“What Do People Expect of General Anesthesia?”, 2017-04-08 ():
…These questions are made more pertinent by our recent report that 4.6% of patients undergoing intubation under general anesthesia respond on the isolated forearm technique, implying they have connected consciousness, with 1.9% reporting connected consciousness with pain. To provide some initial insight into public opinion on this, we conducted a survey posted on our website, social media (Twitter, Reddit, and Facebook) and distributed electronically. We explored the public’s views of states such as disconnected consciousness or dreaming during anesthesia and intraoperative consciousness with and without amnesia.
…A total of 509 responses were recorded between 11 July 2016 and 6 October 2016 (denominator unknown). Of the 439 who answered all questions, the median age (in those who reported their age) was 33 (SD 15) yr, with a range of 18–79 years. For those reporting gender, 198 (40%) were male, 289 (59%) were female, and 3 (0.6%) chose not to specify. Respondents took a median of 169 sec (< 3 min) to complete the 12 question multiple choice survey. Most (57%) had undergone one (29%) or no surgeries (28%) under general anesthesia.
…Our primary objective when designing the study was to ascertain whether patients expect general anesthesia to be an unconscious state. In answer to the question “would you expect to be unconscious under general anesthesia?”, 96% of respondents reported they would expect to be unconscious under general anesthesia. About half (52%) would consider it acceptable to be conscious of surgery provided they were not in pain, while only 2% reported it would be acceptable if they were to be conscious of surgery and in pain (Table 1); 43% would consider it acceptable to be conscious of surgery and unable to recall it afterward, and 36% would consider it acceptable to be conscious during surgery and able to recall it afterward.
…When asked “if you were to be conscious of surgery, and in pain” respondents who had undergone surgery (320) reported finding that situation “unacceptable” more commonly than those with no history of previous surgery under anesthesia (120), 97% vs 92% (p = 0.039) (Supplementary Table 2). Of 19 respondents who left comments in response to the question “if you were to be conscious during surgery, and not able to recall it”, 8⁄19 mentioned pain as being an important consideration. When asked “if you were to be conscious during surgery, and could recall it afterward”, respondents who had undergone surgery more frequently considered this unacceptable compared with those who had not had surgery, 47% vs 37% (p = 0.04) (Supplementary Table 2), with 6⁄13 comments in response to this question mentioning pain as being an important to their response (Appendix 2).
Respondents who had not undergone surgery were statistically-significantly more fearful (45% “very fearful”) of not waking up after surgery, compared with those who had previously undergone surgery (27% “very fearful”) (p = 0.0009) (Supplementary Table 3). Subjects were asked to indicate fear of feeling pain during surgery; those who’ve had surgery were statistically-significantly less fearful of feeling pain during surgery (32% “very fearful”) compared with those who’ve not had surgery (50% very fearful) (p = 0.004) (Supplementary Table 3). Those who have had surgery were statistically-significantly less fearful of permanent cognitive deficits after anesthesia (34% “very fearful”) compared with those who’ve not had surgery (53% “very fearful”) (p = 0.0015).
…Fear of intraoperative awareness (painful or not), not waking after surgery, and permanent cognitive deficits from anesthesia were reported by 60% of survey respondents.