Despite the fact that anesthesia is essential to modern medicine, it is commonly misinterpreted and many people are ignorant of the skills and efforts that anesthesiologists undertake to save lives [1]. William T.G. Morton was the first person to provide anesthesia in public, having done it in 1846. Since that momentous occasion, anesthesia and anesthesiology have undergone tremendous changes, evolving into a well-established and rapidly developing subspecialty of medicine [2]. The role of the anesthesiologist within the operating room is crucial and its scope has expanded in recent years. In general, the medical specialty of anesthesiology focuses on providing reversible states of unconsciousness, amnesia, muscular relaxation and analgesia. Anesthesiologists work in a wide variety of settings, including pain clinics, operating rooms and Intensive Care Units (ICUs) and remain critical providers of patient care and outcomes [3]. There are several types of anesthesia, including local anesthesia, monitored anesthesia care, general anesthesia and regional anesthesia [4]. The most frequently reported adverse events were serious: death was experienced in 26% of cases, nerve injury in 22% and permanent brain damage in 9%. Clearly, risks are high. When examining the damaging occurrences that were the focus of claims, the frequency of regional blocks was highest (20%), followed by respiratory complications (17%), cardiovascular complications (13%) and equipment-related incidents (10%). Together, these harmful events reflect the delicate challenges that anesthesiologists face in assuming their pivotal role in the healthcare system [5]. In Saudi   Arabia, there was one study in 2023 that assessed public knowledge and perception of anesthesia, anesthesiologists’ expertise and their role among Saudi citizens residing, which showed that while most participants acknowledged anesthesiologists as specialized physicians, some misconceptions and gaps in understanding regarding their duties were evident. The research emphasizes the need to enhance public knowledge about anesthesia, addressing prevalent worries such as the fear of mortality linked to undergoing anesthesia [6]. This study aimed to assess Awareness About Anesthesia Among the General Population in Makkah.

Study Design and Setting This cross-sectional study was carried out to assess the general population's awareness of anesthesia in Makkah, Saudi Arabia. It used a structured questionnaire based on a prior study to gather detailed insights.   Study Population and Sampling The study population comprised adults aged 18 years and older residing in Saudi Arabia. Participants were recruited using convenience sampling to achieve a diverse demographic representation, covering age, gender, socioeconomic status and geographic location regions. Adults of any gender who are current citizens of Makkah were included. Exclusion criteria involved visitors to the city, those who declined informed consent and participants who did not complete the study questionnaire. The minimum sample size was calculated using Raosoft, considering Saudi Arabia’s population of approximately 33 million inhabitants, with a 95% confidence interval and an assumed 50% prevalence rate. The calculated sample size was 385 participants but to ensure higher reliability, we expanded the number to exceed 500 participants [7].   Data Collection Instrument An online questionnaire was created with Google Forms and distributed electronically via social media channels. It was adapted from an earlier Saudi study that evaluated knowledge and perceptions of anesthesia, anesthesiologists’ expertise and their role among Saudi residents [6].   The questionnaire included five main sections: (1) Consent form, (2) Sociodemographic data, (3) Assessment of knowledge about anesthesia, (4) Assessment of attitudes toward anesthesia and (5) Specific questions for patients with anesthesia.   Data Management and Quality Control Data were gathered electronically using Google Forms and exported to Microsoft Excel for initial analysis. Quality control involved checking the completeness of responses, removing duplicates and verifying logical consistency among related questions. Responses lacking demographic information or with incomplete sections of the questionnaire were omitted from the final dataset.   Statistical Analysis Statistical analyses were conducted using R software (version 4.3.0). Categorical variables are reported as frequencies and percentages, while continuous variables are summarized with means, standard deviations, medians and interquartile ranges as appropriate. Heatmaps created with the Likert package visualized Likert-type responses to display response patterns across related questions. Questions with similar response scales were grouped into themes: knowledge questions (Yes/No/Not sure), trust and attitude questions (Yes/Sometimes/No).   Ethical Considerations This study complied with the Declaration of Helsinki and received approval from the Umm Al-Qura University Institutional Review Board (IRB). All participants electronically gave informed consent before filling out the questionnaire. Anonymity was maintained during data collection and analysis, with no personally identifiable information gathered or stored. All data remained confidential and were used solely for research, consistent with the study's objectives.

The Table 1 shows the distribution of the research sample participants according to their social and economic characteristics 596 individuals). Examining the Gender distribution reveals that females constituting a larger portion of the sample (60.1% or 358 individuals) compared to males (39.9% or 238 individuals). Regarding Age, the largest group of participants falls within the 20-29 year range (64.1% or 382 participants), followed by smaller representations in the older age 40-49 years (12.9% or 77 participants), 50-59 years (10.7% or 64 participants), 30-39 years (9.2% or 55 participants) and the smallest numbers of 60 years and over (3.0% or 18 participants). In terms of educational level, the majority of the sample holds a post-graduate degree (66.1% or 394 participants), with High school graduates is the next largest group (21.8% or 130 participants). Smaller proportions are consisting for Collegiate (7.7% or 46 individuals), Middle school (2.9% or 17 participants), Primary school (0.8% or 5 participants) and those who did not attend school (0.7% or 4 participants). Based on Monthly income, the largest segment of the participants earns less than 5000 Saudi Riyals (61.1% or 364 individuals). This is followed by those earning 5000-10000 Saudi Riyals (16.9% or 101 individuals), more than 15,000 Saudi Riyals (11.9% or 71 participants) and 10,000-15,000 Saudi Riyals (10.1% or 60 participants). Related to Chronic medical conditions, a significant majority of the sample reported not having any (86.6% or 516 participants), while a smaller portion indicated having a chronic condition (13.4% or 80 participants). Finally, regarding Previous surgeries, over half of the participants reported having no prior surgeries (58.9% or 351 participants). The remaining participants reported having one surgery (22.0% or 131 participants), two surgeries (9.9% or 59 participants) or three or more surgeries (9.2% or 55 participants).   Table 1: The Distribution of the Research Sample Participants According to their Social and Economic Characteristics, (596) Individuals Variables Frequency Percent Gender Male 238 39.9 Female 358 60.1 Age 20-29 382 64.1 30-39 55 9.2 40-49 77 12.9 50-59 64 10.7 60 and over 18 3.0 Educational level Did not attend school 4 0.7 Primary school 5 0.8 Middle school 17 2.9 High school 130 21.8 Collegiate 46 7.7 Post-Graduate 394 66.1 Monthly income Less than 5000 Saudi Riyals 364 61.1 5000 - 10000 Saudi Riyals 101 16.9 10,000 - 15,000 Saudi Riyals 60 10.1 More than 15,000 Saudi riyals 71 11.9 Chronic medical condition (eg, diabetes, high blood pressure) Yes 80 13.4 No 516 86.6 Previous surgeries None 351 58.9 One surgery 131 22.0 Two surgeries 59 9.9 Three or more surgeries 55 9.2   Table 2: Perceptions about Anesthesiologist Role and Responsibilities Statements Frequency Percentage Mean Std. Deviation Who puts the patient to sleep before surgery? Surgeon 34 5.7 2.06 0.502 Anesthesiologist 519 87.1 Nurse 18 3.0 I don't Know 25 4.2 Who is responsible for waking up the patient after surgery? Surgeon 33 5.5 2.51 0.794 Anesthesiologist 308 51.7 Nurse 175 29.4 I don't Know 80 13.4 Who is responsible for monitoring the patient's vital signs throughout the surgical procedure? Surgeon 60 10.1 2.51 0.790 Anesthesiologist 224 37.6 Nurse 261 43.8 I don't Know 51 8.6   Table 2 shows the Perceptions about Anesthesiologist role and responsibilities. It presents the frequency, percentage, average responses (Mean) and the variability of responses (Std. Deviation) regarding who is perceived to be responsible for specific actions during the surgical process. The statement with the highest average score, indicating the strongest consensus among participants, is "Who is responsible for waking up the patient after surgery?" with a mean of 2.51. The other statement with the same average score of 2.51 is "Who is responsible for monitoring the patient's vital signs throughout the surgical procedure?", also pointing towards the Anesthesiologist or Nurse as the perceived responsible party. The statement "Who puts the patient to sleep before surgery?" received a slightly lower average score of 2.06. The standard deviations for all three statements are relatively small (ranging from 0.502 to 0.794), suggesting a moderate level of agreement among the participants regarding these responsibilities as per Figure 1.   Table 3 shows the Perceptions about Anesthesiologists' education and training. It presents the frequency, percentage, average responses (Mean) and the variability of responses (Std. Deviation) of the perceived duration of education and training required for Anesthesiologists and surgeons. Regarding the question "How many years of education are required for an Anesthesiologist to become a medical student?", the average response is 2.00. A slightly higher average of 2.10 was observed for the statement "How many years of education are required for surgeons in medical school?". Concerning the duration of training, the statement "How many years of training are required for Anesthesiologists?" yielded a mean of 2.01.   Table 3: Perceptions about Anesthesiologists’ Education and Training   Statements Frequency Percentage Mean Std. Deviation How many years of education are required for an Anesthesiologist to become a medical student? 4 or less 123 20.6 2.00 0.642 5 or more 351 58.9 I don't know 122 20.5 How many years of education are required for surgeons in medical school? 4 or less 31 5.2 2.10 0.438 5 or more 476 79.9 I don't know 89 14.9 How many years of training are required for Anesthesiologists? 4 or less 205 34.4 2.01 0.834 5 or more 182 30.5 I don't know 209 35.1 How many years of training are required for surgeons? 4 or less 136 22.8 2.06 0.715 5 or more 290 48.7 I don't know 170 28.5     Figure 1: Perception about Anesthesiologist's Role and Responsibilities     Figure 2: Perceptions about Anesthesiologist's Education and Training   A slightly higher average of 2.06 was reported for "How many years of training are required for surgeons?". The standard deviations for all four statements range from 0.438 to 0.834, indicating a moderate level of agreement among the respondents regarding the perceived duration of education and training for both professions. The data of Figure 2 indicated that a general perception among the participants that both Anesthesiologists and surgeons require 5 or more years of education to become medical students and a subsequent 5 or more years of training.   Table 4 shows the trust in physicians and Anesthesiologists. It presents the frequency, percentage, average responses (Mean) and the variability of responses (Std. Deviation) regarding participants' trust in physicians and Anesthesiologists across several statements.   Table 4: Trust in Physicians and Anesthesiologists Statements Frequency Percentage Mean Std. Deviation 1- Do you trust that your doctor will make your health care his first concern before any other factors? Yes 397 66.6 1.66 0.985 No 33 5.5 Not sure 138 23.2 Prefer not to answer 28 4.7 2- Have you ever refused medical care because you didn't trust your doctor? Yes 148 24.8 1.91 0.691 No 379 63.6 Not sure 45 7.6 Prefer not to answer 24 4.0 3- Do you think that Anesthesiologists are influenced by medical insurance regulations during your care? Yes 131 22.0 2.33 0.899 No 184 30.9 Not sure 237 39.8 Prefer not to answer 44 7.4 4- Do you believe that your Anesthesiologists will put all other things aside and make your health care a priority? Yes 406 68.1 1.61 0.947 No 42 7.0 Not sure 124 20.8 Prefer not to answer 24 4.0     Figure 3: Trust in Physicians and Anesthesiologist   For the statement "Do you trust that your doctor will make your health care his first concern before any other factors?", the average response is 1.66. this mean value indicates a general tendency towards "Yes," suggesting that participants mostly trust their doctors to prioritize their health. The statement "Have you ever refused medical care because you didn't trust your doctor?" received a mean of 1.91. This average leans slightly towards "No," implying that the majority of participants have not refused medical care due to a lack of trust in their doctor. Regarding the statement "Do you think that Anesthesiologists are influenced by medical insurance regulations during your care?" shows a mean of 2.33. This average falls between "No" and "Not sure," suggesting that participants are somewhat uncertain towards believing that Anesthesiologists might be influenced by these regulations. The statement "Do you believe that your Anesthesiologists will put all other things aside and make your health care a priority?" has a mean of 1.61. This average strongly indicates a tendency towards "Yes," suggesting that participants generally believe their Anesthesiologists will prioritize their health care. The standard deviations for all four statements are relatively high, ranging from 0.691 to 0.985. This indicates a a less uniform level of agreement or certainty regarding these aspects of trust in physicians and Anesthesiologists. The data suggests a general trust in doctors and Anesthesiologists to prioritize patient health, with most participants not having refused care due to a lack of trust as shown in Figure 3.   Table 5 show the Concerns or fears about anesthesia. It presents the frequency, percentage, average responses (Mean) and the variability of responses (Std. Deviation) regarding various concerns or fears associated with anesthesia. The statement with the highest average score Mean = 2.41 is "Fear of needles". This indicates that participants are leaning towards being "Somewhat concerned" about needles.   Table 5: Concerns or Fears about Anesthesia Statements Frequency Percentage Mean Std. Deviation Fear of pain Very concerned 154 25.8 2.15 0.850 Somewhat concerned 218 36.6 Not concerned 202 33.9 Don’t know 22 3.7 Fear of death during anesthesia Very concerned 189 31.7 2.10 0.940 Somewhat concerned 205 34.4 Not concerned 155 26.0 Don’t know 47 7.9 Fear of brain damage Very concerned 190 31.9 2.14 0.983 Somewhat concerned 192 32.2 Not concerned 153 25.7 Don’t know 61 10.2 Fear of waking up in the middle of surgery Very concerned 218 36.6 2.02 0.937 Somewhat concerned 184 30.9 Not concerned 157 26.3 Don’t know 37 6.2 Fear of memory loss Very concerned 142 23.8 2.37 0.947 Somewhat concerned 146 24.5 Not concerned 253 42.4 Don’t know 55 9.2 Fear of postoperative headache Very concerned 113 19.0 2.39 0.892 Somewhat concerned 191 32.0 Not concerned 239 40.1 Don’t know 53 8.9 Fear of nausea and vomiting Very concerned 129 21.6 2.32 0.906 Somewhat concerned 195 32.7 Not concerned 222 37.2 Don’t know 50 8.4 Fear of needles Very concerned 113 19.0 2.41 0.868 Somewhat concerned 164 27.5 Not concerned 280 47.0 Don’t know 39 6.5 Anxiety about undressing for surgery Very concerned 168 28.2 2.20 0.911 Somewhat concerned 171 28.7 Not concerned 226 37.9 Don’t know 31 5.2 Fear of speaking during anesthesia Very concerned 198 33.2 2.19 0.993 Somewhat concerned 138 23.2 Not concerned 210 35.2 Don’t know 50 8.4   Fear of postoperative headache Mean = 2.39 and Fear of memory loss Mean = 2.37 also show average responses in the "Somewhat concerned" range. The statement "Fear of waking up in the middle of surgery" has a mean of 2.02. This suggests that participants are slightly more than "Somewhat concerned" about this particular fear. The remaining statements, Fear of pain Mean = 2.15, Fear of death during anesthesia" Mean = 2.10, Fear of brain damage Mean = 2.14, "Anxiety about undressing for surgery Mean = 2.20, Fear of speaking during anesthesia Mean = 2.19 and Fear of nausea and vomiting Mean = 2.32 also shows within the “Somewhat concerned" range.   The standard deviations for all the statements are relatively close, ranging from 0.850 to 0.993.   The data suggests that participants generally express some level of concern about the various aspects of anesthesia, with fears of needles, postoperative headache and memory loss being the most prominent as per Figure 4.   Table 6 shows the Knowledge related to anesthesia. It presents the frequency, percentage, average responses (Mean) and the variability of responses (Std. Deviation) regarding the truthfulness of several statements about anesthesia. The statement with the lowest average score, indicating the strongest agreement with being "True," is "Some surgical procedures can be performed under local anesthesia without the need for general anesthesia" with a mean of 1.37. This suggests that participants generally believe this statement to be true. It is essential for the Anesthesiologist to be familiar with the patient's medical history, including all medications the patient is taking before undergoing surgery" with a mean of 1.41, also indicating a strong agreement with its truthfulness.   Table 6: Knowledge Related to Anesthesia Statements Frequency Percentage Mean Std. Deviation A healthcare practitioner who holds a Bachelor's degree in Medicine and General Surgery and has then completed his medical training in the field of anesthesia True 345 57.9 1.68 0.861 False 95 15.9 Don't know 156 26.2 After passing a special training program, the nurse can anesthetize patients under the supervision of an Anesthesiologist True 200 33.6 2.06 0.853 False 161 27.0 Don't know 235 39.4 The Anesthesiologist has extensive experience in pain management and dealing with pain resulting from surgical procedures True 250 41.9 1.95 0.889 False 124 20.8 Don't know 222 37.2 An Anesthesiologist can give a woman an epidural during labor True 328 55.0 1.79 0.921 False 65 10.9 Don't know 203 34.1 All surgical procedures require the patient to undergo general anesthesia True 77 12.9 2.04 0.545 False 418 70.1 Don't know 101 16.9 Some surgical procedures can be performed under local anesthesia without the need for general anesthesia True 458 76.8 1.37 0.719 False 54 9.1 Don't know 84 14.1 It is essential for the Anesthesiologist to be familiar with the patient's medical history, including all medications the patient is taking before undergoing surgery True 455 76.3 1.41 0.767 False 38 6.4 Don't know 103 17.3 Pre-operative fasting means not taking anything by mouth True 337 56.5 1.64 0.806 False 134 22.5 Don't know 125 21.0 Pre-operative fasting means not taking anything by mouth except water True 259 43.5 1.82 0.813 False 184 30.9 Don't know 153 25.7 In general, anesthesia is a largely safe medical procedure True 360 60.4 1.66 0.864 False 81 13.6 Don't know 155 26.0 General anesthesia often causes brain damage to the patient True 120 20.1 2.21 0.753 False 233 39.1 Don't know 243 40.8 There is a direct relationship between the possibility of anesthesia complications and the patient's poor health condition True 234 39.3 2.06 0.917 False 94 15.8 Don't know 268 45.0 Vomiting and nausea are common side effects of general anesthesia True 353 59.2 1.73 0.919 False 50 8.4 Don't know 193 32.4 The patient may be aware of what is happening around him while under general anesthesia True 179 30.0 1.99 0.769 False 244 40.9 Don't know 173 29.0     Figure 4: Concerns of fear about anesthesia     Figure 5: Knowledge related to anesthesia   These statements have means between "True" and "False," indicating a less certain opinion among the respondents. These include: "A healthcare practitioner who holds a Bachelor's degree in Medicine and General Surgery and has then completed his medical training in the field of anesthesia" (mean = 1.68), "In general, anesthesia is a largely safe medical procedure" (mean = 1.66) and "Vomiting and nausea are common side effects of general anesthesia" (mean = 1.73). The statement "An Anesthesiologist can give a woman an epidural during labor" has a mean of 1.79, also suggesting a tendency towards "True". "Pre-operative fasting means not taking anything by mouth" has a mean of 1.64, shows towards "True.", "Pre-operative fasting means not taking anything by mouth except water" has a slightly higher mean of 1.82, indicating more participants might perceive this as false or are unsure. "The patient may be aware of what is happening around him while under general anesthesia" has a mean of 1.99, suggesting a higher number of "Don't know" responses.   Statements with means closer to "False" are: "After passing a special training program, the nurse can anesthetize patients under the supervision of an Anesthesiologist" (mean = 2.06), "All surgical procedures require the patient to undergo general anesthesia" (mean = 2.04), "The Anesthesiologist has extensive experience in pain management and dealing with pain resulting from surgical procedures" (mean = 1.95) and "There is a direct relationship between the possibility of anesthesia complications and the patient's poor health condition" (mean = 2.06). The statement with the highest mean, indicating the strongest agreement with being "False," is "General anesthesia often causes brain damage to the patient" with a mean of 2.21.   The standard deviations for all statements are moderately high, ranging from 0.545 to 0.921. This indicates a clear variability in responses, suggesting that for many of these statements, there is not a strong agreement among the participants and a significant number might have answered "Don't know".   The data suggests that participants generally recognize the truthfulness of local anesthesia being sufficient for some procedures and the importance of the Anesthesiologist knowing the patient's medical history. There is more disagreement regarding the roles of nurses in administering anesthesia, the necessity of general anesthesia for all surgeries, the prevalence of certain side effects, the specifics of pre-operative fasting and the potential for awareness or brain damage during general anesthesia in presented Figure 5.   Table 7 presents the results of independent samples t-tests conducted to examine the differences in participants' knowledge and perceptions towards anesthesia and anesthesiologists based on gender. For the dependent variable "Perceptions about Anesthesiologist role and responsibilities," the average scores were 7.05 for males and 7.08 for females.   Table 7: Results of the Independent Samples Test to Examine the Difference in Participants’ Knowledge and Perception Towards Anesthesia and Anesthesiologists Based on Gender   Dependent variable Gender Number Mean Std. Deviation T (594) Level of significance Perceptions about Anesthesiologist role and responsibilities Male 238 7.05 1.58 -0.239 0.811 Female 358 7.08 1.37 Perceptions about Anesthesiologists’ education and training Male 238 7.95 2.02 -2.058 0.040 Female 358 8.30 1.97 Trust in physicians and Anesthesiologists Male 238 7.30 2.17 -1.738 0.083 Female 358 7.63 2.32 Concerns or fears about anesthesia Male 238 23.62 5.46 4.420 0.000 Female 358 21.43 6.23 Knowledge related to anesthesia Male 238 25.70 7.57 0.768 0.443 Female 358 25.22 7.36   Table 8: One-way ANOVA Results to Examine the Differences in Participants’ Knowledge and Perception Towards Anesthesia and Anesthesiologists Based on Education Dependent variables Education Number Mean Std. Deviation F (595) Level of significance Perceptions about Anesthesiologist role and responsibilities Did not attend school 4 6.25 1.89 0.811 0.542 Primary school 5 7.80 2.49 Middle school 17 7.12 2.52 High school 130 7.02 1.44 Collegiate 46 6.85 1.53 Post-Graduate 394 7.11 1.38 Perceptions about Anesthesiologists’ education and training Did not attend school 4 7.75 2.63 0.783 0.562 Primary school 5 9.20 2.39 Middle school 17 8.35 2.50 High school 130 8.24 2.15 Collegiate 46 8.50 2.01 Post-Graduate 394 8.08 1.91 Trust in physicians and Anesthesiologists Did not attend school 4 6.75 2.22 1.757 0.120 Primary school 5 9.00 1.87 Middle school 17 8.12 2.80 High school 130 7.81 2.58 Collegiate 46 7.04 2.14 Post-Graduate 394 7.41 2.14 Concerns or fears about anesthesia Did not attend school 4 17.50 2.65 0.976 0.432 Primary school 5 21.00 10.65 Middle school 17 22.18 7.34 High school 130 22.44 6.23 Collegiate 46 21.13 4.99 Post-Graduate 394 22.47 5.96 Knowledge related to anesthesia Did not attend school 4 25.75 3.78 1.280 0.271 Primary school 5 24.80 9.68 Middle school 17 27.82 9.26 High school 130 25.90 7.76 Collegiate 46 23.22 6.47 Post-Graduate 394 25.41 7.34   The t-statistic was -0.239, with a level of significance of 0.811. This indicates that there was no statistically significant difference in perceptions about the anesthesiologist's role and responsibilities between male and female participants. Regarding "Perceptions about Anesthesiologists' education and training," the mean score for males was 7.95, while females scored 8.30. The t-statistic was -2.058, with a level of significance of 0.040. Female participants scored significantly higher than male participants in their perceptions about the education and training of anesthesiologists. Concerning "Trust in physicians and Anesthesiologists," the average score for males was 7.30 and for females, it was 7.63. The t-statistic was -1.738, with a level of significance of 0.083. While females exhibited a slightly higher average trust level, this difference was not statistically significant at the 0.05 level. For "Concerns or fears about anesthesia," the mean score for males was 23.62 and for females, it was 21.43. The t-statistic was 4.420, with a level of significance of 0.000. Male participants reported significantly higher levels of concerns or fears about anesthesia compared to female participants. For "Knowledge related to anesthesia," the average score for males was 25.70 and for females, it was 25.22. The t-statistic was 0.768, with a level of significance of 0.443. This indicates that there was no statistically significant difference in knowledge related to anesthesia between male and female participants.   Table 8 presents the results of one-way ANOVA tests conducted to examine the differences in participants' knowledge and perception towards anesthesia and anesthesiologists based on their level of education.   For the dependent variable "Perceptions about Anesthesiologist role and responsibilities," the average scores varied across the different education levels: Did not attend school (6.25), Primary school (7.80), Middle school (7.12), High school (7.02), Collegiate (6.85) and post-graduate (7.11). The F-statistic was .811, with a level of significance of 0.542. This indicates that there were no statistically significant differences in perceptions about the anesthesiologist's role and responsibilities based on the participants' level of education.   Table 9: One-Way ANOVA Results to Examine the Differences in Participants’ Knowledge and Perception Towards Anesthesia and Anesthesiologists Based on Previous Surgeries Dependent variable Previous surgeries Number Mean Std. Deviation F (595) Level of significance Perceptions about Anesthesiologist role and responsibilities None 351 7.06 1.458 0.681 0.564 One surgery 131 7.21 1.508 Two surgeries 59 6.90 1.386 Three or more surgeries 55 7.02 1.421 Perceptions about Anesthesiologists’ education and training None 351 7.94 1.902 6.198 0.000 One surgery 131 8.20 2.066 Two surgeries 59 8.54 2.003 Three or more surgeries 55 9.07 2.107 Trust in physicians and Anesthesiologists’ None 351 7.48 2.303 0.623 0.600 One surgery 131 7.56 2.205 Two surgeries 59 7.78 2.101 Three or more surgeries 55 7.22 2.362 Concerns or fears about anesthesia None 351 22.07 6.334 0.457 0.713 One surgery 131 22.57 5.529 Two surgeries 59 22.73 5.747 Three or more surgeries 55 22.73 5.506 Knowledge related to anesthesia None 351 25.56 7.613 0.806 0.491 One surgery 131 25.10 7.345 Two surgeries 59 26.31 7.509 Three or more surgeries 55 24.31 6.455   Regarding "Perceptions about Anesthesiologists' education and training," the mean scores were: Did not attend school (7.75), Primary school (9.20), Middle school (8.35), High school (8.24), Collegiate (8.50) and post-graduate (8.08). The F-statistic was .783, with a level of significance of 0.562. This shows that there were no statistically significant differences in perceptions about the education and training of anesthesiologists based on the participants' level of education.   Concerning "Trust in physicians and Anesthesiologists," the average scores for the education levels were: Did not attend school (6.75), Primary school (9.00), Middle school (8.12), High school (7.81), Collegiate (7.04) and Post-Graduate (7.41). The F-statistic was 1.757, with a level of significance of .120. This indicates that there were no statistically significant differences in trust in physicians and anesthesiologists based on the participants' level of education.   For the dependent variable "Concerns or fears about anesthesia," the average scores across the education levels were: Did not attend school (17.50), Primary school (21.00), Middle school (22.18), High school (22.44), Collegiate (21.13) and post-graduate (22.47). The F-statistic was 0.976, with a level of significance of 0.432. This indicates that there were no statistically significant differences in the level of concerns or fears about anesthesia based on the participants' level of education.   Regarding "Knowledge related to anesthesia," the mean scores for the different education levels were: Did not attend school (25.75), Primary school (24.80), Middle school (27.82), High school (25.90), Collegiate (23.22) and post-graduate (25.41). The F-statistic was 1.280, with a level of significance of 0.271. This shows that there were no statistically significant differences in the level of knowledge related to anesthesia based on the participants' level of education.   The results indicate that for all dependent variables (Perceptions about Anesthesiologist role and responsibilities, Perceptions about Anesthesiologists' education and training, Trust in physicians and Anesthesiologists, Concerns or fears about anesthesia and Knowledge related to anesthesia), there were no statistically significant differences based on the participants' level of education. While the average scores varied across the different educational groups, these variations were not large enough to be considered statistically significant.   Table 9 presents the results of one-way ANOVA tests conducted to examine the differences in participants' knowledge and perception towards anesthesia and anesthesiologists based on their previous surgical experience. For the dependent variable "Perceptions about Anesthesiologist role and responsibilities," the average scores for the different previous surgery groups were: None (7.06), One surgery (7.21), Two surgeries (6.90) and Three or more surgeries (7.02). The F-statistic was 0.681, with a level of significance of .564. This indicates that there were no statistically significant differences in perceptions about the anesthesiologist's role and responsibilities based on the number of previous surgeries.   Regarding "Perceptions about Anesthesiologists' education and training," the mean scores were: None (7.94), One surgery (8.20), Two surgeries (8.54) and Three or more surgeries (9.07). The F-statistic was 6.198, with a level of significance of 0.000. This shows that there were statistically significant differences in perceptions about the education and training of anesthesiologists based on the number of previous surgeries.   Table 10: Chi-Square Results to Examine the Association Between Level of Knowledge About Anesthesia and Gender Statements P2 Level of Significance 1-A healthcare practitioner who holds a Bachelor's degree in Medicine and General Surgery and has then completed his medical training in the field of anesthesia. 0.850 0.654 2-After passing a special training program, the nurse can anesthetize patients under the supervision of an Anesthesiologist. 0.308 0.857 3-The Anesthesiologist has extensive experience in pain management and dealing with pain resulting from surgical procedures. 1.35 0.509 4-An Anesthesiologist can give a woman an epidural during labor. 13.63 0.001 5-All surgical procedures require the patient to undergo general anesthesia. 0.973 0.615 6-Some surgical procedures can be performed under local anesthesia without the need for general anesthesia. 1.36 0.505 7-It is essential for the Anesthesiologist to be familiar with the patient's medical history, including all medications the patient is taking before undergoing surgery. 2.73 0.255 8-Pre-operative fasting means not taking anything by mouth. 0.190 0.909 9-Pre-operative fasting means not taking anything by mouth except water. 0.377 0.828 10-In general, anesthesia is a largely safe medical procedure. 1.35 0.509 11-General anesthesia often causes brain damage to the patient. 5.22 0.073 12-There is a direct relationship between the possibility of anesthesia complications and the patient's poor health condition. 5.05 0.080 13-Vomiting and nausea are common side effects of general anesthesia. 16.42 0.000 14-The patient may be aware of what is happening around him while under general anesthesia. 0.645 0.724   Concerning "Trust in physicians and Anesthesiologists," the average scores for the previous surgery groups were: None (7.48), One surgery (7.56), Two surgeries (7.78) and Three or more surgeries (7.22). The F-statistic was 0.623, with a level of significance of 0.600. This indicates that there were no statistically significant differences in trust in physicians and anesthesiologists based on the number of previous surgeries.   For "Concerns or fears about anesthesia," the mean scores were: None (22.07), One surgery (22.57), Two surgeries (22.73) and Three or more surgeries (22.73). The F-statistic was 0.457, with a level of significance of 0.713. This indicates that there were no statistically significant differences in the level of concerns or fears about anesthesia based on the number of previous surgeries.   For "Knowledge related to anesthesia," the average scores for the previous surgery groups were: None (25.56), One surgery (25.10), Two surgeries (26.31) and Three or more surgeries (24.31). The F-statistic was 0.806, with a level of significance of 0.491. This shows that there were no statistically significant differences in the level of knowledge related to anesthesia based on the number of previous surgeries.   The results indicate a statistically significant difference based on previous surgeries only for "Perceptions about Anesthesiologists' education and training," with participants having more surgeries tending to have a more positive perception. For the other dependent variables, there were no statistically significant differences based on the number of previous surgeries.   Table 10 presents the results of Chi-Square tests conducted to examine the association between the level of knowledge about specific anesthesia-related statements and the gender of the participants.   For the statement "A healthcare practitioner who holds a Bachelor's degree in Medicine and General Surgery and has then completed his medical training in the field of anesthesia," the Chi-Square statistic (P2) is 0.850 with a level of significance of 0.654. This indicates no statistically significant association between the belief in this statement and the participant's gender. Regarding the statement "After passing a special training program, the nurse can anesthetize patients under the supervision of an Anesthesiologist," the P2 value is 0.308 with a significance level of 0.857. This suggests no statistically significant association between the agreement with this statement and gender. For "The Anesthesiologist has extensive experience in pain management and dealing with pain resulting from surgical procedures," the P2 is 1.35 with a significance level of 0.509, indicating no significant association with gender. Concerning "An Anesthesiologist can give a woman an epidural during labor," the P2 is 13.63 with a significance level of 0.001. This demonstrates a statistically significant association between gender and the belief in this statement. For "All surgical procedures require the patient to undergo general anesthesia," the P2 is 0.973 with a significance level of 0.615, showing no significant association with gender. Regarding "Some surgical procedures can be performed under local anesthesia without the need for general anesthesia," the P2 is 1.36 with a significance level of 0.505, indicating no significant association with gender. For "It is essential for the Anesthesiologist to be familiar with the patient's medical history, including all medications the patient is taking before undergoing surgery," the P2 is 2.73 with a significance level of 0.255, showing no significant association with gender. Concerning "Pre-operative fasting means not taking anything by mouth," the P2 is 0.190 with a significance level of 0.909, indicating no significant association with gender. For "Pre-operative fasting means not taking anything by mouth except water," the P2 is 0.377 with a significance level of 0.828, showing no significant association with gender. Regarding "In general, anesthesia is a largely safe medical procedure," the P2 is 1.35 with a significance level of 0.509, indicating no significant association with gender. For "General anesthesia often causes brain damage to the patient," the P2 is 5.22 with a significance level of 0.073. This suggests a trend towards a significant association with gender but it does not reach the conventional 0.05 threshold for statistical significance. Concerning "There is a direct relationship between the possibility of anesthesia complications and the patient's poor health condition," the P2 is 5.05 with a significance level of 0.080, also indicating a trend but not a statistically significant association with gender. For "Vomiting and nausea are common side effects of general anesthesia," the P2 is 16.42 with a significance level of 0.000. This demonstrates a statistically significant association between gender and the belief in this statement. For "The patient may be aware of what is happening around him while under general anesthesia," the P2 is 0.645 with a significance level of 0.724, showing no significant association with gender.   Table 11: Chi-Square Results to Examine the Association Between Level of Knowledge About Anesthesia and Educational Level Statements P2 Level of significance 1-A healthcare practitioner who holds a Bachelor's degree in Medicine and General Surgery and has then completed his medical training in the field of anesthesia. 15.28 1.22 2-After passing a special training program, the nurse can anesthetize patients under the supervision of an Anesthesiologist. 21.60 0.017 3-The Anesthesiologist has extensive experience in pain management and dealing with pain resulting from surgical procedures. 13.19 0.214 4-An Anesthesiologist can give a woman an epidural during labor. 15.47 0.116 5-All surgical procedures require the patient to undergo general anesthesia. 16.02 0.099 6-Some surgical procedures can be performed under local anesthesia without the need for general anesthesia. 43.16 0.000 7-It is essential for the Anesthesiologist to be familiar with the patient's medical history, including all medications the patient is taking before undergoing surgery. 25.54 0.004 8-Pre-operative fasting means not taking anything by mouth. 6.82 0.742 9-Pre-operative fasting means not taking anything by mouth except water. 8.45 0.585 10-In general, anesthesia is a largely safe medical procedure. 29.99 0.001 11-General anesthesia often causes brain damage to the patient. 18.37 0.049 12-There is a direct relationship between the possibility of anesthesia complications and the patient's poor health condition. 17.23 0.069 13-Vomiting and nausea are common side effects of general anesthesia. 17.57 0.063 14-The patient may be aware of what is happening around him while under general anesthesia. 11.82 0.297   The Chi-Square tests reveal statistically significant associations between gender and the level of knowledge for two specific statements: whether an Anesthesiologist can give an epidural during labor and whether vomiting and nausea are common side effects of general anesthesia. the majority of the statements did not show a statistically significant association between the level of knowledge and the gender of the participants.   Table 11 presents the results of Chi-Square tests conducted to examine the association between the level of knowledge about specific anesthesia-related statements and the education level of the participants.   For the statement "A healthcare practitioner who holds a Bachelor's degree in Medicine and General Surgery and has then completed his medical training in the field of anesthesia," the Chi-Square statistic (P2) is 15.28 with a level of significance of 0.122. This indicates no statistically significant association between the belief in this statement and the participant's education level. Regarding the statement "After passing a special training program, the nurse can anesthetize patients under the supervision of an Anesthesiologist," the P2 value is 21.60 with a significance level of 0.017. This suggests a statistically significant association between the agreement with this statement and education level. For "The Anesthesiologist has extensive experience in pain management and dealing with pain resulting from surgical procedures," the P2 is 13.19 with a significance level of 0.116, indicating no significant association with education level. Concerning "An Anesthesiologist can give a woman an epidural during labor," the P2 is 15.47 with a significance level of .116, showing no significant association with education level.   For "All surgical procedures require the patient to undergo general anesthesia," the P2 is 16.02 with a significance level of 0.099, indicating no significant association with education level. Regarding "Some surgical procedures can be performed under local anesthesia without the need for general anesthesia," the P2 is 43.16 with a significance level of 0.000. This demonstrates a statistically significant association between education level and the belief in this statement. For "It is essential for the Anesthesiologist to be familiar with the patient's medical history, including all medications the patient is taking before undergoing surgery," the P2 is 25.54 with a significance level of 0.004, showing a statistically significant association with education level. Concerning "Pre-operative fasting means not taking anything by mouth," the P2 is 6.82 with a significance level of 0.742, indicating no significant association with education level. For "Pre-operative fasting means not taking anything by mouth except water," the P2 is 8.45 with a significance level of 0.585, showing no significant association with education level. Regarding "In general, anesthesia is a largely safe medical procedure," the P2 is 29.99 with a significance level of 0.001, indicating a statistically significant association with education level. For "General anesthesia often causes brain damage to the patient," the P2 is 18.37 with a significance level of 0.049. This suggests a trend towards a significant association with education level, nearing the conventional 0.05 threshold. Concerning "There is a direct relationship between the possibility of anesthesia complications and the patient's poor health condition," the P2 is 17.23 with a significance level of 0.069, also indicating a trend but not a statistically significant association with education level. For "Vomiting and nausea are common side effects of general anesthesia," the P2 is 17.57 with a significance level of 0.063, showing a trend but not a statistically significant association with education level. For "The patient may be aware of what is happening around him while under general anesthesia," the P2 is 11.82 with a significance level of 0.297, showing no significant association with education level.   Table 12: Chi-Square Results to Examine the Association Between Level of Knowledge About Anesthesia and Age Statements P2 Level of significance 1-A healthcare practitioner who holds a Bachelor's degree in Medicine and General Surgery and has then completed his medical training in the field of anesthesia. 16.59 0.035 2-After passing a special training program, the nurse can anesthetize patients under the supervision of an Anesthesiologist. 25.03 0.002 3-The Anesthesiologist has extensive experience in pain management and dealing with pain resulting from surgical procedures. 14.56 0.068 4-An Anesthesiologist can give a woman an epidural during labor. 19.69 0.010 5-All surgical procedures require the patient to undergo general anesthesia. 9.84 0.276 6-Some surgical procedures can be performed under local anesthesia without the need for general anesthesia. 24.90 0.002 7-It is essential for the Anesthesiologist to be familiar with the patient's medical history, including all medications the patient is taking before undergoing surgery. 14.46 0.071 8-Pre-operative fasting means not taking anything by mouth. 12.58 0.127 9-Pre-operative fasting means not taking anything by mouth except water. 10.82 0.212 10-In general, anesthesia is a largely safe medical procedure. 32.65 0.000 11-General anesthesia often causes brain damage to the patient. 8.93 0.035 12-There is a direct relationship between the possibility of anesthesia complications and the patient's poor health condition. 9.45 0.306 13-Vomiting and nausea are common side effects of general anesthesia. 12.87 0.116 14-The patient may be aware of what is happening around him while under general anesthesia. 10.54 0.229 The Chi-Square tests reveal statistically significant associations between the level of knowledge and the education level of the participants for several statements: whether nurses can anesthetize under supervision, whether local anesthesia can be used for some procedures, the importance of the anesthesiologist knowing the patient's medical history and whether general anesthesia is largely safe. While the remaining statements did not show a statistically significant association between the level of knowledge and the education level of the participants.   Table 12 presents the results of Chi-Square tests conducted to examine the association between the level of knowledge about specific anesthesia-related statements and the age of the participants.   For the statement "A healthcare practitioner who holds a Bachelor's degree in Medicine and General Surgery and has then completed his medical training in the field of anesthesia," the Chi-Square statistic (P2) is 16.59 with a level of significance of 0.035. This indicates a statistically significant association between the belief in this statement and the participant's age. Regarding the statement "After passing a special training program, the nurse can anesthetize patients under the supervision of an Anesthesiologist," the P2 value is 25.03 with a significance level of 0.002. This suggests a statistically significant association between the agreement with this statement and age. For "The Anesthesiologist has extensive experience in pain management and dealing with pain resulting from surgical procedures," the P2 is 14.56 with a significance level of 0.068, indicating a trend towards a significant association with age. Concerning "An Anesthesiologist can give a woman an epidural during labor," the P2 is 19.69 with a significance level of 0.010. This demonstrates a statistically significant association between age and the belief in this statement. For "All surgical procedures require the patient to undergo general anesthesia," the P2 is 9.84 with a significance level of 0.276, showing no significant association with age.   Regarding "Some surgical procedures can be performed under local anesthesia without the need for general anesthesia," the P2 is 24.90 with a significance level of 0.002. This demonstrates a statistically significant association between age and the belief in this statement. For "It is essential for the Anesthesiologist to be familiar with the patient's medical history, including all medications the patient is taking before undergoing surgery," the P2 is 14.46 with a significance level of 0.071, indicating a trend towards a significant association with age. Concerning "Pre-operative fasting means not taking anything by mouth," the P2 is 12.58 with a significance level of 0.127, indicating no significant association with age. For "Pre-operative fasting means not taking anything by mouth except water," the P2 is 10.82 with a significance level of 0.212, showing no significant association with age. Regarding "In general, anesthesia is a largely safe medical procedure," the P2 is 32.65 with a significance level of 0.000. This indicates a statistically significant association between age and the belief in this statement. For "General anesthesia often causes brain damage to the patient," the P2 is 8.93 with a significance level of 0.035. This suggests a statistically significant association between age and the belief in this statement. Concerning "There is a direct relationship between the possibility of anesthesia complications and the patient's poor health condition," the P2 is 9.45 with a significance level of 0.306, showing no significant association with age. For "Vomiting and nausea are common side effects of general anesthesia," the P2 is 12.87 with a significance level of 0.116, indicating no significant association with age. For "The patient may be aware of what is happening around him while under general anesthesia," the P2 is 10.54 with a significance level of 0.229, showing no significant association with age.   The Chi-Square tests reveal statistically significant associations between the level of knowledge and the age of the participants for several statements: the qualifications of an anesthesia practitioner, whether nurses can anesthetize under supervision, whether an anesthesiologist can give an epidural, whether local anesthesia can be used for some procedures, whether general anesthesia is largely safe and whether general anesthesia often causes brain damage. While the remaining statements did not show a statistically significant association between the level of knowledge and the age of the participants.

This study explored public perception and awareness regarding anesthesia and the role of anesthesiologists. Overall, the findings highlight a substantial knowledge gap and several prevalent misconceptions among participants. While most respondents demonstrated a basic understanding of the anesthesiologist’s involvement in perioperative care, many lacked a detailed understanding of anesthesiologists’ training, responsibilities and impact on patient safety. Trust in anesthetists was found to be moderate, with notable influences from gender, age, education and prior surgical experience.   Participants demonstrated a moderate understanding of anesthesiologists' roles, with over half correctly identifying them as responsible for patient recovery after surgery. This aligns with findings from the study 'Anesthesiologist: The Patient's Perception', which emphasized the underappreciation of anesthesiologist roles [8]. These findings indicate that many participants have a good understanding of the anesthesiologist’s duties, showing a generally strong level of awareness.   Our study has shown limited awareness of anesthesiology training, with only 30.5% identifying it correctly. Similar findings were noted worldwide in Portugal and locally in Saudi Arabia, where the majority failed to recognize the length of anesthesiology training [8,9]. Improving public understanding of anesthesiologists’ training can boost trust in anesthesia providers during surgery, because patients who know their anesthesiologist is highly trained will feel safer and more confident during procedures. We can include brief bios or training overviews on hospital walls, websites or pre-operative materials.   Additionally, our study has highlighted patients’ concerns about anesthesia, including needle fear, headache and memory loss. These concerns are common and supported by research articles in the literature [10,11]. Needle phobia is well-documented in medical settings and is especially common among younger people and those with prior negative experiences [12]. Other concerns include postoperative headache, memory loss, fear of pain, death during anesthesia and brain damage. Although Death during anesthesia is rare, these concerns are a result of a lack of understanding how anesthesia works, negative stories, general anxiety or medical phobia [13]. A crucial need for interventions to lower procedural anxiety, such as topical anesthetics or distraction methods.   Surprisingly, our study found that while men and women have a similar understanding of anesthesiologists’ roles, significant gender differences emerged in other areas. Contrary to the literature, males reported greater fear of anesthesia. This contrasts sharply with previous literature, such as the study by Nigussie, which showed that female patients generally report higher levels of preoperative anxiety and fears related to anesthesia [14]. A similar conclusion was found by Caumo et al. [13], who noted that women were more anxious and fearful before surgery [15]. Our findings differ from these results and may suggest that, although female patients might display more anxiety in clinical settings, in broader community perceptions, males could internalize more fear or uncertainty about anesthesia due to sociocultural or informational factors. This reveals a possible disconnect between clinical anxiety and general perception, highlighting the need for more gender-sensitive approaches in community education and reassurance strategies, especially aimed at male populations.   Another unexpected finding revealed that postgraduates did not perform better than middle or high school graduates. This result has also been observed in a study from China, which analyzed over 1 million participants [16]. Even if our societies have a prestigious and strong educational industry that graduates thousands of people yearly, continuous awareness and learning are needed for all individuals with diverse backgrounds in the community.   This study’s strength lies in its comprehensive exploration of demographic influences, age, gender, education and prior surgeries on public perception. Findings guide targeted educational strategies, including the use of infographics and preoperative counseling. Emphasizing anesthesiologists’ qualifications may enhance patient trust. Limitations include the cross-sectional design, reliance on self-reported data and gender imbalance in the sample. Surgical experience was not classified by type and confounding factors like cultural background and health literacy were not controlled. Future studies should use qualitative interviews to explore demographic influences in depth. Interventional research using educational tools could assess changes in perception. Public campaigns should be inclusive of all education levels, as prior academic background does not guarantee a better understanding.

This study reveals a considerable public misunderstanding about anesthesiology. Demographic factors such as gender, age and prior experience influence trust and knowledge. Addressing these gaps through structured, inclusive education will improve patient trust, communication and outcomes.   Conflicts of Interest The authors have no conflict of interest.