June 2011 - Page 3 of 3 - Surgical Serenity Solutions

Surgery with Music Series: Post #9 “How much does music affect the anesthesia requirement of a patient?”

We’ve established that anesthesia is a modern wonder, of sorts. Nevertheless, we also established that it carries with it certain risks and dangers, the worst of which would be an untimely death. Anesthesia MUST be administered by a medical specialist, an anesthesiologist who has gone beyond the MD degree to specialize in anesthesia.

Besides finding the very best anesthesiologist your hospital offers, what else can you do? You already know that I’m going to recommend using slow, steady, purely instrumental music that has the tempo of the resting healthy heartbeat. And not from a nearby boombox or ipod on speakers or even an iPod with earbuds. My recommendation is to use cordless/wireless headphones that are already pre-programmed with the ideal music for surgery under general anesthesia.

Why? Because we know that even when the hearing has shut down from the effects of the general anesthesia, the body still responds to the vibrations coming through the headphones into the body. When this happends, the process called entrainment is triggered and the heartrate and breathing synchronize with the music, keeping the body relaxed and in need of less anesthesia. Just imagine how nervous your would be if you knew your body had a serious problem and you were going to be put to sleep and operated on? Your body would be very tense and it would like require more anesthesia to put you to sleep that if you’ve been listening to slow, steady music for 45 mins or so before you’re taken into surgery? At this moment, a scientific study is being done with our headphones at a large hospital here in Lousiville, KY to measure the exact effects and benefits of these headphones. Tomorrow we’ll look into the benefits of these headphones with regional anesthesia!

By DrAlice|June 10, 2011|Anesthesia, Characteristics of music for surgery, Common Fears in Surgery, Dangers and Side-effects of anesthesia, Music and Anesthesia, Music in the hospital, Music in the hospitals|0 Comments

Surgery with Music Series, Post 8: A Brief History of Anesthesia (Pt. 2)

Even though we are doing a brief history of anesthesia, there is enough to divide into two parts! Tonight we look at part two, beginning with Dr. Colton:

Davy was a remarkable if somewhat erratic chemist who was not only responsible for

the above discovery but many others such as the Davy miners’ lamp and many of the properties of the Alkali Earth metals. He died May 29th, 1829 at the age of 51 from a

myocardial Infarction following a prolonged illness considered to be brought on by the inhalation of many gases over his lifetime.

Despite Davy’s work it wasn’t until 45 years later in 1844 when nitrous oxide was used as an anaesthetic by Gardner Colton and Horace Wells. Colton was a travelling At the age of 21, Davy, a keen chemist was employed as a superintendent of the medical pneumatic institution of Bristol to investigate the properties of various gases and their application to medicine. A quote in the diary of an observer at the time states,

‘He breathed 16 quarts of the gasover a period of 7 minutes and became completely

Colton administered nitrous oxide to Wells and Wells’ partner John Riggs extracted his wisdom tooth whilst under the effect of the gas.

intoxicated.’ scientist who gave public demonstrations of his discoveries. Wells, a practicing Connecticut dentist, was at one such demonstration when he witnessed Colton administer Nitrous oxide to a man who then bashed his shin against a stone bench and displayed no sign of pain. Excited by this observation Wells invited Colton to his dental practice the next day. No pain was experienced during the extraction and Wells and Riggs pioneered the use of Nitrous oxide as a dental anaesthetic and went on to anaesthetise many more patients for wisdom tooth extraction. During his career Wells was to influence the life of one of the most important names in anaesthetic history, William Morton. Unfortunately the rest of Wells’ career was not so illustrious and in 1848 he committed suicide after being arrested for dousing a prostitute in sulphuric acid.

William Thomas Green Morton was born in 1819 in Massachusetts. From a young age he aspired to study medicine but unfortunately lacked the capital to do so and so chose the less expensive option of dentistry.

He trained predominantly under the guidance of Horace Wells and together they started a dental practice that eventually turned out to be a financial failure. At this point in his life he separated from Wells and began studies at Boston medical school under the guidance of prestigious surgeon Charles Jackson. Here he began investigations into the properties of Ether. Unfortunately Morton’s constitution was never strong and he suffered frequently with anxiety and stress. Early on in his studies of ether he was thwarted by a nervous breakdown and had to return to hisfamily home for a period of respite. After this set back he returned to his studies and was briefly reunited with Horace Wells when Wells gave an unsuccessful demonstration of the properties of Nitrous oxide as an anaesthetic for wisdom tooth extraction. The demonstration was a farce with the patient crying out and thrashing around and subsequently Well’s work was rubbished. At this point Morton’s’ life began to flourish as he opened his own dental practice which was a financial success and even allowed him to open a factory which specialised in making false teeth. With his continuing dental practice his interest in anaesthesia was again stimulated. The problem that he and his patients faced were that to fit the dentures the roots of the old teeth had to be removed at considerable pain to the individual undergoing the experience. He decided to return his interest back to ether which he had studied before. His experiments, which almost certainly did not have the approval of the ethics committee, ranged from testing the effects of ether on his goldfish, his pet terrier and himself. Excited by his results from anaesthetising goldfish he was given a prime opportunity to test his research. On the 30th of September 1846 a patient named Ethan Frost came to his surgery for a painful wisdom tooth extraction and agreed to have it extracted under the influence of Ether. Morton held a handkerchief over the patients’ mouth and dripped ether onto it (without accurate end tidal measurements!). The results of the experiment were published the next day in the Boston daily evening Transcript Morton’s Article caught the eye of an up and coming young surgeon, Henry Jacob Bigelow. On the 16th of October 1846 Morton gave the first ever public demonstration of anaesthesia using sulphuric ether and Morton’s Inhaler in the Ether dome at Boston whilst Bigelow removed a tumour from the jaw of his patient, Gilbert Abbot.

Boston Daily Evening Transcript,

October 1st 1846

The Ether Dome, Boston, Massachusetts

As with most historical names in anaesthesia Morton’s tale is not a happy one. Because he was not a physician he did not receive full credit or financial reward for his discovery and spent the rest of his life in legal battles. He died in 1868 at the age of 49, a pauper. Bigelow kindly had inscribed on Morton’s headstone:

Before whom, In all time, Surgery was Agony By whom, pain in surgery was averted Since whom, science has control over pain’

His family were bakers by trade but sacrificed much of their earnings to allow the youngest and cleverest son, James, to go to University and be educated. Simpson went to Edinburgh University at the age of 14 where he studied Greek, Latin and Maths for his first year before applying for Medicine in his second year. He was accepted with the handsome bursary of ten pounds per year. At Medical schoolSimpson was a feisty individual with a keen intellect and was never one to just sit back and accept the standard teachings of his seniors always keen to challenge accepted practice. He graduated from University with his LRCSEd and then for a One of the most notable names in anaesthetic history and possibly one of the most eminent physicians in the history of medicine was James Young Simpson. Simpson was born in Bathgate in 1811

University. Shortly into this role Simpson heard of a discovery in London from his next door neighbour which was to change the course of his life. Robert Liston had performed a leg amputation in December 1846 with the patient anaesthetised with ether (shortly after Morton’s’ discovery). Excited by this he travelled to London to find out more and when he returned to Edinburgh his mind was filled with great ideas of applying the use of ether to the relief of pain in Labour . This was revolutionary and in many circles, unpopular. Simpson faced opposition from many angles. On the one side of the coin his professional colleagues opposed the idea saying that it would pose great risk to the mother and would certainly harm the child. On the other side many members of the public and clergymen opposed the idea on religious grounds. Simpson fought these ideas using his intellect to oppose them. Professionally he opposed his colleagues by using the ether in his practice and collecting data from 800 other maternity patients who had had ether for both natural and instrumental deliveries and demonstrated clearly that it did have a place in obstetric analgesia. On the religious front he produced a leaflet with an equally valid counter argument to some of the religious objections. He used direct quotes from the bible to emphasise his points including:

short period worked in a few general practices before embarking upon and completinghis MD thesis. After this he began work for an eminent Pathologist of the time. From this point Simpson’s’ keen intellect and voracity for his work lead him into the field of obstetrics and gynaecology where he challenged practices and produced a veritable cornucopia of publications, presentations and teachings on the subject. His esteem rose and in 1840 he was voted the Chair of Midwifery at Edinburgh

For everything God created is good, and nothing is to be rejected if it is received with thanksgiving,a

nd Anyone, then, who knows the good he ought to do and doesn’t do it, sins.

Simpson found however that ether took too long to work and was not efficient in terms of the volume that had to be used during the course of labour. For this reason he

searched for another agent. It wasn’t until a pharmaceutical colleague suggested

Chloroform that his mind focused on this. In November of the year after the discovery

of ether, Simpson and two colleagues inhaled Chloroform over his dining room table

and needless to say all fell unconscious and slipped under the table. Simpson’s first

thought on recovering (other than my head hurts) was how much more potent

chloroform was than ether.

A few days later Simpson had progressed from his clinical trial to patient testing and

by the end of the month had anaesthetised several patients with Chloroform. Simpson had first used chloroform on a patient by November 8th 1847. 2 months later on

January 28th 1848, chloroform had claimed its first victim, a 15 year old girl called

Hannah Greener. Investigation into this occurred but it was unclear whether the death was due to respiratory depression or some unknown effect on the heart. It wasn’t until

were:

60 years later that Levy used animal experiments to prove that deaths from chloroform

resulting in cardiac fibrillation’

Despite this discovery the popularity of chloroform rose well into the twentieth 30, 000 mourners lined the streets of Edinburgh as a mark of respect. His memory lives on with the dining room where he first used chloroform on himself being preserved to this day. Also there stands a statue in Princess place, Edinburgh, as well as a memorial plaque in Westminster cathedral. There is also an annual James YoungSimpson gold medal awarded by the Royal college of Surgeons of Edinburgh and the winner gives the annual Simpson memorial Lecture

By DrAlice|June 9, 2011|Anesthesia, Music and Anesthesia|0 Comments

Surgery with Music Series, Post 7: A Brief History of Anesthesia (pt.1)

From Out of the Primordial Soup:

A Brief History of Anaesthesia by Robert Hirst MB ChB
Department of Anaesthesia Sheffield Teaching Hospitals

Anaesthesia has been around in one form or another since around the 12th century and in some sense hundreds to thousands of years B.C. In the last 150 years however a revolution of anaesthesia has occurred with exponential growth in knowledge and substances available for use in anaesthesia making it one of the most advanced specialities in modern medicine. The following essay considers the core roots of our speciality and looks briefly ahead to see what the future may hold.

Primitive Anaesthesia

Medieval anaesthesia was primitive and barbaric when compared to the standards employed today. The most common before the 15th century was probably the use of liberal quantities of alcohol plus or minus opium and a wooden stick to bite down upon. However some of the substances used in this period still hold strong today suchas opium and some are even being ‘rediscovered’ such as Cannabis in chronic pain.Arabic alchemist were perhaps some of the most advanced in their beliefs on anaesthesia in the 12th and 13th centuries employing techniques such as the soporific sponge which was a sponge steeped in hashish, opium and other herbal aromatics. When required for surgery it would be moistened and held over the face inducing a state of unconsciousness. Writings about this practice can be found in Sir Richard Burton’s translation of The Arabian nights (1).

(2) Formal reference to the use of an anaesthetic agent for surgical intervention occurs around 1540 when dioscorides refers in his pharmacopoeia to: ‘Sleeping potions made from opium and mandragora root which may be used as surgical anaesthetics for such people whom be cut or cauteried’ (3) Mandragora continued to be a popular choice of anaesthetic upto the middle ages and was a mythical and respected plant. It was felt that the mandrake plant whose roots resembled a human form would kill the person who picked it if the screams of the root were heard. For this reason the plant was uprooted in novel ways such as tying the loosened plant to the collar of a dog and allowing the dog to uproot the plant, a practice that would be frowned upon by the RSPCA no doubt.

(4) Mandrake was usually combined with a blend of opium and hemlock and either rendered the patient unconscious or dead, as hemlock shows zero order kinetics and is a toxic piperidine alkaloid.

3 One of the commonest anaesthetic potions used was the ‘Dwale Potion’ from the medieval word dwale meaning confused or dazed. This comprised the gall from a castrated boar, lettuce, hemlock, henbane opium, mandrake and bryony.

(5) When the walls of the opium poppy are incised a latex like substance is secreted, from which many of the useful products are derived including opium and the isoquinoline alkaloid derivates morphine, codeine, noscapine, papaverine and thebaine. The Sumerians were the first to cultivate the poppy as far back as 3200 B.C. There is a feeling among some medical historians that the poppy itself is integrated into human culture and that this is one of the reasons that eradication of the illegal opium trade is so difficult. The first writings of opium overdose appear around 1037 A.D when the Islamic physician Avicenna died of an accidental overdose. A famous quote, which still holds true today, was in the 17th century when Thomas Syndenham wrote:

‘ There is no other pain killer that is so universal and efficacious as morphine’ (6) As you can see from the above techniques the balance between life and death was even more tenuous during anaesthesia than it is today. So when did things start to change? Certainly the longest standing substance used in anaesthesia throughout history and into modern day are extracts from the opium poppy, papaver somniferum meaning the poppy of sleep.

4 Evolution

From these primitive beginnings little changed in anaesthesia until the end of the 18th century. During this time a rapid evolution occurred in the practice of anaesthesia largely due to certain key individuals who shaped the foundations of our speciality as it stands today. The discovery of ‘dephlogisated nitrous air’ or nitrous oxide as we now know it, by Joseph Priestly was the catalyst for this evolution. The discovery occurred at the end of the 18th century but the relevance of the discovery was not stumbled across until a couple of years later in the early 19th century when a chemist, Humphrey Davy, conducted some ‘physiological’ experiments with the gas.

(8) Davy was a remarkable if somewhat erratic chemist who was not only responsible for the above discovery but many others such as the Davy miners’ lamp and many of the properties of the Alkali Earth metals. He died May 29th, 1829 at the age of 51 from a myocardial Infarction following a prolonged illness considered to be brought on by the inhalation of many gases over his lifetime. Despite Davy’s work it wasn’t until 45 years later in 1844 when nitrous oxide was used as an anaesthetic by Gardner Colton and Horace Wells. Colton was a travellingAt the age of 21, Davy a keen chemist was employed as a superintendent of the medical pneumatic institution of Bristol to investigate the properties of various gases and their application to medicine. A quote in the diary of an observer at the time states, ‘He breathed 16 quarts of the gas over a period of 7 minutes and became completely Humphrey Davy intoxicated.’ (7)

to be continued tomorrow!

By DrAlice|June 7, 2011|Anesthesia, Common Fears in Surgery, Dangers and Side-effects of anesthesia, Music and Anesthesia|0 Comments

Music with Surgery Series: Post #5 “Side-effects of Anesthesia”

By DrAlice|June 6, 2011|Anesthesia, Dangers and Side-effects of anesthesia, Music and Anesthesia|0 Comments

Surgery with Music Series: Post #4 “Side-effects of surgery”

No one wants to have surgery, but sometimes it really is necessary if you want to continue with your life. Surgical procedures have dramtically improved over the last 50-60 years and most surgeries are completed with no problems whatsoever. Unfortunately, even when the surgery is completely successful, recovery from surgery can be difficult and stressful.

Of course there is no such thing as a “typical surgery.” Surgery includes everything from a Cesarean section for deliver a baby to heart bypass surgery, to joint replacements. No matter what the surgery, certain after-effects can be expected: nausea, pain, grogginess, sleepiness, tiredness, weakness, dizzyness, difficulty walking, stand, sitting, sleeping and many more. Luckily these things don’t last forever, but often there is a correlation with how long these side-effects last and how much anesthesia the patient had. It’s hard to separate the side-effects of surgery from the side-effects of anesthesia, but we do know that the less anesthesia you can get by with, the faster you’ll recover and also have the least number of side-effects.

One of the best ways to reduce the likely amount of anesthesia you’ll need is to use music through headphones for 30-60 minutes before your surgery begins. This allows your body to slow down and relax and when you begin the procedure already relaxed, less anesthesia will be required to put you under. It’s important that the music be very steady, purely instrumental music with the tempo of the healthy resting heartbeat. This way, your own heartbeat and breathing can synchronize or entrain with the music you’re hearing through headphones.

If you continue to wear the headphones into the recovery area, research shows that there can be a greatly reduced amount of pain medication needed…another way to keep you from experiencing nearly as many of the side-effects. If you or a friend has surgery scheduled, please consider using music with your surgery!

By DrAlice|June 5, 2011|Anesthesia, Characteristics of music for surgery, Common Fears in Surgery, Dangers and Side-effects of anesthesia, Headphones for other medical procedures, Music and Anesthesia, Music in the hospital, Surgery Music|0 Comments

Surgery and Music Series, Post #3: Fears about Anesthesia

Anesthesiology currently ranks 7

th of all medicalspecialties in indemnities paid. An average of 34% of all claims madeagainst anesthesiologists close, with an average $362,000 indemnity per physician paid. Mistakes have proven to be very expensive in this medical field. The industry has historically shown speedy acceptance to productsthat can lower the overall risk of receiving sedative drugs.Recent research has uncovered some previously unknown facts about the risk of anesthesia. Researchers are discovering that the level of sedation is positively correlated with the occurrence of many of the risks associated with anesthesia, including death. Patient stress has also proven to be correlated with complications of receiving anesthesia. These findings have opened market opportunities for products that can aid anesthesiologists.

“A company on the cutting edge of this market, is Surgical Serenity Headphones, a subsidiary of Healing Music Enterprises. SSH has a patent-protected process and system for delivering the ideal music for surgery through light-weight cordless headphones.”

These headphones are now in use at both the Mayo Clinic in Minnesota and the Cleveland Clinics in Ohio and in Florida. For more info, see www.surgicalheadphones.com.

By DrAlice|June 4, 2011|Anesthesia, Dangers and Side-effects of anesthesia, Music and Anesthesia, Surgical Headphones reviews|0 Comments

Music and Surgery 30-day series: Post #2 “Fears about Surgery”

So you’ve just been told that you need to have surgery. The fears and anxiety are running through your mind and all over your body like an army of tiny spiders. THINK of all the things that might go wrong! You could end of paralyzed, you could end up dead! They may take the wrong thing out and leave you with a damaged or sick body part. Maybe the anesthesia will not work but they don’t know it and you feel every single knife stroke and pull. Enough!

Chances are, everything will be just fine. Serious accidents and mistakes in surgery are truly rare, but they do happen. How can you help yourself in this situation? By doing exactly what you’re doing…going to the internet and searching for high-quality information about your specific type of situation and the recommended surgery. You might also want to get a second or even a third opinion! I was recently told that I needed plastic surgery on my face to remove a cyst. I visited a plastic surgeon who confirmed this. Then I visited a second plastic surgeon who said “I wouldn’t rush into that. I’d give it 8-9 months and see how it does.” I was never so relieved in my life! I’ll probably wait at least another month or so now and then visit one more plastic surgeon for a consult.

In the final analysis, it’s your body and only you can decide this. If you DO decide to proceed, one thing you can do before, during and after surgery is to take in lightweight, cordless headphones that are pre-programmed with the best music for surgery. This music has been tested around the world and the consensus is unanimous. Every person has said that they would use them again!

No one wants to have surgery, but if surgery is needed, add some soothing, calming, comforting music to the equation! You can end up having less anesthesia, less pain medication and an overall more positive experience!

By DrAlice|June 3, 2011|Anesthesia, Characteristics of music for surgery, Common Fears in Surgery, Dangers and Side-effects of anesthesia, Headphones for other medical procedures, Music and Anesthesia, Music in the hospital, Surgery Music, Surgical Headphones reviews|0 Comments

Dr. Cash was brought in to the Cleveland Clinic Florida to teach surgeons and anesthesiologists about music and surgery

More and more people around the world are becoming aware of the many benefits of music during surgery. It’s a strange paradox because you know that music affects you powerfully and that you can easily reach for the music you love best, whether to relax you or energize you. However, you have been told by “the professionals” that when you’re under general anesthesia that your hearing chut downs and you can’t hear anything. And so, for decades no one thought that music during surgery made any sense.

The problem is, there are hundreds and hundreds of personal stories from patients who have been under general anesthesia waking up and realizing that they did hear conversations going on. Patients say that they heard things that they wish they had not heard. There is no question that when people have certain surgeries such as joint replacement surgery–hip replacements, knee replacements, shoulder replacements–there is actually hammering, drilling and sawing going on. Who wants to hear that?

Why is music during general anesthesia a good idea? All because of the phenomenon of rhythmic entrainment! Scientists have known of this powerful phenomenon for hundreds of years, but apparently, no one considered that if the patient listened through headphones to music that has a slow, steady pulse and a relaxing mood, that their heartrate and breathing would entrain or synchronize with that music and keep the patient more relaxed. When the patient is more relaxed, less anesthesia and analgesia is needed and the patient can have a safer procedure and return to work or home faster.

There are so many other benefits as well and also there are copious benefits for regional anesthesia, local anesthesia and for many other medical procedures. Stay tuned for this unique and ground-breaking series on the use and benefits of music during surgery! Also, feel free to post any questions or comments you might have!

By DrAlice|June 2, 2011|Characteristics of music for surgery, Common Fears in Surgery, Dangers and Side-effects of anesthesia, Headphones for other medical procedures, Music and Anesthesia, Music in the hospital, Music with Brain Surgery, Surgery Music|0 Comments

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