Operating Room Professionals' Awareness of Possible Unconscious Auditory Perception During General Anesthesia: A Cross-Sectional Survey Study.

Abstract

Background: Explicit recall during general anesthesia is rare; however, experimental and clinical evidence suggests that auditory stimuli may sometimes be processed at an implicit or unconscious level. Routine intraoperative conversations differ from structured therapeutic suggestions; nevertheless, they form part of the auditory environment surrounding anesthetized patients. This study aimed to assess operating room professionals' awareness of possible unconscious auditory perception related to intraoperative conversations during general anesthesia, their previous educational exposure, and their professional attitudes.

Methods: In this cross-sectional survey, an anonymous 19-item online questionnaire was distributed to operating room health professionals in Türkiye through professional communication networks. Descriptive statistics were reported as n (%). A study-specific 9-item exploratory Awareness/Professional Attitude Index was calculated with two items reverse-coded, and internal consistency was assessed using Cronbach's alpha. Between-group comparisons were performed using the Mann-Whitney U test and the Kruskal-Wallis test. A p value < 0.05 was considered statistically significant.

Results: A total of 251 responses were analyzed, and 96.4% of participants reported that they were actively working in the operating room. Most participants agreed that intraoperative communication should remain within appropriate professional boundaries (97.2%) and that awareness-oriented education on this topic is needed (88.0%). However, 74.5% reported that they had not received formal education on this topic, and only 19.5% reported exposure to related scientific education or activities. The study-specific exploratory Awareness/Professional Attitude Index was 3.61 ± 0.67 and showed high internal consistency (Cronbach's alpha = 0.83). Index scores were higher in women than in men (3.76 vs 3.43; p < 0.001) and differed across professional groups (p = 0.001) and experience groups (p = 0.023). These findings indicate a gap between the perceived importance of communication around anesthetized patients and formal educational exposure.

Conclusions: Operating room professionals reported substantial awareness of the importance of intraoperative conversations in the context of possible unconscious auditory perception during general anesthesia. However, formal educational exposure to this topic was limited. These descriptive findings do not demonstrate effects on patient outcomes; however, they identify an awareness-education gap and support awareness-oriented education, clearer communication norms around anesthetized patients, and further research using standardized measurement approaches, as well as observational or interventional designs. Trial registration: ClinicalTrials.gov, NCT07396727. Registration date: September 26, 2025.