Noise or silence in the operating room?

Music or no music is a question that has been addressed in many studies, which is why we read with great interest the article, “Effect of noise on auditory processing in the operating room,” by Way and colleagues in the May issue of this journal.1 The study suggested that surgeons demonstrated poorer auditory performance with music than in quiet or with operating room noise. Another recent study also suggested that music might be a potential distractor in operating rooms during urologic procedures.2 There are many studies that try to further elucidate the effects of music on patient factors on one hand (anxiety, stress, need for analgesic drugs, and sedation) and surgeons and surgical staff on the other hand (communication, task performance, speed, and accuracy), as reviewed recently by Moris and Linos.3 In addition, the type of music seems to be important. In a study by Siu and colleagues,4 music with high rhythmicity had beneficial effects on surgical performance in a simulated robotic model, suggesting that music might be of value during skill acquisition and training. In mechanically ventilated patients, patient-directed music reduced anxiety and sedation frequency as compared with noise-cancelling headphones or usual care.5 A caveat of this study was patient selection and lack of standardization of outcomes measures. Also, the findings of this study might not apply to patients who undergo elective surgery. As health care providers, we should be dedicated to keeping the surgical patient safe in the perioperative period and ensuring that care is provided in an optimal environment. Patient safety comes first; it is mandatory that monitors and alarms are audible and necessary measures can be taken in a timely manner. We would like to suggest that volume levels in the operating room should be monitored and balanced to account for the possible beneficial effects on patient satisfaction and surgical performance (which might be positively influenced by music) while not rendering communication between nurses and anesthesiologists difficult. Indeed, all potential distractors and disruptive behaviors pose a threat to patient safety. In the absence of controlled and well-designed studies on the effect of music in the operating room on operating room personnel vigilance and task performance, we cannot definitely answer the question (“music or no music in the operating room?”). Until that time, no general recommendations can be made, and music during intervention still is merely a matter of subjective preference. We acknowledge the fact that on one hand, music might have beneficial effects on patient satisfaction, use of sedative drugs, and surgical performance, while on the other hand, music could be a potential distractor, possibly impending communication. Future work should examine the effects of other nonpatient care activities like reading,6 the role of music in various settings and patient populations, and clear measurements of outcomes. In fact, music is an important aspect of cultural and social life and we as scientists should respect individual preferences of both patients and physicians.