Anesthesia awareness, also known as intraoperative awareness, is a rare but significant phenomenon in which patients regain consciousness during a surgical procedure under general anesthesia, potentially leading to lasting psychological distress and complications. Despite advancements in anesthetic techniques and monitoring, awareness remains a concern, particularly in settings with limited resources and varying levels of healthcare literacy. Public understanding of general anesthesia, its purpose, risks, and potential complications, plays a critical role in fostering realistic expectations and reducing anxiety among patients undergoing surgical interventions.[1-4]

Jogindernagar, a small town in Himachal Pradesh, provides a unique backdrop for examining public knowledge of general anesthesia due to its blend of rural and semi-urban populations with diverse educational and socio-economic backgrounds. The limited availability of anesthesiologists and perioperative care in such regions further underscores the importance of public awareness in empowering individuals to make informed decisions about their health.

Understanding the level of public knowledge regarding general anesthesia is crucial for addressing misconceptions, improving doctor-patient communication, and ensuring informed consent. Existing literature highlights that gaps in anesthesia awareness may lead to heightened preoperative anxiety, poor compliance, and mistrust in medical procedures.[5-7] However, limited data exist on the specific awareness levels in small-town populations, particularly in regions like Himachal Pradesh, where healthcare accessibility and literacy rates vary widely.

This study aims to evaluate public knowledge about general anesthesia in Jogindernagar, with a focus on understanding the population's awareness of anesthesia's purpose, risks, benefits, and potential complications. By identifying knowledge gaps, this research seeks to inform targeted educational interventions and promote better engagement between healthcare providers and patients, ultimately contributing to safer and more patient-centered anesthesia practices in similar rural settings.

Aims & Objectives

The primary aim of this study is to evaluate public knowledge regarding general anesthesia among residents of Jogindernagar, Himachal Pradesh. Specifically, the study seeks to:

1. Assess the population’s understanding of the purpose and functioning of general anesthesia.

2. Examine awareness levels related to the potential risks, complications, and benefits of general anesthesia.

3. Identify common misconceptions or gaps in knowledge about anesthesia among the residents.

Research Approach: This study utilized a descriptive, cross-sectional design to capture and analyze the current state of public knowledge about general anesthesia in Jogindernagar, Himachal Pradesh.

Study Design: A structured questionnaire-based survey was conducted to systematically assess awareness and perceptions regarding general anesthesia.

Study Area: The study focused on Jogindernagar, a small town in Himachal Pradesh characterized by a mix of rural and semi-urban populations with varying levels of access to healthcare and education. This setting provided a unique opportunity to examine public knowledge in a resource-limited region.

Study Duration: The study was conducted over three months, from August to October 2024, ensuring ample time for participant recruitment and comprehensive data collection.

Study Population: The study targeted adult residents (aged 18 and above) of Jogindernagar who had been living in the region for at least one year. This ensured respondents were familiar with local healthcare practices and had potential exposure to surgical or anesthetic services.

Sample Size: A sample size of 400 participants was calculated based on a 95% confidence level, an estimated 50% awareness level regarding general anesthesia, and a 5% margin of error. An additional 5% was factored in to account for non-responses, ensuring robustness in data collection.

Study Tool: The data collection tool was a structured, pre-validated questionnaire distributed through both online and offline channels to maximize outreach. The questionnaire was divided into two sections:

1. Socio-Demographic Details: This section captured participants' age, gender, education level, occupation, income, and healthcare access.

2. Knowledge Assessment: A series of 20 multiple-choice and true/false questions evaluated awareness of general anesthesia, including its purpose, benefits, risks, complications, and common misconceptions. Each correct response was awarded one point, with scores categorized as:

   • Very Good (>80%)

   • Good (60–79%)

   • Fair (41–59%)

   • Poor (<40%)

Data Collection: Data were collected through a combination of in-person surveys conducted in healthcare facilities, public places, and community centers, as well as online distribution via social media platforms and messaging apps to reach tech-savvy participants. The dual approach ensured representation from diverse demographic groups.

Data Analysis: Collected data were organized and cleaned using Microsoft Excel and analyzed using Epi Info V7 software. Descriptive statistics, including frequencies and percentages, were calculated to determine awareness levels. Socio-demographic factors were analyzed for their correlation with knowledge levels using appropriate statistical tests.

Ethical Considerations: Participant anonymity and confidentiality were strictly maintained, and informed consent was obtained from all respondents. Participants were informed of their right to withdraw at any stage of the study, ensuring compliance with ethical research standards.

A total of 400 respondents participated in the study, providing insights into public knowledge about general anesthesia in Jogindernagar, Himachal Pradesh. The following tables summarize the sociodemographic characteristics of participants and their responses to the knowledge assessment questions.

Table 1: Sociodemographic Variables of Study Participants

The sociodemographic profile (Table 1) highlighted a balanced representation, with 53.5% females and 46.5% males. The majority of participants were aged 26–35 years (32%), followed by 36–45 years (23.5%), and educational levels varied from no formal education (9%) to postgraduate qualifications (14.5%), with 31% holding undergraduate degrees. Occupations were diverse, including agriculture/labor (23%), homemakers (22.25%), and service jobs (32%). Most participants were rural residents (65.5%), lived in nuclear families (67%), and had resided in the area for over 10 years (66%), reflecting a population familiar with local healthcare norms.

Table 2: Knowledge Assessment of General Anesthesia among Study Participants

Knowledge assessment (Table 2) revealed varying levels of awareness about general anesthesia. While 74% understood its purpose, 67% correctly identified its administration methods, and 62% knew nausea and vomiting were common side effects. However, awareness about rare but critical phenomena like anesthesia awareness was low (38%). Encouragingly, most respondents understood the importance of anesthesiologists (71.5%), preoperative fasting (78%), and informed consent (74%). Knowledge gaps persisted in areas such as long-term complications (48%), age-related risks (54%), and emergency-related awareness (44%), underscoring opportunities for targeted education.

Table 3: Knowledge Score Classification

Overall, knowledge scores (Table 3) indicated that 24.5% of participants demonstrated very good awareness (scores 16–20), 34% showed good knowledge (scores 12–15), while 28% and 13.5% fell into the fair (8–11) and poor (<8) categories, respectively. These findings highlight a solid foundational understanding among residents but underscore significant gaps in specific aspects of anesthesia awareness that require educational interventions to ensure informed healthcare decision-making.

The findings of this study provide valuable insights into public knowledge about general anesthesia in Jogindernagar, Himachal Pradesh, highlighting both strengths and areas for improvement. The sociodemographic profile revealed a balanced representation of the population, with a slight majority of female respondents (53.5%) and a predominant age group of 26–35 years (32%). Educational diversity, ranging from no formal education (9%) to postgraduate qualifications (14.5%), coupled with a significant rural representation (65.5%), reflects the heterogeneity of the community. This diversity underscores the importance of tailoring health education strategies to address the unique needs of both urban and rural residents with varying literacy levels.

The knowledge assessment demonstrated a foundational understanding of general anesthesia among participants, with encouraging awareness in certain key areas. A majority of respondents (74%) understood the primary purpose of general anesthesia, and 67% correctly identified the methods of administration (injection or inhalation). Awareness of common side effects, such as nausea and vomiting (62%), and the critical role of anesthesiologists (71.5%) further emphasizes a reasonable baseline understanding. Moreover, high awareness of the necessity for preoperative fasting (78%) and the importance of informed consent (74%) highlights participants' familiarity with essential preoperative and perioperative practices.

However, notable knowledge gaps were identified in specific areas. Awareness of rare but critical phenomena like anesthesia awareness during surgery was low (38%), suggesting limited understanding of potential intraoperative complications. Similarly, knowledge about long-term complications (48%) and the impact of age on anesthesia safety (54%) was insufficient, highlighting the need for targeted education. Emergency-related awareness was also limited, with only 44% recognizing the increased likelihood of anesthesia awareness in such settings. These gaps could potentially lead to misconceptions, heightened anxiety, and inadequate preparation for surgical procedures among patients.

The distribution of knowledge scores further underscores the variability in public awareness. While 24.5% of participants demonstrated very good knowledge (16–20 points), the majority scored in the good (34%) or fair (28%) categories, and 13.5% exhibited poor awareness (<8 points). These findings suggest that while the community has a solid foundational understanding of general anesthesia, there is considerable room for improvement, particularly in addressing misconceptions and raising awareness about less common but significant risks and complications.[8,9]

Several factors likely contribute to these knowledge gaps. The predominantly rural population, limited access to anesthesiologists, and variability in educational levels may restrict exposure to accurate information about anesthesia. Moreover, the reliance on informal sources of information, coupled with limited preoperative counseling in resource-constrained settings, may exacerbate these issues. These findings align with existing literature, which suggests that communities with lower healthcare literacy and limited access to specialized care are more likely to exhibit gaps in understanding about anesthesia and surgical procedures.

Addressing these gaps requires targeted, community-centered educational interventions. Strategies such as organizing awareness campaigns, incorporating anesthesia education into routine healthcare communication, and leveraging local media can play a pivotal role in enhancing knowledge. Emphasis should be placed on clarifying misconceptions, explaining rare complications like anesthesia awareness, and promoting informed consent processes. Collaboration between healthcare providers, local authorities, and community organizations is crucial to ensure these efforts are accessible and culturally appropriate.[10,11]

Additionally, improving preoperative counseling practices in healthcare facilities is essential. Anesthesiologists and surgical teams should prioritize effective communication with patients, particularly in rural settings where misconceptions about anesthesia may be more prevalent. Visual aids, brochures, and videos tailored to different literacy levels could enhance understanding and engagement.

Limitations

This study provides a foundation for future research and interventions aimed at improving public knowledge about general anesthesia. However, certain limitations should be considered. The reliance on self-reported data may introduce response bias, and the use of online surveys could exclude individuals with limited internet access, potentially skewing the sample toward more educated participants. Future studies should incorporate mixed methods, including in-person interviews, to achieve a more comprehensive understanding of public knowledge in similar settings.

In conclusion, while the study highlights a reasonable baseline understanding of general anesthesia among residents of Jogindernagar, significant gaps in knowledge persist, particularly regarding rare complications and nuanced risks. Bridging these gaps through targeted education and improved healthcare communication is essential for empowering patients, fostering trust, and ensuring safer and more informed surgical experiences in resource-limited settings. By addressing these challenges, healthcare providers can contribute to more patient-centered anesthesia practices and better overall health outcomes in the region.

The authors declare that they have no conflict of interest

No funding sources

The study was approved by the Civil Hospital, Joginder Nagar , Himachal Pradesh.

1. Veeramachaneni, R., et al. "Awareness about Anaesthesia in India: A Survey in Southern India." International Journal of Research in Medical Sciences 4.2 (2016), pp. 499–508. DOI: https://doi.org/10.18203/2320-6012.ijrms20160647.

2. Mathur, S. K., et al. "Knowledge about Anaesthesia and Anaesthesiologist Amongst General Population in India." Indian Journal of Anaesthesiology 53.2 (2009), pp. 179-186. DOI: https://doi.org/10.4103/0019-5049.50773.

3. Naithani, U., et al. "Public Awareness About Anaesthesia and Anaesthesiologist: A Survey." Indian Journal of Anaesthesiology 51.5 (2007), pp. 420–426. DOI: https://doi.org/10.4103/0019-5049.36201.

4. Bhandary, A., et al. "A Survey on Patients’ Awareness about Anesthesia and Anesthesiologist." Indian Journal of Clinical Anaesthesiology 3.2 (2016), pp. 196–206. DOI: https://doi.org/10.18231/2394-4994.2016.0037.

5. Ambulkar, R. P., et al. "Awareness During General Anesthesia: An Indian Viewpoint." Journal of Anaesthesiology Clinical Pharmacology 32.4 (2016), pp. 453–457. DOI: https://doi.org/10.4103/0970-9185.194906.

6. Modak, A., et al. "Awakening the Anesthetic Mind: Unveiling Public Awareness and Concerns Regarding Anesthesia in Kinnaur, Himachal Pradesh." IAR Journal of Anaesthesiology and Critical Care 4.2 (2023), pp. 2–6. 

7. Sharma, H., et al. "Unlocking Anesthesia Awareness: Evaluating Public Knowledge about General Anesthesia in District Chamba, Himachal Pradesh." IAR Journal of Anaesthesiology and Critical Care 5.1 (2024), pp. 1–8.

8. Bhardwaj, N., et al. "Knowledge, Attitude and Perception of People of Rural India Towards Anesthesia: An Observational Study." International Journal of Science and Healthcare Research 5.3 (2020), pp. 197–201. 

9. Sood, S., et al. "Comprehensive Assessment of Patient Awareness and Knowledge Regarding Pre-Anesthetic Check-up (PAC) at Pt. Jawahar Lal Nehru Government Medical College, Chamba, Himachal Pradesh." Research Article 5.1 (2024), pp. 1–7.

10. Kaushal, N., and I. Badhan. "Knowledge Regarding Anesthesiologist and Anesthesia Among Patients Attending Pre-Anesthetic Check-up in Tertiary Care Hospital." International Journal of Research and Publications Review 3.12 (2022), pp. 220–222. 

11. Jaswal, S., et al. "Guardians of Anesthesia Safety: Assessing Awareness and Expertise in Managing Anesthesia-Related Complications Among Anesthesia Residents in Himachal Pradesh." Himalayan Journal of Medical Surgery 4.2 (2023), pp. 1–5.