Surgery with Music: What’s New in 2014


It’s really exciting to see so many advances in surgery on the horizon, and although I don’t wish surgery on anyone, it definitely will be happening all day, every day, around the world.  What I am most interested in is seeing that everyone has the best possible chance for a positive outcome!

Many astute and perceptive surgeons and anesthesiologists have realized for a long time that music is a powerful and effective addition to the surgical suite, but most were not sure how best to implement this idea.  The idea of using lightweight, behind the neck headphones for the patient, while allowing ambient music delivery for the surgeon, is an ideal solution that will be seen more and more in 2014.

Some other new developments in general surgery include:

  • Intraoperative radiation therapy for newly diagnosed breast cancer (December 2013)
  • Tumor seeding following endoscopic ultrasound-guided fine-needle aspiration of pancreatic tumors
  • Bedside ultrasound prior to skin abscess draining.

Can you imagine how helpful the soothing music headphones could be for patients undergoing any of the above procedures.  And, of course, the calmer and more relaxed the patient is, the better the surgeon can do his or her job.  It just makes sense to relax the patient with music before, during and after any surgical procedure with a method that has no side-effects and reduces recovery time as well as nausea and vomiting.

For more information, see or email me at



Will my surgeon let me use music in the operating room?


Great question!  Many people fear that even if they want to use their own music in the Operating Room, their doctor won’t allow it because of concerns with germs, cleaniliness, or some sort of interference with their equipment.  Let me address these concerns, one by one:

Could music through headphones or an iPod/MP3 play introduce germs into the surgical field?  I have been told repeatedly by surgical personnel, that everything in the OR does NOT have to be sterilized.  Only the instruments that go inside the patient music be sterilized.  The table, floor, lamps, etc. are disinfected but not sterilized.  Although the headphones that each person uses are brand-new and not touched by human hands once packaged, my recommendation that you order them several days in advance allows you to practice relaxing with them at home and get used to turning them off and on and adjusting the volume.  So that when you arrive at the hospital, they will likely be wiped down with disinfectant anyway, but can also easily fit under the cap that the patient wears over their own hair and head.

Even in 2005, there were a few surgeons who would balk at the idea of bringing an ipod or headphones in the to the OR, but today, the benefits of the right kind of music in surgery, are so well documented that it is not an issue.  Also, the fact that probably the majority of surgery now have music playing in the OR, makes it seem more natural for the patient to bring his music in.  Especially for regional anesthesia or local anesthesia, it makes sense to let the patient bring in the music that will be comforting for them.

Rhythmic entrainment is so powerful and so well-documented that there is no questions that slow, steady, soothing music will calm a person down by slowly and regulating their breathing.  You have a couple of choices.  You can choose your favorite slow, steady, instrumental music and load it onto your iPod, or you can purchase cordless, preprogrammed headphones to take into surgery and they will last you for 5-10 years, and can be re-loaded with whatever music you like.  Best wishes on your surgery and let me know if I can help you or answer any questions!


Music Eases the Stress of Surgery—it’s a no-brainer!


 For as long as humans have pounded drums and plucked strings, listening to music has affected people’s sense of well-being, lifting their spirits and — as new research shows — calming their nerves. Literally. According to a study at Cleveland Clinic, music can slow the neuronal firings deep within the brain during surgery designed to treat Parkinson’s patients.

The seeds of this study were planted about two years ago, when a patient named Damir Janigro was being prepped for spinal surgery. Janigro, who is also a neuroscientist at the clinic, lay captive to the nerve-racking din of the operating room and in his frazzled state thought about how dentists often give their patients earphones to help ease anxiety. (See the top 10 medical breakthroughs of 2008.)

If people getting root canals merited a musical intervention, he thought, why not people undergoing brain surgery? Patients with conditions such as epilepsy, brain tumors, severe depression, and obsessive-compulsive and motor disorders like Parkinson’s have to be awake for surgical procedures that often take several hours. Janigro and his team decided to use that wakeful period to determine whether music made the subjects’ experience in the operating room less stressful.

He will present his findings on Oct. 30 as part of a symposium in New York City on music and the brain. The son of a world-renowned cellist, Janigro specializes in studying epilepsy and is associated with Cleveland Clinic’s Arts and Medicine Institute, which is working to advance our understanding of how music can do such things as help decrease pain and blood pressure and improve movement in Parkinson’s patients.

The medical community has long been interested in how the brain is affected by music. Historically, however, most research was linked to the cortex, the brain’s outer layer, which is associated with functions like memory, consciousness and abstract thought.

In those studies, neurosurgical patients, wide awake with their cortex exposed, listened to certain sounds and music. While their neural activity was being recorded, they told researchers how those selections made them feel.

Janigro wanted to perform similar studies on motor centers deep within the brain. Because music is often associated with movement — like tapping one’s feet — he theorized that music could be used to modify the activity of thalamic and subthalamic neurons, which are located in the same area where a neuronal pacemaker is implanted during deep-brain stimulation.

In Janigro’s study, more than a dozen neurosurgical patients, predominantly with Parkinson’s, listened to three musical selections — rhythmic music with no discernible melody (by Gyorgi Ligeti, of Stanley Kubrick–movie fame), melodic music with undefined rhythm (by Aaron Jay Kernis, a Pulitzer Prize winner) and something in between (Ludwig van Beethoven). In the later stages of the research, to prevent familiarity from swaying the subjects’ responses, music was specifically composed for the study by students from the Cleveland Institute of Music.

In the end, patients almost unanimously said the purely melodic offerings were the most soothing. But the recordings of their brain activity were eye-opening. (Read “The Year in Medicine 2008: From A to Z.”)

Listening to melodic music decreased the activity of individual neurons in the deep brain, says Janigro, adding that the physical responses to the calming music ranged from patients’ closing their eyes to falling asleep. Some patients even settled into a nice round of snoring. And when lead neurosurgeon Ali Rezai needed patients to perform an action, such as lifting a limb, during the procedures, he simply removed their earphones and relayed instructions. Once the music resumed, patients returned to their snoozing.

These are very desirable results, says Janigro. With the right music, he says, patients can be more relaxed in the operating room. And that relaxation may mean not only that procedures involve less medication — to control blood pressure, which increases with stress — but perhaps that patients have quicker recovery times and shorter hospital stays.

Janigro anticipates that following institutional approval, music will be used during certain neurosurgical procedures at the clinic as early as 2010. He hopes other hospitals will soon follow Cleveland’s lead. “This type of surgery can be a traumatizing experience, and using music can decrease anxiety,” he notes.

And you can’t beat the cost.

With health-care expenditures through the roof, this patient benefit is practically free, says Janigro, who used his own iPod and that of a colleague’s to pump in the music for the study. “The clinic doesn’t have a budget for iPods yet, but soon I think we will. It’s a no-brainer,” he says. “There’s nothing more calming than sleep.”

from “Time” Magazine, 10/23/2009


Which hospitals in the U.S. are using the Surgical Serenity Headphones?


 This is a question that I get more and more these days.  As people around the country and around the world, find out about our ready-to-go, pre-programmed surgical headphones, they want to know that the research is there and that nationally-known, reputable hospitals are already using them.


Well, good news!  They are already being used at the Mayo Clinic in Minnesota and the Cleveland Clinic in both Ohio and Florida.  Individuals have purchased them and used them here in Louisville, KY at Baptist Hospital East, Jewish Hospital and Norton Hospital downtown as well as Norton Suburban Hospital.  They’ve been used at hospitals in New York City, Greenville, S.C., Spartanburg, S.C., Birmingham, AL, Houston, TX, San Francisco, CA and in Canada, Hawaii and London.

Several patients were afraid that they would not be able to wear them into surgery, but only two people nationwide were told that they could not take them into surgery.  These patients both concluded simply that it had not been done before and that the surgeon or anesthesiologist did not want to try it.  No medical or safety precaution could be cited.

To date, all patients who actually used the music before, during, and after their surgery have reported that they will never have surgery again without using their headphones and music.  Patients have said that they drift off to sleep feeling as though they’re at the beach, listening to favorite music through headphones and totally forget that they’re in a hospital about to have surgery.  Needless to say, when patients are not tensed up and rigid with fear and anticipation, the procedure goes better:  less anxiety meds, less anesthesia, less pain medicaltion = faster and safer procedure and recovery!  Who could argue with that?


Fear of Anesthesia: How Can the Right Music Help?


Waiting for a Ceasarean-section childbirth

  As a therapist and a clinical musicologist, I talk to people nearly every day that have just been told that they need to have surgery and are almost more fearful of the anesthesia than they are of having surgery!  Why?  Because general anesthesia is very powerful medication and occasionally people do not survive the anesthesia.  The vast majority of people do fine, but if the patient is elderly or in a fragile health state already, it is a delicate balance.

How can music help?  Music therapy and Operating Room nursing journals have shown repeatedly shown that listening to your favorite calming, comforting, soothing music can make a very positive difference in your overall surgical experience.  There are also dozens, if not hundreds, of clinical studies showing that music in the recovery area can help the patient stay calm and comfortable as they regain consciousness and begin to feel the pain of the surgery.
Now, studies are being conducted to confirm that music DURING surgery can also make a positive difference and possibly decrease the amount of anesthesia needed to achieve the same degree of sedation, but without as much risk.  This is achieved by tapping into the power of rhythmic entrainment, by which the slow, steady tempo of the music brings the heartrate and the breathing into synchronization with the music and thereby keeps the body relaxed.
To learn more about the incredible power and benefits of music during anesthesia and surgery, please check out:

Surgery with Music Series Post #30: A Recap of why music is so important for your surgery


If you’ve been reading this 30-day series of posts of music with surgery, and you’re still not convinced of music’s power during surgery, I just don’t know what to tell you.  People all over the world, both patients and medical staff including surgeons, anesthesiologists, nurse anesthetists and techs of all kinds are recommending the use of music before, during and after surgery.  There are absolutely no drawbacks or side-effects and so many benefits that the choice is clear.

If you have the ability to make your own playlist, that’s great!  If you have enough lead time to do it, I think it’s a great idea.  I did it for myself back in 1994 when I had a lumbar laminectomy.  The doctors were astounded at how well everything went and how quickly I recovered.  I did it for my mother’s heart bypass in the early 90’s and after quite a bit of skepticism initially, she had such a positive experience that she said she would never again have surgery without music and headphones.

I have been helping patients to use music during their surgery since late 1990 when I began reading about the work of well-known music therapist, Helen Bonny.  I would usually mention her work when I went out speaking at hospitals and universities and associations.  Invariably, someone would say “Dr. Cash, I don’t believe that many people at all know about this music and surgery idea.  I think you should really try to get the word out!

After that, the rest is history.  I have worked with thousands of patients around the world and in 2008 I got a patent on my Surgical Serenity Headphones.  Although you can purchase them online at, my main goal is to get them into hospitals around the world so that they are ready to go when a patient arrives for surgery.  They would be told about the process of wearing the headphones upon arrival at the hospital and would be issued a set of headphones that would then be theirs to keep, eliminating the risk of infection from previous users.

If you are associated with a full-service hospital, please check out the headphones and the documented benefits.  Using the headphones can greatly reduce the amount of drugs and anesthesia required and create a calmer more peaceful atmosphere for the patient.   As a result of less anesthesia, the patient will recover faster and get back to work sooner and with less trauma.  Every doctor or nurse that I have ever talked to about these has said it is a great idea and that they will be standard equipment in all operating rooms one day!  Please join me in making this dream come true.


Surgery with Music Series Post #28: Procedures other than surgery


We all know that there are many serious medical procedures both elective and non-elective.  People ask me all the time if the headphones can be used for situations other than surgery.  The answer is a resounding “Yes!”

There are so many medical procedure performed every day, procedure that are serious but don’t involve cutting into the body with knives or lasers.  Some of these procedures are things like kidney dialysis, chemotherapy and radiation, colonoscopy and diagnostic procedures such as MRI’s and CT scans.  Then there are the elective procedures that often are found in the cosmetic surgery realm:  liposuction, botox injections, and lifts of all kinds to various parts of the body.

Whether your surgery is mandatory or elective, music can help to relax you and calm you and enable you to use less pain medication and less anesthesia.  All of this translates to a safer procedure and a faster recover and return to life.  Of course dental procedures such as root canals, crowns, and implants would definitely benefits from using your headphones to help muffle the sound of the dreaded drill.

No matter what the procedure, using music through headphones will make it easier and less painful.


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 #18: Do any hospitals have headphones waiting for patients?


This is my goal:  that every hospital, clinic and medical center in the world have the Surgical Serenity Headphones or some equivalent waiting and ready for their patients.  The research is there…music before, during and after surgery help the patients in ways that can be measured as well as in ways that can’t be measured.  The picture on the left was taken at the Cleveland Clinic in Florida just a few months ago.  I was flown in to give a Grand Rounds lecture to the entire staff of physicians and residents and they had double the usual crowd there.  Dr. Friedman, Chief of Surgery, said that everyone there is so enthusiastic about this and they hope to start a research study there in the next few months!  They already have some of the headphones that they are using.

The Cleveland Clinic in Ohio is using some right now as is the Mayo Clinic in Rochester, MN.  The VA hospital in Louisville, KY is doing a formal study on our Surgical Serenity Headphones and another hospital in Louisville is using them.  For the most part, they are currently being bought by individuals around the country, in Canada and in Western Europe. 

If you are having surgery soon, they can be shipped overnight to you!  Otherwise they arrive in 3-4 days.  If you are a surgeon, anesthesiologist or hospital staff or administration, please contact me for pricing information.  I want everyone to have these available for their patients and the reviews are excellent.


Surgery with Music Series Post #11: Music with General Anesthesia


  According to a recent article in Scientific American,   people who are being “put to sleep” with general anesthesia are really being put into a temporary a (usually) reversible coma!  I think for the average surgical patient, this sounds a little scarier.  Again, if you can reduce the amount of anesthesia that you need by having slow, steady music played for you through headphones, why not do it?

Patients undergoing significant operations, such as major cardiac or transplant surgery, typically require general anesthesia. But putting patients to “sleep” might not be the best way to describe the process, argued the authors of a new review paper, published in the December 30 issue of the New England Journal of Medicine.

What anesthesiologists are really doing is closer to putting patients—close to 60,000 each day in the U.S.—into a drug-induced coma. “It’s a reversible coma, but it’s nevertheless a coma,” says Emery Brown, a professor of anesthesiology at Harvard Medical School and coauthor of the paper.

General anesthesia before major surgery dips brain activity (as measured by electroencephalogram, or EEG) down to levels akin to brain-stem death. For the most part, Brown has found that anesthesiologists talk about the process in colloquial terms, telling patients they will be “asleep,” rather than “unconscious”—likely in an effort to not make a medical ordeal any scarier than it already needs to be.

That approach is doing both patients and scientists a disservice, he argues.

“It would be nice if your anesthesiologist could explain where drugs are going to be working,” Brown says. Many clinicians, however, might be hard pressed to offer detailed neurological explanations for how each compound they administer is working on the nervous system. They are more likely to think of it in terms of

“we turn the knob and they go to sleep,” says Michael Alkire, an associate professor of anesthesiology at the University of California, Irvine, who was not involved in the new paper.

Inducing a coma-like state does require careful monitoring, breathing and temperature support as well as a delicate balance of “hypnotic agents, inhalational agents, opioids, muscle relaxants, sedatives and cardiovascular drugs,” Brown and his colleagues noted in their paper.

The mechanisms behind this concoction, carefully devised though it might be, are not always well comprehended. Long thought of as a “black box,” anesthesia now “can be explained and understood—it’s not a mystery,” Brown says. And researchers can further help to clear the field’s fog by expanding the field of anesthesiology to collaborations with experts in other fields, such as sleep and coma research.

Although anesthesiology and research on sleep and coma generally carry on independently of one another, “there’s a way to think about them all in the same framework,” Brown explains. And that common frame should be neuroscience, he says.

Alkire agrees that the coma model “is more appropriate,” and that “shifting toward that view is going to be helpful” in moving the field forward. And bringing the disparate fields, including researchers from sleep and coma work, together makes sense because “it’s all the same fundamental neuroanatomy.”

A push for more detailed neuroscience in the field might also help drive research toward new, more effective methods. Diethyl ether was a revolutionary tool in the 19th century that could knock people out before surgery, but it had some unpleasant side effects. “Now we need nuance” and more targeted tools like those cropping up in other areas of medicine, such as cancer treatment and screening, Brown notes.
Anesthesia, Alkire says, “is still kind of on the level of ‘we have a big hammer, and we hit you on the head, and you get knocked out.'” He and his colleagues have been working to find more “regional brain anesthesia that would change the state of consciousness,” he explains. “I think we have a ways to go” he says but notes that they have had some promising leads by zeroing in on the thalamus in animal studies. But even if clinicians might not yet have more delicate tools to dip patients into surgery-ready unconsciousness, Alkire notes, “understanding how it works puts you in a position to do better anesthetics eventually—if not with the agents you have right now.”

And taking a deeper look at how drugs are working during anesthesia might also yield helpful models for different neurological disorders, Brown says, noting the similarities between EEGs in patients under general anesthesia and those in comas.

On the more mundane front, advances in anesthesiology might also help with treatments for insomnia—but not in the ways one might think.

Traditional treatments often work on the same mechanisms as the drugs given to anesthetize patients before surgery, thus helping people conk out, but not necessarily replicating normal sleep patterns. By taking a closer look at the mechanisms at work during general anesthesia—and how some of the more widely prescribed sleeping meds behave in the brain—”we can ask ‘is that the way we want to

[treat insomnia]?'” Brown explains.

And those advances in turn could feed back into the field of anesthesiology, helping to reduce side effects of general anesthesia, such as postoperative cognitive decline. Better understanding of the coma-like state of general anesthesia could also shed light on patients who are in a more permanent vegetative state, who upon waking go through very similar stages as those coming up from general anesthesia—albeit much more slowly. The key, says Brown, is “taking time to understand these mechanisms” and applying them to fine tune the proverbial hammer—a challenge that he and his colleagues hope to announce progress on in the coming months. (here ends the article from Scientific American.)

There is ample evidence that music before surgery calms and relaxes the patient, necessitating less anxiety medication and music after surgery, into the recovery room and on into the patient’s room, decreases the amount of pain medication the patient requires.  If you are a loved are having surgery please visit