Should Doctors Be Allowed to Listen to Music During Surgery?

If you’ve had surgery under anesthesia in the last couple of decades, your doctor was probably listening to her favorite music while operating. There’s growing debate in the medical field about whether music in the operating room really helps surgeons focus or creates a potentially dangerous distraction.

Source: Should Doctors Be Allowed to Listen to Music During Surgery?

Understandably, the music won’t necessarily be liked/preferred by all:

Personally, if I’m having surgery – I don’t care what music my surgeon listens to, if at all, if its going to help them do the best job they can.

As They Lay Dying: Terminally Ill and Organ Donation

…W.B.’s life was turned upside down by the diagnosis. But once the initial shock passed, he began researching his condition intensively. He learned that he was unlikely to survive five years, and that in the meantime his quality of life would diminish dramatically. With limited options, many patients retreat. But, quite bravely, W.B. had other ideas. After much consideration, he decided that if he was going to die, he would like to try to save another person’s life in the process, even if that person was a stranger. And so last May he approached the University of Wisconsin’s transplant program, where we are surgeons, as a prospective organ donor.

…From the earliest days of transplantation, surgeons subscribed to an informal ethical norm known as the “dead-donor rule,” holding that organ procurement should not cause a donor’s death. In practice, this meant waiting until patients were by all measures completely dead—no heartbeat, no blood pressure, no respiration—to remove any vital organs. Unfortunately, few organs were still transplantable by this point, and those that were transplanted tended to have poor outcomes by today’s standards.

Source: As They Lay Dying

The medicine, the US in this article particularly, operates in a strange paradox – we uphold the right to patient autonomy in nearly every situation… Except when an otherwise (legally) competent individual chooses a care option that involves the outcome of death/disability by intervention. Physician-aid-in-dying and this particular case are examples of decisions made by terminally-ill people where we interfere with their right to self-determination.

I don’t stand on a political soapbox – everyone gets an opinion and a vote – but rather an ethical one.

If we can not cure, what are the boundaries of what we do to palliate? What if we are able to simultaneously palliate (psychologically or physically) one patient, while providing an invaluable service to another? Is it truly against the spirit of the Hippocratic oath to provide psychologically and spiritually meaningful interventions at the expense of the physical body?

I personally am of the mind that if the patient and physician enter into a trusting and respectful relationship, that these questions can only be answered/defined within the context of that particular relationship.

The Legend Of The Surgery With The 300% Mortality Rate

Robert Liston was a competent surgeon who contributed significantly to medicine as a science. Then he had the misfortune to have one seriously bad day, and became a legend in the medical community.

Source: The Legend Of The Surgery With The 300% Mortality Rate

Every couple of weeks, this comes up on Reddit…

Does Being Anesthetized Count as Sleep?

There is a small amount of similarity in terms of electrical activity, but the two processes are chemically distinct.  The electrical activity is only similiar in that it comes from the brain and therefore is recognisable as waveforms – you lose all REM sleep while under anaesthesia.  Sleep is a complex state that is not simply just reduced activity. Sleep includes complex processing by various areas of the brain, possibly enhancing memory storage and “cleaning” junk, other parts are periods of reduced activity.

The real difference however comes from the surgical procedure you are likely receiving, the stress, cortisol, sympathetic activation produce a vastly different physiological state to natural sleep.

It should be noted that during minor procedures (i.e dental surgery, etc) you are not actually “knocked out”. Usually you’re put under what’s called “twilight sedation” in which you are mostly conscious and responsive, but your memory is suppressed. This enables you to be responsive and cooperative with the surgeon, such as moving or opening your mouth when needed. Generally you’re not fully awake, but sort of sleepy/extremely relaxed. Pain killers are administered separately so you’re not being tortured.

Do people Snore while Anesthetized?

Snoring is just partial airway collapse due to reduced tone of the muscles holding up the soft tissue in the area. Whether that reduced tone is due to sleep or anesthetics, the end outcome (noises and obstruction) will be the same.  Snoring with an airway in is probably a bad sign, and I would be thinking about changing the airway.

Consider that if somebody got drunk and starts snoring – that doesn’t mean they’re sleeping, they could also be passed out from alcohol.  They should be placed on their side in recovery position, monitored, and drawn on with permanent marker.  That’s just basic triage 😉

More Detail about Sleep:

Sleep is divided up into Rapid Eye Movement (REM) & Non-REM sleep. we spend 80% of sleep in NREM & 20% in REM. Different phases of sleep can be identified on electroencephalogram (EEG) which when awake displays high frequency, low amplitude beta & gamma waves.

REM sleep is characterised by a disorganised EEG similar to the waking state, rapid jerking eye movements, increased blood pressure & heart rate, nonsensical dreams (“I went down a water slide with Santa”) & loss of muscle tone, presumably so we don’t act out our dreams.

NREM sleep has four phases:

  1. Drowsy
  2. Established
  3. Transitionary
  4. Deep

EEG waves become progressively slower and larger (alpha, theta, then delta waves). We spend 50% of sleep in phase 2 NREM. Phase 4 is characterised by difficult rousing and organised dreams (“I have a meeting to get to tomorrow morning”). Deep NREM sleep is also the phase associated with parasomnias (e.g. sleepwalking, sleep talking), night terrors and bed wetting in children. The EEG of anaesthesia varies depending on the agents used but most resembles the synchronised low frequency, high amplitude wave of phase 3/4 NREM.

Bonus: Can We Sneeze When We Sleep?

The trigeminal motoneuron pools that mediate the sneeze reflex are inhibited during NREM sleep and are actively suppressed during REM sleep as part of atonia. Which means it is much more difficult to sneeze during NREM sleep and nearly impossible in REM (without also causing waking).