Quiet O.R. request too obnoxious?

[Noyac]

Music etc at a reasonable volume is great, gives you something to jam to. However, I hate, I mean hate, the surgery is done so now everyone in the room that isn't anesthesia is going to stand around slamming trays and gossiping and joking around like a high school locker room while I'm waking the patient up. Not only has it got to be disorienting to the patient whose senses are just coming back and they're trying to make sense of things but it's quite simply unsafe and unprofessional. If a surgeon can have the gall to ask for pulse ox sounds to be turned off I can ask for quiet during one of the most high risk portions of the entire case. It literally comes off like everyone thinks that once incision is closed nothing bad can happen so it's a party and you don't need focus or potentially help.

we have moments during the case when absolute attention is required. The surgeons at my facility wanted this so I put myself on the committee to arrange this. I make induction and emergence two of those times. No extraneous conversations. No reps in the room going over the implants etc with the scrub. No opening trays. None of that. Its called OR distractions and they are not tolerated during certain times.

Btw we discussed music in the OR as well. It was unanimously decided that music was NOT a distraction and frankly it was quite the opposite. There are some studies stating both so pick your side and make your argument but in my facility it's considered even as a way of focusing. Music can have many beneficial attributes.

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[dhb]

I hate, I mean hate, the surgery is done so now everyone in the room that isn't anesthesia is going to stand around slamming trays and gossiping and joking around like a high school locker room while I'm waking the patient up. Not only has it got to be disorienting to the patient whose senses are just coming back and they're trying to make sense of things but it's quite simply unsafe and unprofessional.

A lot of patients remember waking up in their room on the floor so disorienting to the patient is bs

 

[Random Anesthesiologist]

How do you all handle this? Many of my attendings seem to just let it happen. I'm approaching my senior year of residency and it annoys me so much when I'm emerging to have loud conversations going, loud music and the never-fail accidental tray drop right during stage 2. It's pushed me to try to extubate when or close to when the drapes come down to avoid that crap. Sometimes I get crap for pulling a tube when dressings go on but I don't care.

 

[Wiscoblue]

From patient in the room until anesthesia declares turn over to surgery, I let the anesthesiologist decide (most want it quiet). Once the patient is turned over, I decide on the music. When I scrub out, I take my phone with me and the anesthesiologist gets to decide during wake up.

I did work with an anesthesiologist once who blasted hip hop music while getting lines in, etc.

Well that's mighty generous of you. I wouldn't work with a dick who 'let's me decide'. And my name is not 'anesthesia'. I bet you're real popular.


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[IlDestriero]

Well that's mighty generous of you. I wouldn't work with a dick who 'let's me decide'. And my name is not 'anesthesia'. I bet you're real popular.


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That might not go over well with me either. If people can't agree on the music, there is no music. Many people have horrible taste in music.


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Il Destriero

 

[Noyac]

How do you all handle this? Many of my attendings seem to just let it happen. I'm approaching my senior year of residency and it annoys me so much when I'm emerging to have loud conversations going, loud music and the never-fail accidental tray drop right during stage 2. It's pushed me to try to extubate when or close to when the drapes come down to avoid that crap. Sometimes I get crap for pulling a tube when dressings go on but I don't care.

I think you are handling it just right. Wake the pt up at the moment the last suture or staple are going in. Now everyone has to,help to get the pt on the stretcher and out of the room. No time for BS.
BUT I wouldn't make a huge stink about it in your position unless you plan to stay aboard as an attending. You'll be out of there in no time.

 

[Robotic Wis-Hipple]

A lot of patients remember waking up in their room on the floor so disorienting to the patient is bs

The patient having recall or not of their emergence is not what concerns me there. Regardless, I still think it's a safety and professional courtesy thing. Would surgeons let the scrub, circulator, and whatever other OR staff decides to walk in act like loud obnoxious teenagers in the middle of his/her operation? The answer is no, and they know it, so the fact they do it to us means A.) they are ignorant to the situation, and B.) they have no respect (or maybe fear) for "anesthesia".

 

[ProfMD]

Well that's mighty generous of you. I wouldn't work with a dick who 'let's me decide'. And my name is not 'anesthesia'. I bet you're real popular.


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That might not go over well with me either. If people can't agree on the music, there is no music. Many people have horrible taste in music.


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Il Destriero

Poor choice of words on my part - I apologize. I work with a relatively small group of anesthesiologists and have for several years. They all know the taste in music I have and have not complained. If I am asked to turn it down or off, I do. However, I do find that the music helps me focus, so to me it is important.

And, if you will notice, throughout most of my post I referred to "the anesthesiologist." I said "anesthesia" only once in reference to the team, comprised typically of the staff anesthesilogist + resident/fellow, occasionally of anesthesiologist + CRNA.

And, for what it's worth, I happen to have a very good working relationship with the anesthesiologists at my hospital.

 

[Noyac]

The Royal College of Surgeons says if music is played during surgery, it "must not be distracting".

http://www.bbc.com/news/health-33771022

There are as many studies touting the benefits of music as there are against it.
https://www.researchgate.net/profil...ating_room/links/563b281508ae337ef298807e.pdf
http://www.sciencedirect.com/science/article/pii/S0020138306004049

 

[BLADEMDA]

There are as many studies touting the benefits of music as there are against it.
https://www.researchgate.net/profil...ating_room/links/563b281508ae337ef298807e.pdf
http://www.sciencedirect.com/science/article/pii/S0020138306004049

Yes. But the key factor is that everyone likes the music and it isn't blasting out so loudly that the O.R. team can't communicate with each other. I hate a lot of the music these days as it is trash so I am against any music in the O.R. which prevents communication between team members.


"The desired volume is lower as age increases "
From your study above

 

[BLADEMDA]

The most commonly reported health consequences of chronic exposure to high noise levels are tinnitus and hearing loss. The nature and severity of the hearing impairment is a direct function of the intensity and frequency of the sound pressure and duration and pattern of exposure. There is growing evidence that nurses and surgeons who consistently work in noisy operating rooms are susceptible to noise-induced hearing loss.11 substantial hearing loss has also been demonstrated among anesthesiologists. In a study conducted by Wallace et al.,12 66% of anesthesiologists had abnormal audiograms and those younger than 55 yr had a hearing acuity significantly worse than the general population. Anesthetized patients may be particularly vulnerable to acoustic trauma after long exposure to noisy surgical equipment. Anesthetic drugs weaken the stapedius muscle, which normally contracts and protects the cochlea when exposed to loud sounds. In the absence of this protective reflex, hearing impairment may occur, especially among vulnerable populations such as the elderly. Noise, especially unexpected high-intensity sounds, acts as a biologic stressor that can produce a startle reaction and activate the fight or flight response of the autonomic and endocrine systems. Chronic exposure to excessive noise has been associated with increases in heart rate, blood pressure, peripheral vascular resistance, and an increased prevalence of various forms of cardiovascular diseases, including hypertension, angina pectoris, myocardial infarction, and premature death.13

http://www.cspsteam.org/noiseanddistraction/NoiseintheOperatingRoom35.pdf

 

[BLADEMDA]

In one study, 26% of anesthesiologists felt that music reduced their vigilance and impaired their communication with other staff and 51% felt that music was distracting when a problem was encountered.22 Seventy-eight percent felt that music that they disliked was the most distracting. On the contrary, a subsequent study by the same group failed to identify any adverse effect of self-selected or classical music on psychomotor tests (testing numeric vigilance, tracking, and reaction time) performed by residents in anesthesiology.23 Patients are also affected by music in the operating room. Carefully selected music can have an anxiolytic and sedative effect on patients before, during, and after surgery. This beneficial effect seems to be independent of the additional advantage provided by blocking out ambient operating room noises.24 For all personnel in the operating room, it is apparent that the selection of the music and the manner in which it is delivered play a key role in its effect

http://www.cspsteam.org/noiseanddistraction/NoiseintheOperatingRoom35.pdf

 

[periopdoc]

And, for what it's worth, I happen to have a very good working relationship with the anesthesiologists at my hospital.

For what it's worth, I found your original wording colloquial, not problematic at all. Some people are just too sensitive.

 

[Doctor4Life1769]

Poor choice of words on my part - I apologize. I work with a relatively small group of anesthesiologists and have for several years. They all know the taste in music I have and have not complained. If I am asked to turn it down or off, I do. However, I do find that the music helps me focus, so to me it is important.

And, if you will notice, throughout most of my post I referred to "the anesthesiologist." I said "anesthesia" only once in reference to the team, comprised typically of the staff anesthesilogist + resident/fellow, occasionally of anesthesiologist + CRNA.

And, for what it's worth, I happen to have a very good working relationship with the anesthesiologists at my hospital.

I didn't think your wording was a big deal either.

 

[Noyac]

And 95% of the people who complained and felt the music was a distraction were nearing retirement.

Look, there are all types of distractions. What may be a distraction to one person may be a way to focus for another.

There is a plastic surgeon at my facility that has the worst musical taste I have ever heard. If I'm assigned to his room I pick his brain about different older country music legends and then start playing some. Some that are at least tolerable to the staff and I. We also have a new orthopod that likes that new pop crap by usually Female singers. I don't even know the names. So when I'm assigned to those rooms I will sometimes trade with someone who might be doing a nasty case or working with someone they don't like. The bottom line is that there are many ways of handling it. But one person dictating the atmosphere is not one of those ways. So to the OP find a compromise. You are not the only person in the room. And you are not the most important one either. Not even close.

 

[ranvier]

To me, big difference between volume and choice of music (collaborative) and dictating monitors (my turf). Feel free to adjust the bovie, ligature, da vinci, suction, irrigation, etc, etc (surgeon choice).

I do consider my pandora subscription a business expense

 

[partydoc]

I do consider my pandora subscription a business expense

You need to upgrade to spotify

 

[BLADEMDA]

You need to upgrade to spotify

I have pandora but my kids use spotify. I'm too old to want to change but I readily admit Spotify seems better when we compared them side by side.

 

[BLADEMDA]

Because of each service’s immense popularity, you’d expect both to feature a relatively similar amount of available music. In reality however, this category isn’t even close, easily going to Spotify whose catalog is roughly 20 times larger than Pandora’s. With a music library totaling just north of 20 million songs, compared to roughly 1 million for Pandora, Spotify is the gold standard among music streaming services. Though it doesn’t offer every known song under the sun — artists like Tool and Taylor Swift chose to withhold their music — its massive library is an incredibly impressive offering. Moreover, Spotify continues to add new music every week

http://www.digitaltrends.com/music/spotify-vs-pandora/

 

[Random Anesthesiologist]

I think you are handling it just right. Wake the pt up at the moment the last suture or staple are going in. Now everyone has to,help to get the pt on the stretcher and out of the room. No time for BS.
BUT I wouldn't make a huge stink about it in your position unless you plan to stay aboard as an attending. You'll be out of there in no time.

Thanks. I feel this is the best of both worlds. Everyone's (usually) happy there is no significantly prolonged wake up and I don't have to deal with all the crap. I wouldn't mind working here after fellowship so I pretty much let my attendings be the enforcer.

I've learned some good tips from this forum that have really helped in this department.

 

[Random Anesthesiologist]

The most commonly reported health consequences of chronic exposure to high noise levels are tinnitus and hearing loss. The nature and severity of the hearing impairment is a direct function of the intensity and frequency of the sound pressure and duration and pattern of exposure. There is growing evidence that nurses and surgeons who consistently work in noisy operating rooms are susceptible to noise-induced hearing loss.11 substantial hearing loss has also been demonstrated among anesthesiologists. In a study conducted by Wallace et al.,12 66% of anesthesiologists had abnormal audiograms and those younger than 55 yr had a hearing acuity significantly worse than the general population. Anesthetized patients may be particularly vulnerable to acoustic trauma after long exposure to noisy surgical equipment. Anesthetic drugs weaken the stapedius muscle, which normally contracts and protects the cochlea when exposed to loud sounds. In the absence of this protective reflex, hearing impairment may occur, especially among vulnerable populations such as the elderly. Noise, especially unexpected high-intensity sounds, acts as a biologic stressor that can produce a startle reaction and activate the fight or flight response of the autonomic and endocrine systems. Chronic exposure to excessive noise has been associated with increases in heart rate, blood pressure, peripheral vascular resistance, and an increased prevalence of various forms of cardiovascular diseases, including hypertension, angina pectoris, myocardial infarction, and premature death.13

http://www.cspsteam.org/noiseanddistraction/NoiseintheOperatingRoom35.pdf

High-intensity and high-frequency like suction that operate in the speech frequencies. So then you let your patients have even more problems with speech-in-noise discrimination.

 

[Random Anesthesiologist]

Poor choice of words on my part - I apologize. I work with a relatively small group of anesthesiologists and have for several years. They all know the taste in music I have and have not complained. If I am asked to turn it down or off, I do. However, I do find that the music helps me focus, so to me it is important.

And, if you will notice, throughout most of my post I referred to "the anesthesiologist." I said "anesthesia" only once in reference to the team, comprised typically of the staff anesthesilogist + resident/fellow, occasionally of anesthesiologist + CRNA.

And, for what it's worth, I happen to have a very good working relationship with the anesthesiologists at my hospital.

Good. Have you commented on the safe VA care act and APRN act?

 

[Noyac]

Blade, you seem to have an agenda here. You are admittedly getting
Older and unable to tolerate things that didn't bother you in the past. But pushing your agenda on others isn't absolutely fair. Just like the podiatrist asking for silence in the OR. It reminds me of this:

So when I read all your posts trying to prove your point it's just like the crna stance. We all know that anesthesia is safer with ANESTHESIOLOGISTS so there is no need to do the study but the crnas have an agenda so they do te studies to Prove their agenda and then we must now do a study to disprove it. It's stupid. And a waste of time.

 

[BLADEMDA]

Blade, you seem to have an agenda here. You are admittedly getting
Older and unable to tolerate things that didn't bother you in the past. But pushing your agenda on others isn't absolutely fair. Just like the podiatrist asking for silence in the OR. It reminds me of this:

So when I read all your posts trying to prove your point it's just like the crna stance. We all know that anesthesia is safer with ANESTHESIOLOGISTS so there is no need to do the study but the crnas have an agenda so they do te studies to Prove their agenda and then we must now do a study to disprove it. It's stupid. And a waste of time.

I didn't start this thread but instead provided the peer reviewed evidence the OP can use to bolster his/her argument against playing music in the O.R. Personally, I have no objection to music which is agreed upon by all parties and doesn't interfere with conversation between team members.

 

[Noyac]

I didn't start this thread but instead provided the peer reviewed evidence the OP can use to bolster his/her argument against playing music in the O.R. Personally, I have no objection to music which is agreed upon by all parties and doesn't interfere with conversation between team members.

Ha. Gotcha.
I know you are a reasonable man. But it's so damn fun gabbing you. Glad your at least a good sport.

 

[IlDestriero]

Without Tool or Taylor Swift, I'm out. That's an old school college day retro fix and my embarrassing modern pop/top 40 pleasure. I did see TayTay in concert recently, with really outstanding seats, but it was for the kids.


--
Il Destriero

 

[fakin' the funk]

A lot of patients remember waking up in their room on the floor so disorienting to the patient is bs

Amnesia and unconsciousness, same thing right?

 

[dhb]

Amnesia and unconsciousness, same thing right?

Please

 

[Noyac]

Without Tool or Taylor Swift, I'm out. That's an old school college day retro fix and my embarrassing modern pop/top 40 pleasure. I did see TayTay in concert recently, with really outstanding seats, but it was for the kids.


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Il Destriero

Ok I'm gonna go out on a line and say that you are the only person that has ever admitted to this, liking both TOOL (the best band of the last 20years) and Tay Tay ( the worst possibly but how would I know).

 

[dhb]

He likes Tool and loves Taylor, semantics...

 

[Noyac]

He likes Tool and loves Taylor, semantics...

Oh stupid me.

 

[Psai]

Without Tool or Taylor Swift, I'm out. That's an old school college day retro fix and my embarrassing modern pop/top 40 pleasure. I did see TayTay in concert recently, with really outstanding seats, but it was for the kids.


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Il Destriero

I'd see taylor swift for your kids

 

[deleted50478]

I'd see taylor swift for your kids

I wouldn't see Taylor Swift if it was free. Or Tool.

 

[deleted162650]

Hey take it easy on Blade. He's just bitter since they stopped letting him bring his gramophone into the OR.

And Il D loves Tay Tay and he loves Tool, but until now he didn't know Tool was also the name of a band.

 

[vector2]

Ha. Gotcha.
I know you are a reasonable man. But it's so damn fun gabbing you. Glad your at least a good sport.

cmon noy, you know blade wouldn't have been able to perform 70,000+ central lines and 50,000+ regional blocks by wasting time yammering with everyone about music selection

 

[fakin' the funk]

Please

You argued that having music when the patient is emerging isn't "disorienting" because they can't remember it. THAT'S the BS.

All the points about loud music, loud chatter, and instrument trays banging are great ones. They can freak a patient out when they are waking up, especially if they are of the anxiety/PTSD predisposed variety. It doesn't matter if they can remember it or not.

 

[pgg]

It's a rare event that I think the noise gets so out of hand that I need to speak up. I like al kinds of music.

We had an ENT who played nothing but Christmas music from Thanksgiving through December. That was lame.

I like it generally quiet at induction and emergence, though I understand why the surgeon and scrub and periop RN tend to start talking and get noisy at emergence ... their jobs are done and they're relaxing. Polite reminder to settle down is all they ever need.


I can't believe there are people out there who turn the monitor alarms off, or turn down the pulse ox sound. This isn't a gray area.

I know people who put their monitors in CPB all the time. They tend to be the same ones who pre-chart train track vitals an hour in advance and write their postop discharge notes during the preop interview. They suck.

 

[IlDestriero]

We have a Christmas song ENT guy as well.


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Il Destriero

 

[pjl]

We have a Christmas song ENT guy as well.


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Il Destriero

Better than the musical lovers. The "Mama Mia" CD was "lost" in a hundred pieces after 3 repeats.


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[dhb]

You argued that having music when the patient is emerging isn't "disorienting" because they can't remember it. THAT'S the BS.

All the points about loud music, loud chatter, and instrument trays banging are great ones. They can freak a patient out when they are waking up, especially if they are of the anxiety/PTSD predisposed variety. It doesn't matter if they can remember it or not.

It's not disorienting because they are already disorientated.
What kind of freaks do you work with that flip at every wake up? It's funny how everybody on this board is doing asa 3 and 4s all day but at the same time a bunch of 'roid pumped jocks with ptsd...

 

[Twiggidy]

Music OFF while patient is awake. It's unprofessional. When they're asleep, crank the Yeezy for all I care, just don't bother me. I can see the monitor so I know the vitals.

 

[Twiggidy]

You argued that having music when the patient is emerging isn't "disorienting" because they can't remember it. THAT'S the BS.

All the points about loud music, loud chatter, and instrument trays banging are great ones. They can freak a patient out when they are waking up, especially if they are of the anxiety/PTSD predisposed variety. It doesn't matter if they can remember it or not.

I mean, I guess, if you're working at Landstuhl Regional Medical Center....but garden variety community/academic center?

 

[psychbender]

I mean, I guess, if you're working at Landstuhl Regional Medical Center....but garden variety community/academic center?

Or Brooke, or Walter Reed, or...

This is one reason I'm sad droperidol is gone, it smoothed out the emergence of young marines/soldiers/sailors who had deployed.

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[Random Anesthesiologist]

I mean, I guess, if you're working at Landstuhl Regional Medical Center....but garden variety community/academic center?

Absolutely. Especially if your center has young or middle aged adults with chronic health problems (transplant pts for example) or has a high psych or elderly patient population. PTSD isn't only for veterans.

 

[IlDestriero]

Or Brooke, or Walter Reed, or...

This is one reason I'm sad droperidol is gone, it smoothed out the emergence of young marines/soldiers/sailors who had deployed.

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I always asked the marines if they deployed and I assumed that all that did had PTSD. They got the heavy opiate wake up, maybe deep extubation, etc. Precedex might be a good choice for them.


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Il Destriero

 

[pgg]

Or Haldol.

 

[fakin' the funk]

It's not disorienting because they are already disorientated.
What kind of freaks do you work with that flip at every wake up? It's funny how everybody on this board is doing asa 3 and 4s all day but at the same time a bunch of 'roid pumped jocks with ptsd...

Um, what.

 

[fakin' the funk]

I mean, I guess, if you're working at Landstuhl Regional Medical Center....but garden variety community/academic center?

The only point I was making is that having music off and a quiet OR is beneficial when you need to communicate clearly and calmly with your patient peri-extubation.

A lot of times it doesn't matter cuz they're chill.

But VA'ers, ex-military, homeless schizophrenics, the acutely intoxicated, the already-delirious inpatient, benzo-dependent anxious suburbanites with COWLS (Crazy Old White Lady Syndrome), young tough-guys, they all benefit from quiet and calm communication and re-orientation.

As opposed to most surgeons', nurses', and techs' favorite technique, holding down their arms and shouting YOU'RE WAKING UP FROM SURGERY

 

[urge]

It's funny how everybody on this board is doing asa 3 and 4s all day but at the same time a bunch of 'roid pumped jocks with ptsd...

I'm always impressed about how some people have the highest number of sick hearts, peds ent, blocks, ob, etc., and sometimes all in a single day. Amazing!

 

[dhb]

when you need to communicate clearly and calmly with your patient peri-extubation.

i extubate, i don't communicate, sorry.