Abstract
Introduction
We aim to assess patients’ understanding of anesthesia and the anesthesiologist’s role in pre-, intra, and post-operative periods. Anesthesiologists’ responsibilities have expanded beyond the operating room to include trauma centers, labor analgesia, resuscitation units, etc. This is particularly important as patients in developing countries often have limited knowledge about anesthesia.
Methods
This cross-sectional study was conducted on 170 patients from January to February 2021 at Faghihi Hospital, affiliated with Shiraz University of Medical Sciences. Consenting patients were interviewed based on a pre-designed and pre-tested checklist.
Results
Out of 170 patients with an age of 46 ± 12 years, 85 % had previous exposure to anesthesia. 93 % of patients thought anesthesia meant to sleep, while only 66 % knew it was a medical specialty, and 24 % were aware of postoperative pain control by an anesthesiologist. Education level was the most important factor influencing patient knowledge, followed by place of residence and previous anesthesia experience. Previous anesthesia experience did not affect opinions about anesthesia ( P = 0.15).
Conclusion
The study participants generally had poor knowledge about anesthesia and anesthesiologists’ responsibilities. To improve this, we must endeavor to educate patients in the field of anesthesia. Also, attention should be focused on finding ways to inform patients about anesthesiology in rural areas and unschooled patients with video/audio instructions, as our findings indicate that a patient’s place of residence influences their knowledge about anesthesiology.
1
Introduction
Patients’ perception of anesthesia is crucial, and it assists patients in understanding the complications and advantages of anesthesia. Anesthesiologists’ roles extend beyond the operating room and the postoperative period as they participate in trauma centers, labor analgesia, resuscitation units, intensive care units, and acute and chronic pain management. Also, anesthesiology is advancing in technological equipment and medical professionals’ knowledge to provide better anesthesia care services to patients. However, patients’ poor awareness of anesthesia and the anesthesiologists’ responsibilities are documented, especially in developing countries. In Northern Ghana, a survey conducted in 2020 at a teaching hospital with 100 participants documented patients’ poor knowledge about anesthesia and the role of anesthesiologists. Studies showed that in the developed and developing world, patients knew and learned little about anesthesia and the roles and responsibilities of anesthesiologists. In addition, there is a large misconception about that. Even in developed countries, the progression of understanding anesthesia is not so fast. For example, many individuals think that an anesthesiologist’s only role is to administer anesthesia during surgery, neglecting their responsibility for pre-and post-operative care. Factors associated with patients, such as their prior experiences and exposure to anesthesia, along with issues related to anesthesiologists—like the lack of effective communication during preoperative visits—can greatly influence patients’ understanding of anesthesia and the role of anesthesiologists during both the intraoperative and postoperative periods.
Few studies have been conducted in this field and have assessed patients’ knowledge of anesthesia and anesthesiologists. Patients’ knowledge about anesthesia and anesthesiologists remains mostly unexplored in many countries and areas.
Establishing a good relationship between the anesthesiologist and patients during the preoperative visit can reduce patients’ anxiety. Reduced anxiety in patients can be obtained by informing them about anesthesia and knowing their specific concerns and fears regarding anesthesia. It is crucial that a patient is informed about his disease, surgery process, and anesthesia. Reliable information can help the patient to assist with his care and prepare himself for the operation and anesthesia.
Knowledge of patients about procedures can lower anxiety in pre-operative. , Perioperative anxiety adversely affects the immune system and the duration of recovery. ,
Our research is among the first in southern Iran (Shiraz) to examine a large sample size regarding patients’ awareness of anesthesia and the role of anesthesiologists. The study reveals the level of understanding among patients who have previously undergone surgery with anesthesia about the anesthesiologists’ responsibilities. Despite anesthesiologists in Iran operating in environments similar to those in developed countries, public perception of their role is not very favorable. A significant difference lies in their income, which is considerably lower than that of their counterparts in developed nations like the US.
Hence, our study aims to assess the patient’s knowledge of anesthesia and the roles of anesthesiologists in the pre-operative, intra-operative, and post-operative periods.
2
Material and methods
In this cross-sectional study, 170 patients undergoing elective surgery were enrolled in our study. This study was designed and performed in Faghihi Hospital, affiliated with Shiraz University of Medical Sciences, from January to February 2021 ( Fig. 1 ).
The study protocol was registered and approved by the ethics committee of Shiraz University of Medical Sciences (Ethical code: IR.sums.med.rec.1400.72), and written informed consent was obtained from each eligible participant. The inclusion criteria were male and female patients aged 18 to 70, ASA grade I and II, and an understanding of the Persian language. Also, the exclusion criteria were patients with a history of psychiatric disorders (based on self-report), substance abuse or opium addiction, alcohol overuse, and patients who were the medical staff.
The instrument of our study was a checklist and was a predesigned and pretested one. Cultural adaptation of the checklist was performed by an anesthesiologist and was used to evaluate the patient’s awareness of anesthesia and the anesthesiologist. It consisted of three parts and was used once for all patients. Section one included demographic data (age, pre-anesthesia visits in clinics, previous anesthesia exposure, previous surgical procedure, education (unschooled, primary school, secondary school, university and above, past medical history, drug history, ID number, and patient code, address). Sections two and three contained 20 questions about the patient’s knowledge of anesthesia and the role of anesthesiologists.
After confirming their willingness to participate in this survey, the pattern and form of the questions were explained to the participants. Questionnaires were printed in English. The questions were asked verbally. The perception and knowledge of the participants were ticked by the author, a medical student, the day before their surgery.
3
Statistical analysis
Data were analyzed using SPSS software (version 22, SPSS Inc., Chicago, IL). Continuous variables are reported as mean ± standard deviation (SD), and categorical variables are summarized using numbers and percentages. Statistical analysis was done using the Chi-square test to test the association between questionnaire questions and patients’ characteristics.
4
Results
This study was conducted on 170 patients, such that 76 (44.7 %) were male and 94(55.3 %) were female. The mean age and SD were 46.23 ± 11.74 years.
Almost 80 % of the patients were educated, and 20 % were uneducated. Of those who were educated, 45 % had finished primary school, 27 % in high school, and 7 % in university. 46.5 % of the participants were urban, 53.5 % were rural, and the majority (85 %) of the patients had a history of anesthesia exposure ( Table 1 ).
| Age | Mean ± SD (46.23 ± 11.74) | |
|---|---|---|
| Sex | Male | 76(44.7 %) |
| Female | 94(55.3 %) | |
| Education | Unschooled | 36(21.2 %) |
| primary school | 76(44.7 %) | |
| secondary school | 46(27.1 %) | |
| University | 12(7.1 %) | |
| Urban | Urban | 79(46.5) |
| Rural | 91(53.5) | |
| Previous anesthesia | Yes | 143(84.1 %) |
| No | 27(15.9 %) |
Among the 170 participants, 84 % had undergone a surgical procedure. Additionally, 85 % had previous exposure to anesthesia, with 66 % having experienced general anesthesia. A majority, 93 %, believed that anesthesia meant going to sleep. About 70 % reported being aware of anesthesia through their experiences or friends. When it came to fears and concerns about anesthesia, 14 % were afraid they might not wake up, 6 % feared feeling pain, 4 % were concerned about losing consciousness, and <1 % were worried about being unable to move. Notably, 94 % of participants who had received regional anesthesia reported not knowing potential complications, while 4 % identified back pain as a possible complication. Of the 36 % who were aware of anesthesia complications, 24 % stated that not waking up was a complication of general anesthesia. Regarding consent before anesthesia, the vast majority (88 %) knew that anesthesia consent is required, while 12 % were unaware of the requirement for anesthesia consent.
Most participants (82 %) were aware of different types of anesthesia. 61 % knew about general anesthesia, and 41 % were familiar with general and spinal anesthesia. According to the answers, 66 % of respondents recognized that an anesthesiologist is a specialist, while 29 % had no idea about their role. When asked about the responsibilities of an anesthesiologist in the operating theater, 56 % correctly identified their role in anesthetizing and monitoring patients, 32 % had no idea, and 12 % thought they only administered drugs. When participants were asked about the anesthesiologist’s presence during an operation in the OT, 35 % were unsure, while 52 % confirmed that the anesthesiologist was present. Of their knowledge about different methods of anesthesia, 52 % indicated that injections are used, and 32 % mentioned that gases are administered through a mask. In response to who was in charge of pain relief during and after surgery, 37 % answered the surgeon, 25 % had no idea, 24 % responded it was an anesthesiologist, and 9 % answered the nurse. Concerning willingness to visit an anesthesiologist/surgeon before the operation, 88 % were keen to meet both. In response to whether an anesthesiologist was in charge of recovery after the operation, 47 % had no idea, 21 % responded yes, and 32 % answered no. Regarding the workplace of the anesthesiologist, 22 % had no idea, and 76 % responded only to OT ( Table 2 ).
| Question | Answer | n (%) |
|---|---|---|
| 1. Have you undergone any surgical procedure? | Yes | 143(84.1) |
| No | 27(15.9) | |
| 2. What is your idea/opinion about anesthesia? | No idea | 8(4.7) |
| Making area numb | 4(2.4) | |
| Putting to sleep | 158(92.9) | |
| Do you have any previous exposure to anesthesia? | Yes | 145(85.3) |
| No | 25(14.7) | |
| If yes | Local | 18(10.3) |
| General | 112(66.2) | |
| Both | 40(23.4) | |
| 3. What is your source of information about anesthesia? | No idea | 25(14.7) |
| Media | 10(5.9) | |
| Relative | 16(9.4) | |
| Friend/self-exposure | 119(70) | |
| 4. What are your fears about operative procedure? | Don’t know | 88(51.8) |
| Feeling pain | 5(2.9) | |
| Being awake | 1(0.6) | |
| Being anesthetized | 22(12.9) | |
| Surgical Procedure | 54(31.8) | |
| 5. What are your fears related to anesthesia? | Don’t know | 128(75.3) |
| Feeling pain | 10(5.9) | |
| Becoming unconscious | 7(4.1) | |
| Not waking up | 24(14.1) | |
| Not able to move | 1(0.6) | |
| 6. Do you know about complications due to anesthesia? | ||
| (A) General anesthesia | No idea | 118(64.4) |
| Overdose | 6(3.5) | |
| Not waking up | 41(24.1) | |
| Ventilator support | 1(0.6) | |
| Death | 4(2.4) | |
| (B) Regional anesthesia | No idea | 161(94.7) |
| Backache | 6(3.6) | |
| Nerve injury | 3(1.8) | |
| 7. Have you been explained about giving consent for anesthesia procedure? | Yes | 150(88.2) |
| No | 20(11.8) | |
| 8. Do you know about different types of anesthesia? | Yes | 140(82.4) |
| No | 30(17.6) | |
| If yes | general Anesthesia | 104(61.4) |
| Local | 1(0.7) | |
| General & Spinal | 41(24.3) | |
| General & Local | 15(8.6) | |
| General & Local & spinal | 9(5) | |
| 9. What do you know about techniques in regional anesthesia? | Yes | 170(100) |
| No | 0(0) | |
| If yes | Spinal/epidural | 102(60) |
| local blocks | 68(40) | |
| 10. Who is an anesthesiologist? | No idea | 50(29.4) |
| General practitioner | 7(4.1) | |
| Specialist | 112(65.6) | |
| Technician | 1(0.6) | |
| 11. What is the role of anesthesiologist in Operation Theater? | No idea | 54(31.8) |
| Administers drugs only | 21(12.4) | |
| Anesthetizes and monitors patient | 95(55.9) | |
| 12. Do anesthesiologists stay throughout the procedure? | No idea | 60(35.3) |
| Maybe | 13(7.6) | |
| Yes | 88(51.8) | |
| No | 9(5.3) | |
| 13. How do you think patients will be anesthetized? | No idea | 21(12.4) |
| only injection at the site | 5(2.9) | |
| Injection | 89(52.4) | |
| gasses administered with mask | 55(32.4) | |
| 14. How many anesthesiologists /anesthesiologists do you think will be present in operation? | No idea | 81(47.6) |
| One | 50(29.4) | |
| Two | 25(14.7) | |
| Three | 14(8.2) | |
| 15. Who is responsible for pain relief during and after surgery? | No idea | 43(25.3) |
| Nurse | 15(8.8) | |
| Anesthesiologist | 41(24.1) | |
| Surgeon | 63(37.1) | |
| All | 8(4.7) | |
| 16. Would you like to meet anesthesiologist/surgeon before undergoing surgery? | Yes | 7(4.1) |
| No | 9(5.3) | |
| Only treating surgeon | 4(2.4) | |
| Both | 150(88.2) | |
| 17. Do you think it is important to meet anesthesiologist before surgical procedure? | Yes | 149(87.6) |
| No | 10(5.9) | |
| No idea | 11(6.5) | |
| 18. Are the anesthesiologists responsible for the recovery of the patient? | Yes | 36(21.2) |
| No | 54(31.8) | |
| No idea | 80(47.1) | |
| 19. What other places do the anesthesiologists work in the hospital setup? | No idea | 37(21.8) |
| Operating theatre only | 130(76.5) | |
| Intensive care unit | 1(0.6) | |
| Recovery | 1(0.6) | |
| Pain clinic | 1(0.6) |
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