To the Editor: Music is often played in operating theatres, for a variety of reasons. It has been shown to decrease the anaesthetic requirements of patients1 and the autonomic reactivity of surgeons,2 and not to interfere with laparoscopic task performance under non-clinical conditions.3 However, I have witnessed several events that have “pushed back the boundaries” of this common practice.

In one case, a surgeon requested that a videocassette player and monitor be moved into the operating suite before a major operation. Thinking that this might be for educational purposes before use of a new technique, the nursing staff obliged. After the operation was under way, the surgeon directed that a commercial videocassette of an opera be taken from his briefcase and played during the operation. The anaesthetic team were concerned about this, and the video player was turned off when the operation became more difficult.

In another case, a surgeon undertook an operation while listening through ear-bud headphones to low-level music from his digital music player. Before the operation began, the anaesthetist questioned the surgeon about the wisdom of this practice and asked several times if it might interfere with communication or concentration. The operation proceeded without incident with the surgeon listening to his music.

These examples may represent extremes of practice, but they do remind us that we should remain vigilant and not allow developments in entertainment technology to interfere with patient care. Further studies are required to determine the effect of these practices on technical performance and decision-making of surgeons and also communication between staff in the operating suite.

Comment: Ask most surgeons about their operating theatres, and they will describe them as havens from the stresses and pressures of a busy clinical practice. The theatre protects them from the interruptions of telephone calls, the demands of patients and their relatives, and the politics of medicine. It is a microcosm where a surgeon may rule autocratically. Within reason, most theatre personnel would gladly accommodate any means that might diminish the stress or enhance the smooth running of an operation. Techniques such as dimming the lights, decreasing human traffic, eating lollies and playing music are common practices in operating theatres.

As a surgeon, I find background music essential during surgery. It masks the chatter of the scout nurse, the telephone conversation of the anaesthetist, and the beeping of the diathermy machine and the electrocardiograph monitor. Without the pleasant background sound of ABBA or the love songs of Elvis, my stress levels would be compounded by every other audible distraction.

The question of whether surgeons should be able to use whatever means necessary to achieve the best outcome, even if the anaesthetic and nursing staff perceive it as inappropriate, could only be answered with a prospective study using patients’ clinical outcomes as the end-point. With so many variables, a study of this nature would be impossible.

Personally, I have no objection to the scenario in Riley’s second case if the surgeon can maintain adequate communication with the scrub nurse. However, I cannot accept that a person would not be distracted by watching a video while operating. Even if the surgeon was simply listening to the music, the video playing on the monitor would be a distraction to other theatre personnel. I agree with Riley that we must continually re-evaluate technology in the workplace. Patient care is paramount, and, unless audiovisual technology is helping us achieve this end, we would be wise to return to simpler times.