A SURVEY ON PUBLIC AWARENESS ABOUT THE ROLE OF ANESTHESIOLOGISTS

Abdullah S. Alqefari,Abdullah A. alyami, Tarik M. Almowald, Faisal M. Alturi, Mousa R. Alhokail, Mohammed A. Alqhtani, Jamal A. Alghamdi, Naif S. Alotaibi, Maha A. Alenezi, MohammedA.Alkahmous, Abdulaziz A. Alkahmous and Omar A. Ahmed. GPs, College of Medicine, Jordanian University of Science and Technology (JUST), Riyadh, KSA. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History

Anesthesia has developed after the first anesthesia was administered by TG Morton in 1846, it has a supportive role in performing advanced surgeries (Ribeiro et al, 2015). Anesthesiology is one of medical Science branches (Sable et al, 2016), it has been grown in the recent pastyears (Cooper et al, 1995), by development of monitoring system, new anesthetic agents and techniques (Khara et al, 2013), however it is behind the light, the knowledge about this specialty and the exact role of anesthesiologists is limited between public (Cooper et al, 1995).After the great advances in anesthesia field (Lee et al, 2014), now anesthesiologists play a very important role in peri-operative, the operating room, intensive care, trauma centers,pain management and on the code team (Lee et al, 2014;Prasad et al, 2014; Kadriet al, 2014), however they don't receive the deserved attention andtheir due regards between public (Prasad et al, 2014), this limited awareness of public about the anesthesiologist exceeds anesthesiologist's role in the operating room (Ribeiro et al, 2015), reaching to anesthetist's roles outside the operation room (Garry, 2001).This lack in public awareness about anesthetist's role is not new (Armitage, 1978).Many studies have reported a low public awareness about anesthesia and the role of anesthetists in both developing and developed countries (Swinhoe et al, 1994;Jathar et al, 2002).Patients think that the surgeon is responsible for tasks of anesthesia(Acosta-Martínez et al, 2016),44.5% think so, while only 22% of them know that anesthesiologistswere the providers of anesthesia ISSN: 2320-5407 Int. J. Adv. Res. 5 (2), 1901-1906 1902 (Sable et al, 2016)but inanother report 42% of patients knew that the anesthetist was responsible for providing anesthesia (Naod et al, 2016)this still low percent. Actually patients don't know if the anesthesiologist is even a physician(Erdenet al, 2012), but it was reported that 67% ofsurvey respondents in a survey conducted in the United Kingdom during knew that anesthesiologist is a doctor (Keep et al, 1978),while this percent raised in 1933 to reach 81% and then dropped again in 1994 to 65% (Swinhoe et al, 1994;Hennessy et al, 1993).These results seems quite good, but in developing countries this percent is low (Hariharan, 2009).In Pakistanonly 56% of the patients hadknown that anesthesiologist is a physician (Khan et al, 1999). Here in Saudi Arabia 50 % of the patients had the awareness about the previous fact (Baaj et al, 2006).Beside that other patients did not know thatanesthesiologists are responsible for monitoring their vital signs throughout surgery, only27.33% of the patients knewthat role.Also a limited number of patients had the knowledge aboutanesthesiologist's role in intensive care unit (ICU), painless labor and relief of chronic pain with percentage 7.33%, 12.67%and 4.67% respectively (Naithani et al, 2007).The reason for the poor knowledge may be related to anesthetists being busy in operating room and they have limited time to interact with their patients' pre & post-operatively (Naod et al, 2016).Not only is the role of anesthetists neglected by patients, but also by others such as administrative staff in the hospitals who did not see the importance of this specialty (Hariharan, 2009). The Audit Commission in Englanddid not realize any role for anesthesiologists outside the operating room (Pleuvry et al, 1982)and in some universities all over the world,they see that there is no requirement for anesthesiologyto be taught for medical students (Cheunget al, 1999).A widehealth care awareness especially in developed countries has been taken place (Khara et

Materials and Methods:-
Subjects:-This cross sectional observational study was performed on 202 patients in the period from 20 th January 2017 to 7 th February2017 from Yamama Hospital in Riyadh, an approval from thehospital was obtained to perform this study. This study was performed after operation performing. Patients accepted to answer questions, theywere not exposed to any pressure andthey freely answered the questions, there was no exclusion for patients.

Questionnaire:-
A questionnaire was established to record patients' answers. It was containing 10 questions written in both Arabic and English. The answers were recorded as Yes and No in the questionnaire to be easy for patients.
Statistical analysis:-Data were analyzed by using Statistical Package for Social Studies (SPSS 22; IBM Corp., New York, NY, USA). Continuous variables were expressed as mean ± standard deviation and categorical variables were expressed as percentages. Chi square test was used for categorical variables. P-value <0.05 was considered statistically significant.

Results:-
This study was conducted on 202 patients after performing operation. The number of males was 69 (34.16%) while females' number was 133 (65.84%), the female represents most of patients in this study. The mean age of participants was 32.84± 10.94. Most of the individuals were Saudi 184 (91.1%) and few of participants were non Saudi 18 (8.9%). The majority of patients were from urban areas 197 (97.5%) and only 5 (2.5%) came from rural area. The questions of questionnaire are summarized in table1.

Discussion:-
Complex surgery is now possible and easier due to developed techniques by anesthetists (Naod et al, 2016), indeed the role of anesthesiologist not only inside the operating room, but also in preoperative evaluation, pain management and intensive care (Erden et al, 2012). However public awareness about anesthesiologist is low. In the present study we investigated about the knowledge of patients about anesthesiologist and anesthesia, we found that most of participants 87.62 % knew about anesthesia, this is a high percent compared to many other studies (Prasad et al, 2014;Swinhoe et al, 1994;Ismaeil, 2011) where the percentage of people knew about anesthesia were 82%, 80% and 60.6%. In another study (Pandyaet al, 2016) only 26% of participants knew about anesthesia. Most of our patients were from urban area this may explains the height in our patients , knowledge about anesthesia. In the present study high percent of participants 82.67% knew that anesthesiologist is a doctor, this in agreement with a study by Acosta Caribbean and Singapore studies toreach 59% and 65.8% respectively of patientsknew that anesthesiologist is a doctor [Hariharan et al, 2006;Chew et al, 1998), another study (Hariharan, 2009)recorded least percent, only 5.5 % of patients knew that anesthesiologist is a qualified doctor.This low percent reflects very poor knowledge about anesthesiologists who really are.This may return to many reasons such as; patients choose surgeons not anesthesiologist because some patients think that anesthesiologist is surgeon's assistant, another reason is the short duration often spent between patient and anesthesiologist (Hariharan, 2009).In replay to the question about safety of anesthesia, 70.30% of patients realized that anesthesia was safe; this result is close to one study (Garry, 2001)where 76 % of individuals felt anesthesia as safe, while in another study (Ahsan-Ul-Haq et al, 2004)only 40 thought anesthesia was safe. Although our result about safety of anesthesia seems to be good, much awareness still needed to patients, this will decrease their fears before surgery especially with the presence of developed anesthesia techniques. There are different types of anesthesia for different surgeries, but only 61.88% of our patients knew that. This percent was lower compared to many other studies (Prasad et al, 2014;Ahmad et al, 2011), where percentage were higher 73% and 82.4%, however in other study(Kadriet al, 2014), it was found that 48.1% of patients were aware of the various types of anesthesia techniques, while in a study by Pandya et al (2016) 74% did not know about different anesthesia techniques.Informed consent is a document signed by the patient, it is a medicolegal binding between doctor and patient (Prasad et al, 2014). In the current study, 72.77% of participants knew that the consent is important and nothing will be performed unless patient signed it. In a study by Prasad and Suresh (2014), they found that 77% of patient knew about this consent, while lower percent 34.67% was reported by Naithani et al (2007), however in another study (Pandya et al, 2016)57.69 % of patients had awareness about this consent.Anesthesiologist can manage all types of pain, this fact was known by 64.85% of our patients and 88.12% knew about painless labor, our results were close to a study by Prasad and Suresh (2014) (Bhandary et al, 2016). In Finland study (Tohmo et al, 2003) 36% of patients did not know the role ofanesthesiologists in pain clinics.This results show the weak awareness of patients about the role of anesthesiologists postoperatively. In the current study, a question especial to female was asked, it was about preferring painless delivery, 88.72% of them said yes, only 11.28% chose the painful delivery, whereas 73% preferred painless delivery in another study (Prasad et al, 2014). Although 11.28% is very low percent in preferring painful delivery, the fear of female from anesthesia may be the reason, it is recommended for pregnant to visit anesthesiologist before delivery, so she can know more about anesthesia and feel safe, as a result she may choose the painless way. By comparing our results to the results of Prasad and Suresh (2014) regarding preoperative instruction that patients should follow and benefit by visiting the anesthesia stall at the mela, we found that our patients were more aware of the preoperative instruction 92.08 % than the other study 81%, whereas in the previous study more individuals get benefit by visiting anesthesia stall at the mela 92% than ours 72.77%. Regarding to gender as a factor affect awareness of individuals about anesthesiologist role, there was no significant difference in this study between male and female except for question number 2 about anesthesiologist as being a doctor (p-value=0.048), actually more female knew that anesthesiologist was a doctor, but in the other questions there were no significant differences between the two genders. Gender had significant association with knowledge of patients about anesthesia was a doctor. In contrast to our study, it was reported no significant differences between gender when asked if anesthesiologist was a doctor (Khara et al, 2013).However it was mentioned that gender had significant association with knowledge of patients about anesthesia (Naod et al, 2016).

Conclusion:-
Awareness about the role of anesthesiologistsand anesthesia of patients in this studywas very good and promising, however good contact between patients and anesthesiologists preoperatively still required and period spent between them should be increased to raise patients , awareness and knowledge about anesthesia and anesthesiologists , roles. The good relationship between anesthesiologists and patients can remove any fear before operation, also increasing trust in anesthesiologist leads togood outcome of operation. Our patients had good awareness, but programmes of awareness and eduction still needed to cover all the area in society to reach the best results.