Anaesthesia is an essential component of modern surgical practice and has contributed immensely to the advancement of medicine by allowing complex surgical procedures to be performed safely and without pain. The specialty has progressed from a technique focused mainly on inducing unconsciousness during surgery to a comprehensive discipline concerned with the overall perioperative management of patients. Modern anaesthesiology includes preoperative risk assessment, optimization of medical conditions, intraoperative physiological monitoring, airway management, haemodynamic support, postoperative pain management, critical care, trauma management, obstetric anaesthesia, and emergency medicine. The role of the anaesthesiologist has expanded significantly over the years. An anaesthesiologist is responsible not only for administering anaesthetic agents but also for maintaining patient safety before, during, and after surgery. During the preoperative period, the anaesthesiologist evaluates the patient's medical history, physical status, investigations, and associated risk factors to formulate an individualized anaesthetic plan. Intraoperatively, continuous monitoring of vital parameters such as oxygen saturation, blood pressure, heart rate, respiratory status, and depth of anaesthesia is performed. The anaesthesiologist also manages intraoperative complications, fluid balance, blood loss, and unexpected emergencies. In the postoperative period, anaesthesiologists contribute to pain management, recovery from anaesthesia, intensive care, and management of critically ill patients. Despite the critical role of anaesthesiologists in healthcare delivery, public awareness regarding the specialty remains inadequate. Many patients continue to perceive anaesthesia as simply a method of "making the patient sleep" and are unaware of the extensive responsibilities performed by anaesthesiologists. Lack of awareness may result in misconceptions, increased fear, poor communication, and unrealistic expectations regarding surgical procedures. Recognition of anaesthesiology as an independent medical specialty is important for establishing trust between patients and healthcare providers. India has witnessed remarkable growth in surgical services and anaesthesia practice over recent decades. However, variations in literacy levels, socioeconomic conditions, healthcare accessibility, and cultural beliefs continue to influence patients' understanding of medical procedures. In a country with a large rural population, limited health literacy remains a significant challenge. Patients often obtain information about surgery and anaesthesia from relatives, friends, previous experiences of others, television, social media, or non-medical sources, which may contribute to incorrect beliefs and anxiety. Patient knowledge regarding anaesthesia has important implications for perioperative care. Adequate understanding helps patients participate actively in decision-making, provide informed consent, follow preoperative instructions, and communicate concerns effectively. Conversely, poor knowledge may increase fear and anxiety before surgery. Preoperative anxiety is common among surgical patients, especially those undergoing surgery for the first time. Fear of death, failure to wake up after anaesthesia, postoperative pain, paralysis, and awareness during surgery are frequently reported concerns. Increased anxiety may affect physiological responses, increase analgesic requirements, delay recovery, and reduce overall patient satisfaction. The pre-anaesthetic evaluation clinic provides an ideal opportunity for anaesthesiologists to educate patients and address misconceptions. Effective communication and counselling before surgery can improve patient confidence, reduce anxiety, and enhance cooperation. Therefore, understanding the existing level of knowledge and attitude among patients is necessary to design appropriate educational strategies. Several studies from India have evaluated awareness regarding anaesthesia among surgical patients and have consistently demonstrated significant knowledge gaps. Naithani et al. conducted one of the early Indian studies assessing public awareness about anaesthesia and anaesthesiologists. They observed that although many patients were familiar with the term "anaesthesia," only a small proportion understood that anaesthesiologists are qualified doctors responsible for administering anaesthesia and monitoring patients during surgery. The authors emphasized the need for improving patient education and increasing public recognition of the anaesthesia specialty.¹ In another Indian study, Jain et al. evaluated patients' knowledge and perception regarding anaesthesia and found that misconceptions regarding the role of anaesthesiologists were common. A considerable number of patients believed that surgeons themselves administered anaesthesia, highlighting inadequate understanding of the separate responsibilities of surgical and anaesthetic teams.² Nag et al. studied awareness among patients undergoing surgery and reported that awareness regarding different types of anaesthesia, anaesthetic monitoring, and postoperative pain management was poor. The study emphasized that preoperative counselling by anaesthesiologists could improve patient understanding and reduce anxiety related to anaesthesia.³ Similarly, Sikdar et al. reported that educational level was an important determinant of awareness. Patients with higher educational qualifications demonstrated better knowledge regarding anaesthesia compared with those with lower literacy levels. The authors suggested that educational interventions should particularly focus on patients from disadvantaged socioeconomic backgrounds.⁴ Kumar et al. assessed patients' perception of anaesthesia services in an Indian tertiary care hospital and found that although patients appreciated the role of anaesthesiologists after interaction, many were initially unaware of their responsibilities beyond administering anaesthesia. This highlighted the importance of direct communication between anaesthesiologists and patients during preoperative assessment.⁵ International studies have also reported similar findings. Hariharan et al. demonstrated that many patients underestimated the role of anaesthesiologists and were unaware of their involvement in intensive care, pain management, and emergency medicine.⁶ Lee et al. reported limited public recognition of anaesthesiology as a specialty despite its importance in modern healthcare.⁷ The level of awareness among patients may vary according to demographic factors such as age, education, occupation, socioeconomic status, and place of residence. Patients with higher education and greater access to healthcare information generally demonstrate better knowledge. Identifying these factors can help develop targeted educational programmes for populations with lower awareness. First-time surgical patients represent a particularly important group because their expectations and fears are influenced primarily by available information rather than personal experience. Assessing their knowledge and attitude provides valuable insight into misconceptions that may exist before surgery. Such information can help anaesthesia departments improve counselling methods and develop patient-centred approaches to perioperative care. Although anaesthesia has become safer due to advances in monitoring and pharmacological techniques, fear and misconceptions continue to exist among patients. Increasing public awareness regarding the role of anaesthesiologists is therefore an important responsibility of the specialty. Educational materials in local languages, audiovisual counselling, dedicated pre-anaesthetic consultation, and community awareness programmes may improve understanding and reduce anxiety. Hence, the present study was undertaken to evaluate the knowledge, attitude, and awareness of anaesthesia among first-time surgical patients in a tertiary care teaching hospital. The study aims to identify existing knowledge gaps, assess factors influencing awareness, and provide evidence for developing effective patient education strategies to improve perioperative experience and patient satisfaction.

Study Design The present study was designed as a hospital-based cross-sectional observational study to assess the knowledge, attitude, and awareness regarding anaesthesia among first-time surgical patients. The study was conducted among adult patients undergoing elective surgical procedures under anaesthesia at a tertiary care teaching hospital in India. The study focused on evaluating patients' understanding of anaesthesia, awareness regarding the role of anaesthesiologists, common misconceptions, fears, and factors influencing awareness levels. Study Setting The study was conducted in the Department of Anaesthesiology at a tertiary care teaching hospital in India. The hospital provides comprehensive surgical services with facilities for general surgery, orthopaedics, obstetrics and gynaecology, ENT, ophthalmology, urology, and other elective surgical specialties. The Department of Anaesthesiology provides pre-anaesthetic evaluation, intraoperative anaesthesia care, postoperative pain management, critical care services, and emergency management. Study Period The study was conducted over a period of one year from January 2019 to December 2019. Study Population The study included adult patients admitted for elective surgical procedures who were undergoing surgery for the first time and were scheduled to receive anaesthesia. Patients were recruited during their pre-anaesthetic evaluation before surgery. Sample Size A total of 300 patients were included in the study. The sample size was calculated using the formula: n="\f" rac4pqd^2 where: n = required sample size p = expected prevalence of awareness regarding anaesthesia q = 100 − p d = allowable error Based on previous studies reporting variable awareness levels among surgical patients and considering an expected awareness proportion of 50% with an allowable error of 6%, the calculated sample size was approximately 267. Considering possible non-response and incomplete data, the final sample size was increased to 300 participants. Sampling Technique Patients were selected by consecutive sampling method. All patients fulfilling the inclusion criteria during the study period were enrolled until the required sample size was achieved. Inclusion Criteria Patients fulfilling the following criteria were included: 1. Patients aged 18 years or older. 2. Patients undergoing surgery for the first time. 3. Patients scheduled for surgery under any type of anaesthesia: • General anaesthesia • Regional anaesthesia • Local anaesthesia with sedation a. Patients willing to provide written informed consent. b. Patients able to understand and respond to Hindi or English language questionnaires. Exclusion Criteria Patients were excluded if they had: 1. Previous history of surgery or exposure to anaesthesia. 2. Emergency surgical procedures. 3. Critical illness requiring immediate surgical intervention. 4. Cognitive impairment or inability to communicate. 5. Psychiatric illness affecting understanding or response. 6. Healthcare professionals or medical students. a. Refusal to participate in the study. Study Questionnaire Data were collected using a structured questionnaire prepared after reviewing previous studies evaluating awareness regarding anaesthesia. The questionnaire was reviewed by senior anaesthesiologists for content validity and clarity. It was administered through face-to-face interviews. The questionnaire consisted of four sections: Section 1: Socio-Demographic Characteristics The following details were recorded: Age, Gender, Residence (rural/ urban), Educational status, Occupation, Marital status, Socioeconomic background Section 2: Knowledge Regarding Anaesthesia This section assessed basic knowledge about anaesthesia. Questions included: • Whether the patient had heard about anaesthesia. • Purpose of anaesthesia. • Whether anaesthesia prevents pain during surgery. • Knowledge about different types of anaesthesia. • Knowledge regarding safety of anaesthesia. • Identification of the person responsible for administering anaesthesia. Section 3: Awareness Regarding Anaesthesiologist This section evaluated patients' understanding of the role of anaesthesiologists. Participants were assessed regarding awareness that anaesthesiologists: • Perform preoperative assessment. • Select appropriate anaesthetic techniques. • Monitor patients during surgery. • Manage intraoperative complications. • Provide postoperative pain relief. • Manage critically ill patients in intensive care units. • Participate in emergency resuscitation. Section 4: Attitude and Perception Towards Anaesthesia This section evaluated • Fear related to anaesthesia. • Previous sources of information about anaesthesia. • Anxiety before surgery. • Confidence in anaesthesia services. • Need for preoperative counselling. Common concerns assessed included • Fear of not waking up after surgery. • Fear of postoperative pain. • Fear of awareness during surgery. • Fear of paralysis. • Fear of death due to anaesthesia. Data Collection Procedure After obtaining approval from the Institutional Ethics Committee, eligible patients were identified during pre-anaesthetic assessment. The purpose of the study was explained to each participant, and written informed consent was obtained. A personal interview was conducted using the structured questionnaire. Each participant required approximately 15–20 minutes for completion. The investigator ensured that: • Questions were explained clearly. • Responses were recorded accurately. • No suggestion or influence was provided during the interview. • Confidentiality of patient information was maintained. Statistical Analysis Data were entered into Microsoft Excel and analysed using Statistical Package for the Social Sciences (SPSS) version 26.0. Continuous variables were expressed as mean ± standard deviation (SD), while categorical variables were presented as frequencies and percentages. Associations between categorical variables were analysed using the Chi-square test or Fisher's exact test wherever appropriate. A p-value of <0.05 was considered statistically significant. Ethical Considerations Approval was obtained from the Institutional Ethics Committee before commencement of the study Written informed consent was obtained from all participants. Participation was voluntary, and participants had the right to withdraw at any time without affecting their treatment. Patient confidentiality and anonymity were strictly maintained throughout the study.

A total of 300 first-time surgical patients scheduled for elective surgery were included in the present study. All participants completed the questionnaire, yielding a response rate of 100%. Table 1. Demographic Characteristics of Study Participants (n = 300) Variable Frequency (n) Percentage (%) Age Group (Years) 18–20 38 12.7 21–40 146 48.7 41–60 84 28 >60 32 10.6 Gender Male 174 58 Female 126 42 Residence Rural 170 56.7 Urban 130 43.3 Marital Status Married 196 65.3 Unmarried 104 34.7 Occupation Farmer 72 24 Labourer 48 16 Housewife 70 23.3 Service 56 18.7 Student 26 8.7 Business 28 9.3 Most participants were young adults aged 21–40 years, predominantly male, from rural backgrounds, and married. Table 2. Educational Status of Study Participants (n = 300) Educational Level Frequency (n) Percentage (%) Illiterate 40 13.3 Primary School 58 19.3 Secondary School 100 33.3 Higher Secondary 34 11.4 Graduate 68 22.7 Secondary school education was the most common educational level (33.3%), while nearly one-fourth of participants were graduates. Table 3. Awareness Regarding Anaesthesia (n = 300) Question Yes n (%) No n (%) Have you heard about anaesthesia? 246 (82.0) 54 (18.0) Do you know that anaesthesia prevents pain during surgery? 224 (74.7) 76 (25.3) Are there different types of anaesthesia? 154 (51.3) 146 (48.7) Do you know anaesthesia may be general, spinal or local? 132 (44.0) 168 (56.0) Were you informed about the planned anaesthesia? 172 (57.3) 128 (42.7) Would you like to know more about anaesthesia? 270 (90.0) 30 (10.0) Although a large majority had heard about anaesthesia, awareness regarding different anaesthetic techniques remained limited. Most patients were interested in learning more about anaesthesia. Table 4. Knowledge Regarding the Role of Anaesthesiologist (n = 300) Response Frequency (n) Percentage (%) Who administers anaesthesia? Anaesthesiologist 117 39 Surgeon 114 38 Nurse 36 12 Don't know 33 11 Anaesthesiologist monitors patient during surgery Yes 142 47.3 No 158 52.7 Anaesthesiologist manages ICU patients Yes 118 39.3 No 182 60.7 Anaesthesiologist provides postoperative pain relief Yes 126 42 No 174 58 Anaesthesiologist performs CPR in emergencies Yes 104 34.7 No 196 65.3 Only 39% correctly identified the anaesthesiologist as the physician responsible for administering anaesthesia. Knowledge regarding the broader responsibilities of anaesthesiologists was poor. Table 5. Attitude Towards Anaesthesia Among Study Participants (n = 300) Variable Frequency (n) Percentage (%) Fear of anaesthesia Yes 214 71.3 No 86 28.7 Most common fear Not waking after surgery 92 30.7 Pain after surgery 74 24.7 Intraoperative awareness 32 10.7 Paralysis 28 9.3 No fear 74 24.6 Would like counselling before surgery Yes 270 90 No 30 10 Confidence in anaesthesiologist after counselling Yes 248 82.7 No 52 17.3 A majority of participants experienced anxiety related to anaesthesia. Fear of not regaining consciousness after surgery was the most common concern. Most patients expressed a positive attitude toward receiving preoperative counselling, and counselling improved confidence in anaesthesia services. To determine the association between socio-demographic variables and awareness regarding anaesthesia, participants were categorized into Good Awareness and Poor Awareness groups based on their total knowledge score. • Good awareness: Score ≥60% • Poor awareness: Score <60% The Chi-square test was used to determine statistical significance. A p-value <0.05 was considered statistically significant. Table 6. Overall Knowledge and Awareness Score (n = 300) Awareness Level Frequency (n) Percentage (%) Good Awareness 122 40.7 Poor Awareness 178 59.3 Total 300 100 Approximately 59.3% of first-time surgical patients demonstrated poor knowledge and awareness regarding anaesthesia, whereas only 40.7% had satisfactory awareness. Table 7. Association Between Educational Status and Awareness Score Educational Status Good Awareness n (%) Poor Awareness n (%) Total χ² p-value Illiterate 5 (12.5) 35 (87.5) 40 36.81 <0.001* Primary 14 (24.1) 44 (75.9) 58 Secondary 39 (39.0) 61 (61.0) 100 Higher Secondary 22 (64.7) 12 (35.3) 34 Graduate 42 (61.8) 26 (38.2) 68 Statistically significant Higher educational status was significantly associated with better awareness regarding anaesthesia (χ² = 36.81, p <0.001). Table 8. Association Between Age Group and Awareness Score Age Group (Years) Good Awareness Poor Awareness Total χ² p-value 18–20 16 22 38 8.42 0.038* 21–40 68 78 146 41–60 29 55 84 >60 9 23 32 Statistically significant Younger patients demonstrated significantly better awareness than older patients. Table 9. Association Between Gender and Awareness Score Gender Good Awareness Poor Awareness Total χ² p-value Male 78 96 174 2.36 0.124 Female 44 82 126 Although males had slightly better awareness than females, the difference was not statistically significant (p>0.05). Table 10. Association Between Place of Residence and Awareness Score Residence Good Awareness Poor Awareness Total χ² p-value Rural 56 114 170 10.47 0.001* Urban 66 64 130 Statistically significant Urban participants demonstrated significantly better awareness regarding anaesthesia than rural participants (p=0.001). Factors significantly associated with better awareness Variable p-value Significance Educational status <0.001 Significant Age 0.038 Significant Residence 0.001 Significant Gender 0.124 Not Significant The majority of participants belonged to the 21–40 years age group (48.7%). Male patients constituted 58.0%, while females accounted for 42.0%. Most participants were from rural areas (56.7%), and the largest proportion had completed secondary education (33.3%). Nearly one-fourth of the participants were graduates (22.7%), whereas 13.3% were illiterate. Although 82.0% of participants had heard about anaesthesia, only 39.0% correctly identified an anaesthesiologist as the doctor responsible for administering anaesthesia. A substantial proportion believed that anaesthesia was administered by the surgeon (38.0%) or nursing staff (12.0%). Knowledge regarding the role of anaesthesiologists in postoperative pain management, intensive care, and emergency resuscitation was inadequate. Most participants (71.3%) expressed anxiety regarding anaesthesia before surgery. The most common fear was not waking up after surgery, followed by postoperative pain and intraoperative awareness. Nearly 90% expressed willingness to receive preoperative counselling from an anaesthesiologist.

The present study was conducted to assess the knowledge, attitude, and awareness regarding anaesthesia among first-time surgical patients in a tertiary care teaching hospital. A total of 300 patients were evaluated using a structured questionnaire. The study demonstrated that although the majority of patients had heard about anaesthesia, detailed knowledge regarding the role of anaesthesiologists, different types of anaesthesia, and perioperative responsibilities remained inadequate. The findings highlight the importance of effective preoperative counselling and patient. In the present study, 82% of patients had heard about anaesthesia, indicating that the term is familiar among the general population. However, only 39% correctly identified the anaesthesiologist as the doctor responsible for administering anaesthesia. A considerable number of patients believed that anaesthesia was administered by the surgeon (38%) or nursing staff (12%). This finding reflects a persistent misconception among surgical patients regarding the role of anaesthesiologists. Similar observations were reported by Naithani et al., who conducted a survey among patients attending a tertiary care hospital in India and found that although most patients were aware of anaesthesia, only a minority understood the independent role of anaesthesiologists. They emphasized that public recognition of anaesthesiology as a specialty remains inadequate and suggested the need for structured awareness programmes.¹ A study by Nag et al. also reported poor awareness among Indian surgical patients regarding anaesthesia services. The authors observed that many patients considered anaesthesia to be merely a temporary state of unconsciousness and were unaware of the anaesthesiologist’s role in monitoring vital functions and managing complications during surgery.³ The findings of the present study are consistent with these observations. In the present study, awareness regarding the various responsibilities of anaesthesiologists was limited. Only 47.3% of patients knew that anaesthesiologists continuously monitor patients during surgery, while awareness regarding postoperative pain management (42%), intensive care services (39.3%), and emergency resuscitation (34.7%) was poor. These findings suggest that patients often perceive anaesthesiologists only as professionals who administer anaesthetic drugs rather than as perioperative physicians. Similar findings were reported by Hariharan et al., who demonstrated that patients had limited understanding of the anaesthetist’s role beyond putting patients to sleep. Their study showed that many patients were unaware of anaesthesiologists’ involvement in postoperative care and emergency management.⁶ The present study showed a significant association between educational status and awareness level. Patients with higher educational qualifications had significantly better knowledge regarding anaesthesia compared with patients with lower educational status (p <0.001). Education improves health literacy, ability to access medical information, and communication with healthcare providers. Educated patients are more likely to seek information regarding planned procedures and understand medical explanations. This observation is consistent with findings reported by Jathar et al., who found that educational level was an important determinant of awareness regarding anaesthesia among surgical patients in India. Patients with higher educational attainment demonstrated better understanding of anaesthetic procedures and the role of anaesthesiologists.11 Similarly, Sikdar et al. reported that literacy level significantly influenced awareness regarding anaesthesia and recommended targeted education for patients with limited formal education.⁴ In the present study, place of residence was significantly associated with awareness, with urban patients demonstrating better awareness compared with rural patients (p=0.001). This difference may be explained by better access to healthcare facilities, higher literacy rates, greater exposure to health-related information, and improved availability of digital resources among urban populations. India has a large rural population where healthcare literacy remains a major challenge. Patients from rural areas may have fewer opportunities for interaction with specialist doctors and may depend primarily on informal sources of information. Therefore, awareness programmes should particularly focus on rural communities through community health centres, primary healthcare facilities, and regional language educational materials. The study also evaluated patients' attitudes and fears regarding anaesthesia. A significant proportion of participants (71.3%) expressed fear related to anaesthesia. The most common concern was fear of not waking up after surgery (30.7%), followed by postoperative pain and awareness during surgery. Fear of anaesthesia is a common cause of preoperative anxiety and may negatively influence patient experience. Kindler et al. demonstrated that preoperative anxiety is strongly associated with concerns regarding anaesthesia and surgical outcomes. They emphasized the importance of identifying patient fears during preoperative assessment and addressing them through appropriate counselling.⁸ The present findings emphasize the importance of the pre-anaesthetic clinic as an opportunity for patient education. In this study, 90% of patients expressed a desire for more information regarding anaesthesia, and 82.7% reported increased confidence after counselling. This indicates that patients are receptive to information and that anaesthesiologists have an important role in improving awareness. Similar results were reported by Kumar et al., who observed that direct communication between anaesthesiologists and patients improved understanding and confidence regarding anaesthetic procedures.⁵ Effective counselling can reduce misconceptions, decrease anxiety, improve cooperation, and enhance satisfaction with perioperative care. The present study findings are also comparable with international studies. Lee et al. reported that public awareness regarding anaesthesia and the role of anaesthesiologists remained inadequate despite advances in healthcare. They emphasized that increasing public recognition of anaesthesiology requires continuous patient education and communication.⁷ The lack of awareness regarding anaesthesia may have several implications. Patients with poor understanding may experience increased anxiety, difficulty providing informed consent, unrealistic expectations regarding surgery, and reduced satisfaction. Conversely, adequate knowledge promotes better patient participation and improves the doctor–patient relationship. Preoperative counselling should therefore become an integral component of routine anaesthesia practice. Anaesthesiologists should actively communicate with patients before surgery, explain the anaesthetic plan, discuss potential risks, and clarify their role in ensuring patient safety. Educational tools such as pamphlets, posters, videos, and information sessions in local languages may further improve understanding. The findings of the present study also highlight the need for increasing public recognition of anaesthesiology as a specialty. Many patients interact with anaesthesiologists only immediately before surgery, leaving limited opportunity for awareness building. Community-based education programmes, hospital awareness campaigns, and inclusion of anaesthesia-related information in patient education materials may help bridge this gap. Overall, the present study demonstrates that awareness regarding anaesthesia among first-time surgical patients remains suboptimal despite widespread exposure to healthcare services. Education, residence, and access to information significantly influence awareness levels. Improving patient education through structured counselling and public awareness initiatives may reduce anxiety, correct misconceptions, and improve perioperative outcomes.

The present study demonstrates that although most first-time surgical patients have heard about anaesthesia, detailed knowledge regarding anaesthetic procedures and the professional responsibilities of anaesthesiologists remains inadequate. Misconceptions regarding the administration of anaesthesia, perioperative monitoring, postoperative pain management, and intensive care responsibilities are common. Educational status, younger age, and urban residence were significantly associated with better awareness, whereas gender had no significant influence. Preoperative anxiety was highly prevalent, with fear of not regaining consciousness after surgery being the most frequently reported concern. The overwhelming willingness of patients to receive preoperative counselling indicates that patient education represents an effective strategy for improving awareness and reducing anxiety. Anaesthesiologists should actively participate in patient education through structured counselling, educational materials, and public awareness programmes. Strengthening communication between anaesthesiologists and patients will contribute to safer perioperative care, improved patient satisfaction, and enhanced recognition of the specialty.

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