Sir:
For many surgeons, music is an integral part of operating. The perfect playlist creates a pleasant environment that can turn otherwise tedious operations into enjoyable experiences. Moreover, music provides measurable benefits to surgeon performance. It has been shown to reduce muscle tension and improve surgeon efficiency in tasks such as wound closure.1 , 2
There are times, however, when music can become distracting, or when a critical event arises and turning the music off is necessary to permit clear communication. Musical distractions can even become dangerous if the volume overpowers anesthesia alarms. Such situations necessitate quick volume adjustment. With conventional loudspeaker equipment, the surgeon must ask nonsterile operative staff to adjust the music. This can take precious time and human resources in critical situations. If musical adjustment becomes frequently desired, surgeon hesitancy to repeatedly bother staff members may arise, causing the surgeon to simply accept the distraction until the end of the song.
With the development of voice-controlled virtual assistants such as the Amazon Echo Dot (Amazon.com Inc., Seattle, Wash.) and Google Home (Google LLC, Mountain View, Calif.), the potential has arisen for rapid and facile music control that bypasses physical human input. The ability to use voice commands to adjust volume and skip songs may allow surgeons to avoid removing nonsterile staff from other duties to adjust the music, and the ability of the any operative team member to simply say “Alexa, stop!” enables more rapid attention to critical moments as they arise. We have included a video demonstrating how easily music can be adjusted by voice control using the Amazon Echo Dot. (See Video, Supplemental Digital Content 1, which demonstrates how voice commands can be used to select and adjust music, to set reminders, and to make phone calls by means of the Amazon Echo Dot, http://links.lww.com/PRS/D280.)
Virtual assistants may have further applications within the operating room beyond music control. Current functions include setting reminders and timers, and making phone calls and communicating with devices in neighboring operating rooms to facilitate simple inter–operating room communication. Miehle et al. have suggested using virtual assistants to help with preoperative safety checklists and to provide quantitative information gathered throughout the operation.3MacDonald4 and Schlesinger5 have suggested integrating music volume control with anesthesia alarms such that certain alarms or vital sign thresholds would trigger music volume reduction.
Although these are exciting routes for future exploration, they may be technically difficult and cost prohibitive at this time. Instead, the installation of current virtual assistants may be achieved for as little as $39 (Amazon Echo Dot, before tax) per operating room. Most devices require only a power outlet, a smartphone with the virtual assistant device–compatible application, and a wireless Internet connection. Currently, most virtual assistants do not support the wireless Internet Protected Access II enterprise security found in hospitals, but registering the device’s Media Access Control address with the information technology department will allow access to hospital wireless Internet Protected Access II–secure personal networks and guest networks. When using virtual assistants for music control and simple reminders that do not include patient protected health information, little risk of confidentiality breeches exists. We believe the voice-controlled power that virtual assistant devices provide over such simple tasks make them interesting and potentially worthwhile investments in the operating room.
DISCLOSURE
There are no financial disclosures, commercial associations, or any other conditions posing a conflict of interest to report for any of the authors.
David E. Janhofer, B.S.
Chrisovalantis Lakhiani, M.D.
Tara M. Chadab, M.S.
David H. Song, M.D., M.B.A.
Department of Plastic Surgery
MedStar Georgetown University Hospital
Washington, D.C.
REFERENCES
1. Moris DN, Linos D. Music meets surgery: Two sides to the art of “healing”. Surg Endosc. 2013;27:719–723.
2. Lies SR, Zhang AY. Prospective randomized study of the effect of music on the efficiency of surgical closures. Aesthet Surg J. 2015;35:858–863.
3. Miehle J, Ostler D, Gerstenlauer N, Minker W. The next step: Intelligent digital assistance. Innov Surg Sci. 2017;2:159–161.
4. MacDonald A. Smart operating room music. Anesth Analg. 2015;121:836.
5. Schlesinger JJ. In response. Anesth Analg. 2015;121:836.
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