure to the relief of human suffering, to a higher development and a richer integration of the human personality, to the harmonious synthesis of all human “notes” of all “group chords and melodies” – until there will be the greater symphony of the One Humanity.” He feels that soothing music notes can be applied in the operation theatre not only to help relax the surgeon, but would also be beneficial for the patient in alleviating sufferings. Preliminary studies conducted in the 90’s suggest that music could be very beneficial for patients under anesthesia.
One of the important studies conducted was by Dr. Galpin at the Witwatersrand University and Garden City Clinic, at Johannesburg, to determine the effect of therapeutic music on patients undergoing surgery in anaesthesia. Therapeutic music referred to the kind of music whose therapeutic music was understood through other aspects of medicine. The study was conducted to determine the effect of therapeutic music on reduction in the pain levels and recovery period, in patients undergoing surgery with anesthesia.
A fact known in anesthesia is that a patient undergoing surgery with anesthesia may have active auditory sensations thus allowing them to hear sounds.This is because the auditory cortex is otherwise unaffected with anesthesia. However, as other centers of the brain may not be functioning fully, they are not able to remember the sounds. It can also be observed in patients suffering from coma that they are able to hear and respond to sounds.
Keeping this in mind, it would be advisable to test how music would work for a patient under anesthesia. As patients are capable of responding to sounds under anesthesia, they are also capable of responding to music. The soothing voice of a person can be replaced with relaxing music. Through music several barriers such as educational levels, race, language, etc are crossed.
Music is known to relax the muscles of the body through various mechanisms. The application of music in surgery can be considered to work on a very simple mechanism. One of the scientists, who conducted initial investigations as early as 1830, was Dogiel, to determine the effect of music on the body. He found that music altered several physiological processes in the body.
Music tended to affect the blood pressure and circulation. Once music is played, the medulla oblongata gets activated through auditory stimulation, and the benefits are felt. Scientists also believe that music has a positive effect on respiration and the manner in which muscles spend energy (Kellerman, 2006). Assagioli in 1965 found that music also has a psychoanalytic influence on the patient, even at the subconscious level.
Music is capable of removing any kind of repressions that work on the normal character of the human being, thus helping to release motives and emotions. The individual would feel much better with the release of such emotions and motives, and thus helping in healing (Kellerman, 2006). Scarantino (1987) found that some kinds of music possessing certain kinds of characteristics were able to relieve emotional and physical pain that may develop following surgery, or even in association with a disease, which encouraged healing. Music is frequently utilized in holistic medicine as a means of ensuring treatment of the human body as a whole, and not the individual condition.
Take for example, the normal heartbeat. Music is capable of bringing the heartbeat down to normal, and also bringing the rhythm within the normal range. With regards to mental functioning, music was able to improve mental functioning to a certain extent. When students were asked to do certain tasks, certain kinds of music were able to improve attention levels and also reduce the intensity of any problem the students were suffering from (Such as headache, etc) (Kellerman, 2006).
Another study conducted in Garden City Clinic demonstrated that in patients undergoing hysterectomy and laparotomy, the discomfort levels reduced, the recovery periods were shorter, and the pain and stress levels were lesser when music was played in the operation theater. However, a lot depends on the quality of music that is played for the patients. Baroque music needs to follow the Pythagorean rules closely in order to be effective and Classical music needs to follow the individual tastes of the patients. The patient should be able to appreciate the type of music depending on his/her tastes.
Romantic music needs to be played only for patients who are romantic in nature. Music therapy combined with breathing exercises can have a synergestic effect on the individual (Kellerman, 2006). One of the anesthesiology who uses music during surgery frequently is Dr. Gentile.
He chooses a range of music depending on the tastes of his patients and the surgeons, type of surgery, etc. One of the key equipment in the operating room is the CD player. He has more than a 100 CD’s and plays from a range of 5000 songs. He collects feedback both from the patient and the surgeon.
He finds that several surgeons suggest that music helps them to relieve tension and help them work better. However, the type of music and the individual tastes of the people played a very important role. Some surgeons felt that the quantity of anesthesia required to complete a pain-free surgery was less when music was utilized (MSNBC, 2008). The best people to introduce music in the operating theatre are the surgeons who love music.
This is because the ability to work better depends on the nature of music that an individual likes. Dr. Burnett is one of the cardiac surgeons who utilize music during his surgery sessions. He is a music lover and considers the ability to work better in the operating theatre depends on the type of music the person likes.
The Kootenai Medical Center encourages surgeons and anesthetists to utilize music in the operation theatre. All the operation theatres in the hospital contain a music system and a CD collection. The surgeons and the anesthetists can plug in their I-pods and play the music of their choice during the surgery sessions. Lalley suggests from review of previous studies that music played in the operation theatre is not only beneficial for the patient, but also for the surgeons and the anesthetists.
Surgeons have been known to perform the surgery and other difficult tasks better. Women often felt more relaxed and experienced less pain compared to those who did not listen to music during a gynecological surgery. Researchers at NY’s Buffalo University found that music helped to reduce the blood pressure of the patients and thus helped to reduce several problems. Dr. Keeve on the other hand, likes heavy country music and rock. He prefers hard music during his operation sessions, and finds that with music, his ability to work is certainly improved. Dr. Keeve also finds music and surgery similar to each other in several ways.
Music can be encouraging, relaxing, exciting, etc. However, many administrators and the medical personnel feel that music can be utilized only in routine procedures, and in time of emergency and critical situations, it would be best to switch of the music. This is because the ability to function more efficiently in disastrous situations or emergencies with music is rather unknown. The medical personnel at Kootenai Medical Center feel that music should be played in order to make the operation theatre environment livelier.
During a routine surgery conducted by qualified surgeons, there may be extreme silence, and to reduce silence music may be required. However, several healthcare professionals’ including nurses and anesthetists have their own opinion of music played during surgery. Some of the surgeons have a kind of DJ in the operation theatre known as a ‘Circulator’. This is usually a nurse who would play the kind of music appropriate for the situation and also suiting the needs of the surgeon, anesthetist, patient and other personnel.
The use of spinal anesthesia and local anesthesia is being increasingly utilized for several procedures instead of general anesthesia, as better equipment and techniques are helping to overcome previous limitations. Coupled with music, local and spinal anesthesia can be utilized in order to manage pain better. Some surgeons suggest that music has a great effect as patients would be less apprehensive after listening to music (Lalley, 2003). Nilsson et al (2003) conducted a study to determine the effect of music on post-operative pain when music was administered during the surgery or after the surgery.
The experiment was conducted on about 150 patients who had undergone either inguinal repair surgery or varicose repair surgery under general anesthesia. The patient were divided into three groups, namely, group one who listened to music during the surgery, group two who listened to music after the surgery and group three who did not listen to any music. It was found that the patients in group one and two had less pain after the surgery. On the other hand, patients belonging to group two required less amounts of painkillers compared to group three.
As a whole, music seemed to be beneficial in the short-run following the period after surgery. However, the study also demonstrated that there was no difference whether anesthesia was administered before the surgery or after the surgery (Nilsson, 2003). Dr. Zeltzer at the JFK Medical Center would be performing all surgeries including emergency cases under music.
He finds the manner in which music helping to perform a delicate case under stressful circumstance amazing. Zeltzer would be playing all types of music including blues, jazz, rock, disco, etc. Dr. Zeltzer also finds that in an operating room, a relationship exists between the surgeon, the support staff and the music.
He finds that the result of the surgery frequently depends on the relationship between these three. Dr. Zeltzer says that music also helps to pass time in routine surgeries (where the tasks are routine). A study conducted in 1994 by the AMA demonstrated that music played during surgery helped the surgeons to work better, more precisely and faster.
For the patient the pain in the post-operative period was of lower intensity. Dr. Levitt, a neurosurgeon from St. Mary’s Medical Center has been playing music since three decades feels that music helps the surgeons to function better and more efficiently.
Music played during the surgery sessions helps to limit any unwanted conservations. He considers that some surgeons may prefer to work in silence and considered such a group to belong a different ideology. Dr. Levitt likes classical music but would also like today’s music included in his play list.
Dr. Baynham, a pediatrician began to play music in his operation sessions only following a stressful case in which he had to perform a spinal surgery for a dislocated neck (Pensa, 2007).;Even in the past, music was utilized as a mean to create distraction and soothe the patient during the surgery. Music was utilized as early as 1914 in order to supplement anesthesia.
It was especially useful for a nervous and an anxious patient and could help the surgery team to concentrate better. It is very important for the surgeon to talk with the patient in order to plan out what music has to be played. Dr. Burdick feels that it is very important to determine what type of music has to be played, as music is not always helpful.
He said that however, even during an emergency music could be played as it helped to reduce stress and anxiety levels. As music helped the patient’s mind into pleasant thoughts, it could be utilized during the excitement stages of anesthesia and helps to reduce any kind of resistance. In the year 1948, music was tried out for the first time in dental anesthesia and it was found that it greatly helped to reduce anxiety and stress levels. Music is even useful in cataract surgeries in elders (ASA, 2007).
However, there also seems to be certain limitations with anesthesia. Researchers found that music is not very useful when the surgeons are performing complex arithmetic tasks. There were variations with different kinds of music and the performance of surgical tasks. Hence, a lot depended on the type of music that was played.
However, the ASA also suggests that familiar music helped to improve attention levels, vigilance and performance. When a surgeon performs auscultation of the heart and the lungs, the sounds may not be clearly visible if music is playing. Music may also act as a distraction in the operation theater and hinder vital communication between the surgical team. Another study conducted by the ASA found that 63 % of the anesthetists preferred music, whereas 51 % felt that music was a huge distraction (ASA, 2007).
Dr. Rienhart also considers that patient’s tastes are very important during surgery under local anesthesia. If an elder patient is hearing something like rock or rap during a surgery session he/she might get scared to death. Dr. Irvine, an orthopedic surgeon prefers using music that the patient prefers (MSNBC, 2008).;Music during a medical surgery procedure may be useful when the surgery is especially long and time-consuming. In order to prevent boredom from setting, a surgeon may select a collection of tracks to assist during the entire surgical procedure. Even during long surgeries, music can be especially useful in order to ensure that the surgeon is attentive and can perform delicate procedures as precisely as possible.
Dr. Keeve prefers classical music for the long and time consuming procedures that require close attention. The silence that is usually present during the entire procedure can be ended using music. If an emergency arises or if communication is needed, then the music player can be switched off at anytime.
Music played during the surgery may be so relaxing that the surgical team would coordinate and function better (Lalley, 2003).;Following post-Cesarean surgery, the women would require good pain relief and mobility. There is a significant higher chance of developing thromboembolitic disease as the risk is higher following pregnancy. As the mother may have to take care of the infant, it may be difficult to cope up during the post-operative period.
One method of preventing any problems from developing would be to use music therapy. Music has very few side-effects and is very non-invasive in nature. In a study conducted by Reza et al (2007), one group was given Spanish music during the intraoperative period and the other group was given white music. Post-operatively it was found that the intensity of pain similar in the case group than the control group.
Besides, the case group required same amount of anesthesia compared to the control group. The incidence of post-operative complications such as anxiety, nausea and vomiting were similar in the group administered white music than the case group. This clearly suggests that a lot depends on the type of music that the patient would be hearing during the operation. The patient should like and appreciate the music that is being played (Reza et al, 2007).
In another study in patients undergoing extracorporeal shock wave lithotripsy (ESWL) treatment, the effects of an anxiolytic drug versus music was determined. About 100 patients were divided into two groups. One group was given an anxiolytic and the other group was allowed to listen to music of their choice. Several hemodynamic parameters (such as heart rate, BP, respiration rate, etc), anxiety levels, and pain intensity (through VSO) was determined at frequent intervals.
The hemodynamic parameters did and the pain intensity levels did not reduce much in the music group. However, the anxiety levels reduced to a significant extent through the State and Trait Anxiety Inventory-Trait Anxiety tool. Thus it can be said that music played during ESWL procedure can act as an alternative to anxiolytics and sedatives (Yilmaz, 2003).;One of the reasons why music could be considered for patients under anesthesia is that such patients active auditory sensations although they would not remember what has happened (as the cerebral cortex is not functioning fully).
Some patients are also capable of responding to sounds in anesthesia as comatose patients are able to. In the case of regional anesthesia or local anesthesia, it is all the more important to have something that would soothe and relax the patient, and music plays a very important role. Surgeons also prefer music as they are not only able to function better, more effectively but also capable of beating the boredom that may develop from a routine surgical procedure. For the surgeon and other personnel, music helps to maintain activity level and may motivate to perform better.
However, a lot depends on several factors, more importantly the particular taste of music the person. Earlier studies clearly demonstrate that music relaxes the muscles, improves circulation and also lowers the blood pressure. It also relaxes the respiratory muscles. Music seems to be of immense use in holistic medicine.
The type of music played needs to closely follow individual tastes in order to be beneficial. However, in the time of an emergency the effect of music is really not known, and in such circumstances it would be best not to have music. Some surgeons may argue that in an emergency situation, music is helpful as it helps to relax the associated stress. However, further studies need to be conducted in this regard, and only if clear benefits are seen, it should be suggested.
Looking at the past studies, and patient and surgeon experiences, it suggests that music can have a special role to play in an operation theatre. Surgeons and anesthetists can perform much better and when music suiting their tastes is being played. Besides, as patients under general anesthesia are able to here sounds, music could help them recover much faster, with lower post-operative pain levels. Studies have also demonstrated that patients administered regional or local anesthesia have much lower anxiety levels.
Studies conducted by Scarantino et al (1987), Nilsson et al (2003), and Reza et al (2007) demonstrated that music benefited the patient, surgeon and the anesthetist during the operation. It also helped in the interactions and the teamwork of the operation staff. However, a lot depended on the ability to suit individual tastes. Consistent with all studies, it was felt that the most beneficial music was the one that the surgeons/patients had a taste for, irrespective of the type (rock, pop, rap, classic, etc).
Several methods were utilized including previous studies, personal experiences, etc. Music also helped to reduce the dose of anesthesia required during certain surgeries and the amount of painkillers required to lower postoperative pain. From this paper, I would suggest that music to be utilized by the surgeon and the anesthetist during a routine surgery to benefit themselves and the patient. Further studies should be conducted to determine the effect of music in an emergency.
References
- ASA (2006). “Music in the Operating Room: Harmony or Discord?” Retrieved on March 31, 2007, from ASA Web site: http://www.asaabstracts.com/strands/asaabstracts/abstract.
- “Smooth operator.” Retrieved on March 31, 2007, from Spokesman Review Web site: http://www.spokesmanreview.com/pf. asp?date=101403;ID=s1424462;
- Nilsson, U., Rawal, N., Unosson, M. Et al (2003). “A comparison of intra-operative or postoperative exposure to music–a controlled trial of the effects on postoperative pain.” Anaesthesia, 58(7), 699-703.
