International Journal of Research in Medical Sciences

Marulasiddappa V et al. Int J Res Med Sci. 2018 Feb;6(2):486-492

www.msjonline.org pISSN 2320-6071 | eISSN 2320-6012

DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20180286
Original Research Article

Assessment of surgical patients’ knowledge about anaesthesia and

anaesthesiologist in a tertiary care teaching institute-a survey
Vinay Marulasiddappa, Nethra H. N.*

Department of Anaesthesia, BMCRI, Bengaluru, Karnataka, India

Received: 08 January 2018

Accepted: 11 January 2018

*Correspondence:
Dr. Nethra H. N.,
E-mail: [email protected]

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background: Anaesthesia is a speciality, playing a crucial role in the perioperative care of patients. Complex
surgeries are facilitated due to the anaesthesiologists catering to the ever-advancing surgical field requirements.
Although an important speciality, patients are unaware of the speciality of anaesthesia and anaesthesiologist. Patients
are subjecting themselves for surgical procedures without having adequate knowledge of anaesthesia and
anaesthesiologist. Hence, the survey was designed with the aim to assess the patients’ knowledge about anaesthesia
and anaesthesiologist in surgical patients.
Methods: A cross sectional study conducted on four hundred surgical inpatients using predesigned questionnaire
containing questions related to the knowledge of anaesthesia and anaesthesiologist. The results were expressed as
percentages. Chi-square/ Fisher Exact test was used to find the significance of study parameters.
Results: Anaesthesiologists were considered as “doctors” by 60.5% of patients; Thirty three percent of the survey
population had “no idea” of Anaesthesia. The survey populations’ knowledge about complications was 32.25%.
Awareness about separate consent for anaesthesia was 49%. Anaesthesiologists’ work place was not known to 77.5%
of survey population. Anaesthesiologists’ role in operation theatre was known only in 59.5% and remaining 40.5%
were unaware of Anaesthesiologists’ role. None of the patients preferred to meet the Anaesthesiologists before
surgery.
Conclusions: Surgical inpatients in tertiary care hospital have a poor understanding of anaesthesia and poor
recognition of the role of anaesthesiologist. The knowledge about anaesthesia and anaesthesiologist is not known in
general population. Hence, anaesthesiologists must work towards getting recognition for the speciality of
anaesthesiology and the anaesthesiologists.

Keywords: Anaesthesiology, Anaesthesiologist, Consent

INTRODUCTION Lack of recognition and decreased appreciation of the

speciality leads to disinterest and frustration in the work
Anaesthesia is relatively a new speciality when compared place.2,4,5
to surgery and medicine. Anaesthesia has rapidly evolved
and has become the supporting specialty for the Anaesthesiologists are considered as perioperative
advancement of surgical specialities, critical care and physicians, leaders in resuscitation and relievers of pain.5
pain medicine. Anaesthesiology is considered as “behind Lack of awareness about Anaesthesiologists and
the scene” speciality and “low profile” speciality by the Anaesthesiology may lead to anxiety and fear in patients
medical fraternity as well as the general public.1-4 subjecting themselves to surgery.

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In the present era of advanced healthcare facilities, with All participants were explained about the questionnaire.
access to media and technology, patients are expected to After confirming their willingness to take part in the
be well informed about healthcare and anaesthesia. On survey, patients were explained about the pattern of
the contrary, patients are subjecting themselves for questions. Questionnaire was available in two languages-
complex surgical procedures without adequate Kannada and English. Patients could opt for language of
knowledge about pre-anaesthesia checkup, anaesthesia their preference. Literates were defined as “any person
consent, procedure and risks related to anaesthesia. who is able to read and write”. Illiterates and patients
with vernacular other than Kannada and English had an
Studies conducted on general population, tribal interpreter to help in analysing questions. Interpreter was
population and medical students to assess the knowledge a preoperative nurse who was not involved in the study.
about anaesthesia and anaesthesiology, showed that large Literate patients were given questionnaires and asked to
percentage of people were unaware of the role of tick the answers after going through the questionnaire.
anaesthesiologists in surgical procedures, critical care and Anaesthesia post graduate students were present to clarify
labor analgesia.2,3,5 In the recent years, anaesthesia related any queries related to the understanding of the questions.
complications have been highlighted in media with Questionnaires were collected and analysed after the
respect to patient morbidity and mortality. Being aware completion of the study period by the investigator.
of the present situation of the speciality of anaesthesia,
we intended to conduct a study on surgical in-patients in Chi-square/Fisher Exact test has been used to find the
a tertiary care teaching institute, and assess their significance of study parameters on categorical scale
knowledge about anaesthesia and the role of between two or more groups. The Statistical software
anaesthesiologist. namely SAS 9.2, SPSS 15.0, Stata 10.1, MedCalc 9.0.1,
Systat 12.0 and R environment ver.2.11.1 were used for
METHODS the analysis of the data and Microsoft word and Excel
have been used to generate graphs, tables etc.
The cross section survey was conducted in four allied
hospitals of a Tertiary Care Teaching Institute from RESULTS
October 2015- March 2016.
The results of all hospitals were pooled, and data was
The aim of our study was to assess the knowledge and expressed as percentages. One third of the survey
awareness, about anaesthesia and anaesthesiologist in population were females. Majority of the patients
surgical population. Our primary objective was to assess (67.5%) were in the age group of 18-45 years. About half
the knowledge about anaesthesia and anaesthesiologist. of our survey population (52.5%) were homemakers.
Our secondary objectives were to assess the awareness Residents of Bangalore city constituted to 62.5% of
about the role of anaesthesiologists in the perioperative survey patients. Illiterates were only 16.25% of survey
management of patients and to assess the influence of population. The details of demographic parameters are
previous exposure to surgery and anaesthesia on the summarized in Table 1.
knowledge about anaesthesia and anaesthesiologist.
Table 1: Demographic parameter.
Sample size of 400 was determined based on study
outcome and conservative estimate of 50% and 95% Parameters Sub-parameter %
confidence Interval with 10% level of margin of error. 18-45 years 67.5
Age
Study tool used was a Closed End Questionnaire, with 21 45-70 years 32.5
questions organised under three sections- Section 1 had Females 64.5
Gender
demographic details of surgical patients and speciality of Males 35.5
surgery; Section 2 had questions related to Bangalore 62.5
Residence
Anaesthesiology; Section 3 contained questions about Non-bangalore 37.5
anaesthesiologists and their role in perioperative care Illiterate 16.25
(Annexure 1). Questionnaire was designed based on High school 51.5
Education
validated questionnaires of previous studies with Intermediate 19
questions to address the objectives of the study.1,2,4 Graduate 13.25
Random patient allocation was done by computer Homemaker 52.5
generated random numbers. Farmer 5.75
Coolie 11
Adult patients admitted for elective surgery in the age Business 6.75
group of 18-65 years of ASA physical class 1 and 2, were Sales 6
Occupation
included in the survey. Patients not willing to take part in Driver 5.25
the study; Age<18 years and >65 years; ASA physical Teacher 2.5
class 3 and patients posted for emergency surgery were Engineer 1
excluded from the survey. Survey was conducted in Doctor 0
preoperative period in the pre anaesthesia clinic. Student 9.25

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To the questions on assessment of knowledge about Patients who had “no idea’ of anaesthesiology were not
anaesthesiology, two third of the population answered excluded but were allowed to answer other questions in
that they had some idea of anaesthesiology and one third the survey. The answers of the assessment of knowledge
of patients were totally unaware of anaesthesiology. about anaesthesiology are depicted in the Table 2.

Table 2: Knowledge about anaesthesiology.

Idea of anaesthesiology % Knowledge about anaesthesia complications %

No idea 33 Yes 32.25
Making area numb 30.75 GA
Putting to sleep 13.75 -not waking 5.5
Making unconscious 22.5 -overdose 11
Source of information about anaesthesia Death 1.75
No idea 27.5 Ventilator support 1.7
Self-exposure 20.7 Regional
Friend 10.25 Nerve injury 3.5
Relative 8.75 Backache 10.5
Media 5.5 Weakness 0.75
Nurse 2.5 No idea 67.75
Surgeon 18.25 Awareness about consent for anaesthesia
Multiple source 6.5 Yes 49
Fears about operative procedure No 33.5
Do not know 28.75 Only for surgery 17.5
Feeling pain 46 Knowledge of different types of anaesthesia
Fear of surgery 13.25 No idea 75.75
Being anaesthetized 8 Yes 24.25
Being unconscious 1 -GA 6.25
Being awake 2.75 -SA/EA 6
Fears about anaesthesia -LA 3.25
Do not know 35 -GA+RA+LA++ 8.75
Feeling pain 33.75 Knowledge of different techniques in regional anaesthesia
Being unconscious 19.5 No idea 83
Not waking 9 Yes 17
Immobility 2.75 -spinal/epidural 8.75
-local blocks 4.75
-SA^+EA^^+ LA+ blocks 3.5
++
GA-general anaesthesia,la-local anaesthesia, RA-regional anaesthesia
^-spinal anaesthesia, ^^EA-epidural anaesthesia

Importance of signing the consent for surgical procedure methods of anaesthetising. Terminologies like “general
was understood by 66.5% of study population. About half anaesthesia, regional anaesthesia and local anaesthesia
of the survey population were not aware of giving a were understood only by 24.2% of patients. “Injection”
separate consent for anaesthesia procedures. Prior was the assumed method of administering anaesthesia
exposure and treating surgeons were the main sources of according to 50.2% of the patients.
information about anaesthesia
It was disappointing to note that the awareness about
Fear of pain from the operative procedure was the anaesthesia complications were very poor. A large
foremost concern in 46% of patients. Only 8% of patients percentage of patients (67.75%) were unaware of the
expressed fear of getting anaesthetized. To the question possibility of complications. A few complications as
of “fears related to anaesthesia”-patients expressed ‘fear listed by patients are depicted in figure 2
of pain’ and ‘immobility’ as the important concerns.
Fears related to anaesthesia are depicted in Figure 1. Although Pain was the prime concern, patients were
ignorant about doctors responsible for pain relief. Patients
Patients were unfamiliar with techniques in anaesthesia. were not clear about the role of anaesthesiologists in
Majority of the patients (75.7%) had no idea about the perioperative care. The answers to the questions

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addressed to assess knowledge of the anaesthesiologists are presented in Table 3.

Table 3: Knowledge about anaesthesiologist.

Qualification of anaesthesiologist Responsibility of pain relief during/after surgery

No idea 29% No idea 29.75%
Technician 2% Surgeon 27.25%
Assistant 0.5% Anaesthesiologist 15.5%
Doctor 60.5% Nurse 8.25%
Specialist 8% All 19.25%
Role of anaesthesiologists in operation theatre Preference to meet OT# doctor
No idea 40.5% Yes (any doctor) 57.75%
Administers drugs only 35% Only surgeon 18%
Anaesthetizes & monitors 24.5% Anesthetist 0%
Presence of anaesthesiologists in OT Both 6.5%
No idea 43.25% No 13%
Yes 31.25% No idea 4.75%
May be present 25.5% Willingness to meet anaesthesiologist
Methods of administering anaesthesia Yes 51%
No idea 29.25% No 17.5%
Injection (non specific site) 50.25% No idea 31.5%
Injection site 13.5% Source of referral to anaesthesiologists
Gases 5.25% No idea 0.75%
Injection + gases 1.75% Self 5.5%
Number of anaesthesiologists in OT Surgeon 62.5%
No idea 68.75% Nurse 31.25%
One 18.5% Work place of anaesthesiologists
Two 6.5% No idea 77.5%
Three 6.25% Only OT 17.5%
ICU/PACU 5%
#-
OT operation theatre

According to 60.55% of patients, ‘anaesthesiologists’ anaesthesia procedure and anaesthesia complications. The
were doctors. Few considered anaesthesiologists as answers of pre-exposure group and post exposure group
‘technician’ and ‘assistants to surgeons’. Role of the has been summarised in the Table 4.
anaesthesiologists in perioperative care was poorly
understood by patients. Work place of anaesthesiologist DISCUSSION
was not known to 77.5% of the population. Patients did
not know about the Presence of anaesthesiologist in Anaesthesiology is a speciality playing a significant role
operation theatre (43.2%). Surgeons and ward nurses in surgical patient care. Anaesthesiology has surpassed
were considered as pain relievers (27%). Operating the limits of operation room and spread the services to
surgeons were preferred than the anaesthesiologist. It was critical care, palliative care, labour analgesia and pain
disappointing to note that no patient preferred to meet clinics. Although an important speciality, anaesthesiology
anaesthesiologist in particular has lacked the recognition deserved by the speciality
anaesthesia and anaesthesiologist are not appreciated by
In our study, 45% of patients had previous exposure (PE) medical fraternity as shown by various studies.1,3,5,4,6,7
and 55% of the patients had no exposure (NE) to surgery Anaesthesiologist of the present day are expected to
and anaesthesia in the past. Among patients with previous possess the multitasking abilities, updated knowledge
exposure to surgery, 89.5% of patients could recollect the about rapidly evolving techniques in anaesthesia, surgery,
type of anaesthesia they were exposed and 9.35 % could resuscitation, pain management and monitoring
not recollect the type of anaesthesia administered to equipments.7 Despite rendering lifesaving, pain relieving
them. services to the patients, anaesthetists lack the due respect.

Patients with previous exposure to anaesthesia had a Our study was conducted in the tertiary care teaching
better understanding about anaesthesiology, consent, and government institution located in a metro city. In our

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study as majority of patients were residents of Bangalore tribal/rural area in India due to lower literacy.1 On the
city, the awareness about anaesthesiology was expected contrary, knowledge of anaesthesiology and
to be better than people in tribal or rural areas. The anaesthesiologist was poor as found in studies conducted
knowledge about of anaesthesiology is lower in in urban tertiary care hospitals in India.2,5

Table 4: Comparison of answers between Previous Exposure and Non- exposure groups.

Question Previous exposure Non exposure p value

N (%) N (%)
Idea of anaesthesiology <0.001**
No idea 37 (20.35) 95 (43.13)
Making area numb 80 (44.00) 46 (20.88)
Putting to sleep 21 (11.55) 35 (15.89)
Making unconscious 42 (24) 44 (20)
Knowledge of different types of anaesthesia <0.001**
No idea 114 (62.7) 198 (89.89)
Yes 66 (36.3) 22 (9.98)
Methods of administering anaesthesia <0.001**
No idea 31 (17.05) 106 (48.12)
Injection (non specific site) 113 (62.15) 70 (31.78)
Injection at site 9 (4.95) 26 (11.80)
Gases 4 (2.2) 10 (4.54)
Injection +gases 23 (12.65) 8 (3.6)
Knowledge about anaesthesia complications <0.001**
Yes 62 (34.1) 45 (20.43)
No idea 118 175 (79.45)
Awareness about consent for anaesthesia <0.001**
Yes 118 (64.9) 88 (39.95)
No 35 (19.25) 94 (42.30)
Only for surgery 27 (14.85) 38 (17.25)
Fears about operative procedure 0.011*
Do not know 49 (26.95) 65 (29.51)
Feeling pain 76 (41.80) 111 (50.39)
Fear of surgery 23 (12.65) 30 (13.62)
Being anaesthetized 24 (13.20) 9 (4.08)
Being unconscious 2 (1.1) 0 (0)
Being awake 6 (3.3) 5 (2.27)
Fears about anaesthesia 0.574
Do not know 60 (33.) 85 (38.59)
Feeling pain 57 (31.35) 72 (32.68)
Being unconscious 39 (21.45) 40 (18.16)
Not waking 16 (8.8) 18 (8.17)
Immobility 8 (4.4) 5 (2.27)
+ suggestive significance (p value: 0.05<p<0.10)* moderately significant (p value:0.01<p  0.05)** strongly significant
(p value : p0.01)

Higher literacy in patients is found to influence the Surgeons and nurse play an important role as they are the
knowledge about anaesthesiologist.2,3 Although, large primary consultant and care takers of the in-patients. In
number of patients answered that anaesthesiologists were our study surgeons and nurses were the persons who
doctors (60.5%), very few patients were aware that referred the patients to pre anaesthesia clinics. Prior
anaesthesiologists were specialists. Although, literacy exposure was also an important way of acquiring
was 83.4% in our patients, we did not study the knowledge about anaesthesia. Hence, patients undergoing
correlation with literacy with knowledge of surgery for first time should be made aware about
anaesthesiology. anaesthesia.3

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losing mobility
patient has to undergo. The reasons that could be
not waking up assumed are-minimal interaction by anaesthesiologists
losing consciousness with the patient and relatives; change in shift of
losing feeling pain anaesthetists and administration of sedatives might
mobility,
No Fear influence the patients’ understanding of anaesthesia
2.75% practice as well as lack of appreciation of
anaesthesiologists role.
not waking
up, 9% losing feeling In our study, we noted that patients who had past history
consciousnes pain, of exposure to anaesthesia and surgery, had better
19.50% 33.75% understanding about anaesthesiology and
anaesthesiologist (Table 4). Significant difference
No Fear, (p<0.001) was seen in the answers pertaining to idea of
35% anaesthesiology, methods of administering anaesthesia
and complications of anaesthesia. Patients who had prior-
exposure to anaesthesia recognised anaesthesiologist as
doctors and specialists (p<0.001) as compared to non-
exposed group. Patients with previous exposure were also
Figure 1: Fears related to anaesthesia. aware of number of anaesthesiologists, role of
anaesthesiologists in operation and pain relief. Patients
with prior exposure expressed their willingness to meet
weakness 0.75 % the anaesthesiologist prior to surgery. Experience of
surgery will influence the knowledge about anaesthesia.
death 1.75% Hence, every opportunity of interaction with an
anaesthesiologist should be stressed on imparting
ventilator support 1.75%
awareness about anaesthesia and techniques.
nerve injury 3.5%
The drawbacks in our study are as follows:
not waking 5.5% Questionnaires were given to patients visiting pre
anaesthesia clinics. Answers could have been influenced
backache 10.5%
by answers of other patients and relatives.
overdose 11%
67.75% In our survey, as the method followed was a written
No idea questionnaire, people who had no idea of anaesthesia or
anaesthetists were not eliminated from the study but
instead asked to answer further questions, therefore any
Figure 2: Knowledge about anaesthesia complications. given choice could have been marked by patients. We did
not correlate answers based on literacy, gender, region,
Media can be an effective medium in creating awareness occupation, religion and surgical speciality of admission.
about anaesthesiology with its widespread network and We have not conducted a pre-assessment and post
accessibility to the public. However, in our study, assessment survey of knowledge of anaesthesiology and
information from mass media was only 5.1%. This could anaesthetists following PAC/surgical procedure. Our
be due to lack of information and material on to the mass study was focused on assessing the overall knowledge
media. Spreading knowledge by use of mass media may about anaesthesiology and anaesthesiologists in tertiary
improve the awareness about anaesthesiology.8,9,10 care teaching government hospital and the influence of
previous exposure. The results and discussion are based
Studies have shown that pain is the most feared aspect of on findings of survey in our institution. The results may
surgical procedure than getting anaesthetized.4,7,11 Also, vary in private or corporate hospitals.
people are more concerned of surgical procedure than
anaesthesia procedure. Lack of awareness about The explanation for poor knowledge about anaesthesia
anaesthesia procedure and ignorance about anaesthesia and anaesthetists may be due to following
could have been the explanation for lack of fear about
anaesthesia. • Change in operation theatre shifts with change in
anaesthesiologist,2,5
General lack of interest in knowing anaesthesiology and • Non availability of anaesthetist in outpatient
anaesthesiologist leads to poor knowledge about consent, department to answer queries by patients or patients
techniques and complications. One third of survey attendees,
population were unaware about the need to give consent • Lack of introduction by anaesthesiologists to the
either for surgery or anaesthesia thereby showing patients during pre operative or post operative
ignorance towards understanding the procedure every visits.5

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 Marulasiddappa V et al. Int J Res Med Sci. 2018 Feb;6(2):486-492

• Interaction by the consultant anaesthetists only on Funding: No funding sources

the day of surgery and short interaction,4,8,9 Conflict of interest: None declared
• Non availability of information related to Ethical approval: The study was approved by the
anaesthesia in Out-patient slips/ in patient books and Institutional Ethics Committee
discharge cards.
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Cite this article as: Marulasiddappa V, Nethra HN.
Improving knowledge is the need of the hour in order to
Assessment of surgical patients’ knowledge about
have positive outcomes in anaesthesia and surgery, as
anaesthesia and anaesthesiologist in a tertiary care
well as improve doctor-patient relationship.
teaching institute-a survey. Int J Res Med Sci
2018;6:486-92.

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