Surgery with Music Series Post #23: Entrainment in Surgery

Entrainment and Surgery

Drs. Friedman and Cash at CCF

 To put it as simply as possible, entrainment in surgery is all about synchronizing.  The slow, steady tempo of the music entrains with the patient’s heartbeat and breathing.  Mostly we hear about rhythmic entrainment and brainwave entrainment.  When talking about music during surgery, both of the these types of entrainment are tapped.  The power of this during surgery comes from the slow, steady pulse of the music coming through the headphones.  In this instance, the synchronization begins when the patient can hear the music and feel the relaxation.  As they go into deeper states of “sleep” the vibrations of the slow, steady music keep the heartbeat and breathing entrained or synchronized with the pulse of the music.

The more relaxed the body is during surgery, the less anxiety medication, pain medication and even less anesthesia is required.  The less medication the patient requires,  the safer the procedure will be and the faster the patient will recover.  It’s so easy and so logical, that it has been overlooked for many, many decades.  Now people are beginning to understand how entrainment works and tap into the power of musical entrainment.

Rhythmic entrainment is a core principle of music therapy.  Many years ago I was introduced to the concepts of music therapy and began to realize that this was so powerful and yet so simple.  It’s the same phenomenon that makes people clap their hands to music, or sway gently, tap their toes or fingers.  When listening to many kinds of music, the urge to entrain is almost irresistible!  For many years I thought about all of the many ways the power of rhythmic entrainment might be harnessed for medical benefits.  When I finally decided to create a surgical playlist that would induce this phenomenon, I knew that I had come up with an idea that could really make a big contribution to health and healing.

Will you be next?


Surgery with Music Series Post #22: Can anyone benefit from music during surgery?

Surgical Serenity w colonoscopy

Surgery with music

Can anyone benefit from surgery with music?  Well, do you love music?  Does it relax you, comfort you, make you feel safe and secure?  Are there lots and lots of songs and pieces that remind you of happy times and all of the people you love?  If you answered “yes” to any of these questions, there is an excellent chance that you would benefit from music during your procedure.   Before and after your procedure, I think it’s a great idea to listen to the music that is especially meaningful to you.  During your surgery, whether you’re using a regional anesthesia or general anesthesia, research shows that purely instrumental music that has a slow, steady beat and a soothing, calming mood is best.

Ideally, everyone would be able to create their own playlist for their surgery, but that’s not very realistic.  Most people are a little bit rattled when they find out that they need surgery and sitting down to choose their favorite music and loading it methodically onto their Ipod is just not going to happen.  Then too, many older people wouldn’t know how to put music on an iPod anyway.

In addition, unless you have a brand-new iPod, your’s is likely pretty germy and not something that you want to bring into the operating room.

This is why I decided to create some pre-programmed, cordless headphones that would have the perfect, slow, steady, soothing music for surgery.  The headphones are lightweight and have no cord so that they can’t get tangled with any medical equipment.  The music was chosen by a clinical musicologist who has studied this for over 20 years.  If you have been told that you need surgery and if you love music and would like to experience the many benefits of music during surgery, click HERE.  If you have any questions, please don’t hestitate to contact me through this blog.


Surgery with Music Series Post #20: How difficult is it to find the pre-programmed headphones for surgery?


 If you have just found out that you need surgery for any given condition, you’ll want to get the headphones as soon as possible.  Having the ability to listen to this music for an hour or so a day leading up to the surgery will allow you to condition your body to relax when the music starts. 

It’s also good to be able to let your doctor know that you want to use music during the surgery in case he has questions about doing this.  Although most doctors are fine with the idea once they understand the considerable research behind them, some doctors will balk.  A few people have reported that their doctor allowed them to wear the headphones until the surgery and immediately afterwards, but not during. 

If you are going to a large, cutting-edge facility, it’s possible that they will already have the headphones ready to go for you, but in smaller communities and hospitals, you’ll probably have to bring your own!  As I said above, though, just be sure to let the doctor you’ll be bringing in your own music and player.

The only surgery that the headphones might not work for would be brain surgery and even then they could possibly be worn.  Anything new always has many skeptics at first, but these surgical serenity headphones are rapidly gaining credibility in the medical world.  I think the fact that the Cleveland Clinic has brought be in to do a Grand Rounds presentation is proof enough that they are a great idea!

Even if your surgery is less than a week away, I can probably get them to you if you’re willing to pay overnight postage.  Just go to and you can order either the headphones or a download of my proprietary music, chosen especially for it’s characteristics.  You can put the music on your own iPod or MP3 player if you prefer, but the cordless headphones are the easiest and most convenient!  Best wishes on your procedure!


Surgery with Music Series Post #19: How long will music continue to be helpful in recovery process?


 A reader has asked the question about how long after returning home from surgery will the headphones and music continue to help.  Great question!  The wonderful thing about music is that it always relaxes you and healing happens best and fastest when the body is relaxed.  Stress and anxiety cause every muscle in your body to tense up and it’s hard to heal when your body is full of tension.

That’s why putting the headphones on at least 30-45 before you are taken in to surgery is so important.  Here too, the more relaxed your body is, the less anesthesia and pain medication will be required to put you to sleep and keep you asleep comfortably.

After you return home you will find that it’s easy to add new music to the headphones or change all of the music completely.  You’ll be able to wear the headphones outdoors or indoors.  You could even travel with them and wear them on planes, trains and cruise ships, just like you would an iPod, but cordlessly.  These headphones are an investment that you’ll enjoy for years to come.

Thanks for all the questions people are sending me.  Keep them coming!


Surgery with Music Series Post #15: Talking with your Surgeon about Using Music


 Today many surgeons and anesthesiologists are aware of the benefits of music before, during and after the surgical procedure.  But occasionally, a patient comes to me or calls me saying that their surgeon doesn’t like the idea?  Why?  Usually because the surgeon has not read all of the latest research on the the many benefits that music brings to the situation.  Some surgeons don’t understand the concept of entrainment, whereby the vibration of the music causes your heart and breathing to slow down and synchronize with the music.  Even after your ears cease to hear the music through the headphones, the vibrations of this music cause your inner rhythms of heartbeat and music to synchronize with that tempo and all with the mood of the music which is peaceful and serene.   For that reason, it really doesn’t even matter if you like classical music or not because when you are deeply “asleep” under the anesthesia, you won’t even hear the music as music!

I’ve actually written a free report entitled “How to Talk with Your Doctor About Using Music with your Surgery.”  Just click on this link to get it for free!  Don’t miss out on this important step of the process!


Surgery with Music Series Post #14: Music with Dental Anesthesia


Music with Dental Anesthesia

Just yesterday we talked about the use of novocaine in dentistry.  Today we’ll take a look at the other main anesthesia used in dentistry:  Nitrous Oxide or “laughing gas.”  My main concern would be not whether or not it’s effective because I’ve had it and I know that it does work.  What you want to know is what the dangers or side-effects might be.  Here is some good information that I found on a site called “Just Say N2O”

“N2O, or Nitrous Oxide, also known as laughing gas, is a weak anaesthetic (painkilling) gas that was first synthesised in 1775 by Joseph Priestley. Of the three early anaesthetics discovered (chloroform, ether and nitrous oxide) it is the only one still in regular use. While insufficiently strong for surgery, it was ideal for the lesser pain of dentistry. Unfortunately, it became popular as a scientific demonstration for public edification (and entertainment). The public entertainment aspect reduced its respectability and although it was first used in dentistry in 1844, it was not until the 1860s that it became more commonly used. Many famous people are recorded as having tried nitrous oxide.

What Is Nitrous Used For?

Common uses of nitrous oxide include surgical, food service and recreational purposes. Many people have experienced nitrous as an anaesthetic for dental surgery. Nitrous oxide chargers are also used to make whipped cream. The dairy industry uses nitrous as a mixing and foaming agent as it is non-flammable, bacteriostatic (stops bacteria from growing) and leaves no taste or odour. Nitrous is sometimes used in auto racing to speed combustion. Nitrous is even used in diving to prepare divers for the nitrous-like effects of nitrogen narcosis. It is also a greenhouse gas emitted by fertilizer and implicated in global warming.

Is Nitrous Illegal?

Given its myriad uses, it is not illegal to sell or possess nitrous. However, in the State of California the possession of N2O with intent to inhale is a misdemeanor: this is probably true of most states. One internet merchant was sentenced to 15 months in prison for selling nitrous with devices intended to facilitate its inhalation. The following is taken from the CA penal code:

381b.  Any person who possesses nitrous oxide or any substance
containing nitrous oxide, with the intent to breathe, inhale, or
ingest for the purpose of causing a condition of intoxication,
elation, euphoria, dizziness, stupefaction, or dulling of the senses
or for the purpose of, in any manner, changing, distorting, or
disturbing the audio, visual, or mental processes, or who knowingly
and with the intent to do so is under the influence of nitrous oxide
or any material containing nitrous oxide is guilty of a misdemeanor.
This section shall not apply to any person who is under the
influence of nitrous oxide or any material containing nitrous oxide
pursuant to an administration for the purpose of medical, surgical,
or dental care by a person duly licensed to administer such an agent.

You should check your State’s Laws. When purchasing nitrous you implicitly agree to abide by the laws governing its use: the same as with gasoline, marker pens, white out, spray paint, ant poison, fabric softener, etc, etc, etc.

What Does Nitrous Do?

Physiological effects last a minute or two for a lungful of nitrous and then mainly dissipate. Some residual effects may last up to several minutes later. Unlike other drugs, the effects of nitrous very rapidly recede. As noted in 1845, “Those who inhale the Gas once, are always anxious to inhale it the second time.” When inhaled, nitrous produces a variety of physical effects including:

  • Disorientation (both spatial and time-based)
  • Fixated vision
  • Throbbing or pulsating auditory hallucinations
  • Similarly pulsating visual hallucinations
  • Increased pain threshold
  • Deeper mental connections
  • Lowered vocal pitch (opposite of helium)

What Are The Dangers?

The most common dangers from nitrous are due to its disorienting effects and the silliness that surrounds something called laughing gas. Tripping, falling or tipping over in a chair are very common. In one recorded case this caused death. The main cause of death from nitrous seems to be asphyxiation from a bag over the head. Frost bite from the very cold gas is also a concern, especially if dispensing when still disoriented.

Use common sense to avoid most problems.

Because nitrous permeates the lipid (fatty) membranes of your body, it can outgas into your gut or middle ear causing an ache. Cronic heavy usage has very unpleasant effects that could be permanent. Read more detailed dangers of nitrous use.

What Does Nitrous Feel Like?

After several deep breaths of air, I inhale nearly a lungful of nitrous and pull some air down on top and then hold my breath. Within seconds, a light tingling can be felt which seems to increase in frequency. The sensation is much as if waves were traveling up your body or as if you were twisting or spinning. Disorientation increases rapidly and the pulsing sounds/feelings increase, wrapping over one another. It is now, with eyes shut, that I enter a dreamlike state, where I am thinking out something and the external world has essentially ceased to exist. The urge to breathe takes over at some point and partial or whole breaths taken. Open eyes reveal some sort of tunnel vision, with regions of disorientation about the outside. Slowly the throbbing subsides. At other times I experience a sense of paranoia mixed with disorientation. I have a deep conviction while under the influence that all things are cycling together, that there is some deeper cyclical event occuring. It is as an experience of deja vu continually occuring. The feeling is profound and not altogether pleasant.

So how can music make a difference?  Well, what I have found after 25 years as a therapist dealing with addictions, any substance that makes a person feel better or puts them in an altered state, is subject to abuse.  I don’t think that nitrous oxide is not one of the top drugs to abuse, but it is true that dentists and anesthesiologists do sometimes become addicted because of easy access and a tendency to chemical addictions:

Abuse in the Medical and Dental Fields

There have also been cases of nitrous oxide abuse among healthcare professionals. Dentists and anesthesiologistsMedical doctors trained to use medications to sedate a surgery patient. with easy access to the drug seem to be at a higher risk than the general public of developing nitrous-related dependence problems. Dependence is the belief that a person needs to take a certain substance in order to function.

Substance abuse is also especially high among healthcare professionals who administer anesthesia in a hospital setting. According to the American Association of Nurse Anesthetists (AANA), about 15 percent of anesthesia providers are substance abusers. “Nurse anesthetists are dying … from accidental overdose or from suicide,” reported Carlos “Rusty” Ratliff in “Anesthetists in Recovery: Chemical Dependency in the Profession.” Like dentists, certified registered nurse anesthetists have large supplies of nitrous oxide readily available to them. Consequently, nitrous oxide is one of the drugs these professionals may end up abusing.

Dental Highs

In an article posted on the American Dental Association (ADA) Web site titled “Escaping Addiction: The Door to Freedom,” Dr. Thomas L. Haynes discusses the topic of addiction among dentists. “The access to large amounts of nitrous oxide,” noted Haynes, along with the stress and isolation of the profession, increases the risk of abuse. “Many a dentist has been found lifeless in the office,” he continued, “the N2O mask still strapped to the face.”

“Chemical Dependence in Anesthesiologists,” a document developed by the ASA TaskForce on Chemical Dependence, addresses the problem of drug abuse among anesthesiologists. Although addicted medical doctors typically become hooked on opioidsA substance created in a laboratory to mimic the effects of naturally occurring opiates such as heroin and morphine. such as fentanyl, nitrous oxide was mentioned by the ASA as another potential drug of abuse. (An entry on fentanyl is available in this encyclopedia.)

The main use of music here is to decrease the amount of nitrous oxide needed for something like a root canal or an extraction.  If you can use mainly your favorite calming music and no other anesthetic, that is ideal!  Good luck!


Surgery with Music Series Post #10: How does music affect other medication requirements


 This is such a simple concept, and yet, very few hospitals or sugery centers implement therapeutic music.  There are many, many studies that document that music pre- and post-surgery can decrease the use of  anxiety medications before and pain medication afterwards.  Studies have been conducted on major hospitals and universities all over the world.  As recently as April 1, 2011 I presented a Grand Rounds at Cleveland Clinic Florida that went over the top studies for music before, during and after surgery.  To see highlights of this, click HERE.

How does it work?  Before surgery, when you put on the headphones, the music enters your brain through the 8th cranial nerve.  Within moments, you close your eyes and your heartrate and breathing begin to slow down and become steady.  You begin to relax, naturally, and the need for I.V. anxiety medication greatly reduces.  After surgery, the headphones are again used as you move into the recovery area and your body stays relaxed as you come out from under the anesthesia. 

The recovery room is known for it’s busy-ness and (often) lack of peace and quiet.  In today’s crowded hospitals, nurses are trying to take care of many patients at the same time and those without music are often moaning and crying out.  Those with the headphones are not only staying relaxed, but the headphones help block out other patients cries and sounds of pain and discomfort.

Some hospitals have tried having CD players at bedside, but that doesn’t work nearly as well as the pre=programmed headphones.  A recent patient wrote this to me:

  • I kept expecting to be nervous  as the date of surgery rolled around but couldn’t seem to summon up any anxiety
  • My blood pressure has dropped to normal limits
  • I “knew ” I wouldn’t be able to sleep prior to surgery but guess what I slept well
  • I was calm and relaxed before surgery
  • The dentist and staff tucked me in, made sure I had my music (I had my i POD set to repeat ) and away we went.
  • Post -op I was still relaxed – had a sleep and had little pain- I had a bunch of work done – I did take an Advil at bedtime just for “insurance” but really didn’t need it.
  • My mouth is healing beautifull

Thank you for the wonderful music.

Blessings, Anne

If you have any questions at all, please don’t hesitate to leave them as comments on this blog and I will get right back to you!


Who’s the Best DJ in the Operating Room?


CHICAGO— General anesthesia or local? Hiphop
or Sinatra? These are among the decisions
facing Dr. Frank Gentile in his double-duty job
as anesthesiologist and self-styled DJ of the
He doesn’t use a microphone or speak in a
fake baritone. But the eclectic range of CDs he
loads onto the anesthesia cart headed for the
operating room would impress any bona fide
disc jockey. Gentile’s collection is between 50
and 100 CDs, and his iPod holds about 5,000
“I choose my music strategically. I know my
surgeons’ tastes,” says Gentile, the
anesthesiology chairman at Edward Hospital in
There’s Eminem and 50 Cent for one surgeon
who likes rap — the songs are “cleaned-up” to
avoid offending anyone. For another doctor it’
s Metallica. Others prefer oldies or opera.
Gentile picks different types of music for
different stages of surgery. Many surgeons
prefer up-tempo beats for the final stage and
one doctor Gentile works with “always closes
to J-Lo.”
Many U.S. operating rooms have sound
systems, so playing music during surgery has
become commonplace. Some doctors say it
relieves the tension; studies have shown it can
also benefit patients, even reducing the need
for anesthesia somewhat during surgery.
In many hospitals, the task of selecting OR
music often falls to the anesthesiologist — and
it’s one many take seriously. Some say
amassing impressive music collections is even
an effective marketing tool — a way an
anesthesiologist can ensure being picked
when a surgical team is being chosen.
“Sometimes surgeons will say, ‘I won’t work
Dr. Frank Gentile adjusts a stereo system as he holds a bunch of CDs in an operating room
at Edward Hospital in Naperville, Ill
Anesthesiologists face double-duty while on the job
with that anesthesiologist because he’s a
fuddy-duddy and I don’t like the kind of music
he plays,”’ said Dr. Doug Reinhart, an
anesthesiologist in Ogden, Utah.
Reinhart surveyed 301 American Society of
Anesthesiology members and found that
providing operating music was among nonmedical
tasks many performed.
Anesthesiologists in private practice and those
under 50 were most likely to serve as the
operating-room DJs.
Gentile says the DJ task falls sort of naturally
to anesthesiologists, given their role. While
their medical duties continue after a patient is
asleep — including monitoring vital signs and
administering intravenous fluids —
anesthesiologists are less tethered to the
operating table than surgeons and other OR
staff. They’re often more free to walk around
during surgery, or to change a CD.
Gentile thinks music makes surgeons work
more efficiently. “If they’re working faster and
they’re happy, the flow of the operating room
is happier.”
If things aren’t going well during an operation,
or if the music starts becoming a distraction,
Gentile says he turns it off.
Reinhart, 51, said nurses and surgeons
provide the music in the surgery center where
he works, but he was the OR DJ at his former
job at a private Dallas hospital.
“I had a little boom box on top of my
anesthesia cart and I had a selection of CDs —
a lot of country and classical and kind of
quieter soft rock,” Reinhart said.
Patients’ tastes must be considered when
surgery involves only a local anesthetic, he
said. “We’re not going to play rap when there’s
a 90-year-old lady in there — it would scare
them to death.”
Dr. Greg Irvine, an orthopedic surgeon in
Portland, Ore., says he’s worked with
anesthesiologists who load their iPods and
laptops with special music mixes catering to
specific surgeons’ tastes, then plug them into
the operating-room sound system.
Irvine says he’s usually so focused on
operating that he barely hears the music and
generally lets others decide what to play —
unless “they put on something I really can’t s
tand,” like when an anesthesiologist started
playing military music from Eastern Europe. “It
was a little intense,” Irvine said.
On the flip side, Irvine said several years ago
an anesthesiologist turned him on to
bluegrass singer Alison Krauss — he’d never
heard her “phenomenal” voice until it filled the
operating room one day.
“I went out and bought one of her early CDs,”
Irvine recalls.
Gentile’s own taste in music leans more
toward heavy metal, though he chose
something much more mellow when he had
sinus surgery a couple of years ago.
“I went to sleep listening to Coldplay,” he said.
Gentile dreamily says that now, whenever he
hears that same CD, “I get taken to a pretty
cool place.”
© 2011 The Associated Press.


New Study Confirms that Music in Surgery is Powerful and Positive


J Perianesth Nurs. 2010 Dec;25(6):387-91.
Implementation of music as an anesthetic adjunct during monitored anesthesia care.

Newman A, Boyd C, Meyers D, Bonanno L.

Operating room sounds and music can be influential on a patient’s experience, especially during monitored anesthesia care (MAC). In this article, the effect of music and noise on patients during MAC was assessed. The Bispectral Index (BIS) Monitor was used to evaluate the effect of music on the level of sedation or anesthesia in the articles reviewed. A review of current literature was completed regarding the use of music in the OR during MAC cases and its relationship to propofol sedation requirements. Ten journal articles were reviewed with publication dates ranging from 1997 to 2009. The use of music as an anesthetic adjunct during MAC cases can reduce the amount of sedation required, speed recovery time, and prevent the likelihood of converting to a general anesthetic.

Copyright © 2010 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

PMID: 21126669 [PubMed – in process] FacebooktwitterpinterestlinkedinmailFacebooktwitterpinterestlinkedinmail

Are there any drawbacks to music with surgery?


You know, I’ve asked myself that many times and I’ve talked with surgeons and anesthesiologists about it.  Very simply, the answer is no!  Music during surgery has absolutely no drawbacks but stands to improve the outcome of the surgery.  How does this happen? 

When the patients has slow, steady, purely instrumental music coming through headphones, the body’s heart-rate and breathing synchronize with the pulse of the music and keep the patients bio-rhythms slow and steady.  When this happens, the patients stays relaxed and stabilized naturally and does not require as much anesthesia during the procedure or as much pain medication afterwards.

When the patient chooses his own favorite slow, steady music and listens to that through wireless/cordless headphones, the procedure will be safer (as a result of less anesthesia) and the patient will recover faster and go home faster.  I recently got a testimonial from a patient who raves about how well his heart surgery went.  To see this video testimonial, go to

Please let me know any questions you might have!

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