Smooth Operator: The British Medical Journal offers recommended playlist for surgeons, warns to avoid 'Another One Bites the Dust'

The BMJ warns against 'irritating' music which will distract trainee medics

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Surgeons should serenade patients with a blast of "Smooth Operator" when they are under the knife but avoid "Another One Bites The Dust", the British Medical Journal has advised.

The weekly medical journal has endorsed the widespread practice of playing background music in the operating theatre to soothe patients.

However, an editorial in its Christmas edition warns against introducing music which might distract trainee medics from their tasks and cause “irritation.”

The authors - David C Bosanquet surgical registrar, James CD Glasbey, a foundation year 1 doctor, and Raphael Chavez, consultant general and transplant surgeon, at the University Hospital of Wales, Cardiff, cite data supporting the efficacy of music in the operating theatre.

“In a randomised trial of 372 patients having elective surgery, relaxing melodies (60-80 bpm mimicking the resting heart rate) proved to be superior to midazolam as a pre-anaesthetic anxiolytic,” the authors wrote.

“Combined data suggest that this calming effect is maintained before, during (when awake), and after surgery, with music faring better than noise blocking devices alone. For patients requiring further respiratory support postoperatively, music’s ability to reduce anxiety, heart rate, and respiratory rate extends even to ventilated patients in intensive care.”

Music is played “62-72% of time in theatre, and most often chosen by the leading surgeon”. Around 80% of theatre staff report that music benefits communication between team members, helps to reduce anxiety and “increase task focus”.

But the benefits are not clear-cut. Anaesthetic staff are critical and “most commonly argue that music consumes cognitive bandwidth, reduces vigilance, impairs communication, and proves a distraction when anaesthetic problems are encountered.”

“Other studies (again small observational and often simulation based) have shown that music increases the time taken to acquire skills (particularly for trainees), slows overall completion time for procedures, and increases general irritation.”

The authors note that “Classical music predominates as the music of choice in the operating theatre, perhaps because of its ability to ‘evoke mental vigilance’ and the absence of lyrics…Noise levels should be monitored and balanced to ensure minimal potential for interfering with communication.”

They conclude: “Though most practitioners favour the use of music, each theatre will need to reach a (preferably harmonious) consensus. We however, embrace music in the operating theatre whenever the situation allows it. We suggest tunes likely to resonate harmoniously with the operating environment, alongside musical faux pas best avoided.”

Songs for surgery: The BMJ ‘playlist’

“Stayin’ Alive” (Bee Gees, 1997) Operating team members should resist the urge to emulate John Travolta’s dance moves. Doubles as a metronome for correct cardiac compression rate in case of cardiac arrest.

“Smooth Operator” (Sade, 1984) The exemplar of feelgood operating, and a must for all theatre mix-tapes.

“Un-break My Heart” (Toni Braxton, 1996) Ideal for cardiac surgery.

“Wake Me Up Before You Go-Go” (Wham, 1984) Best played in recovery. Handover to recovery staff should not take longer than the duration of the song.