Our knowledge of anatomy, physiology, pharmacology and complications of spinal anaesthesia has expanded considerably increasing the safety of the technique . These advancements have probably influenced the attitudes towards spinal anaesthesia to some degree; however, it was our suspicion that most practitioners and patients still preferred general anaesthesia, and were somewhat fearful of spinal anaesthesia. To test this hypothesis, we conducted an oral survey to determine whether anaesthesiologists would consent to spinal anaesthesia if this technique were appropriate for surgery they themselves required. We also looked at how the answers related to the subjects' personal and job characteristics.
Three hundred anaesthesiologists (132 males, 168 females), attending a National Congress of Anaesthesiology and representing a sample of convenience, were approached by two anaesthesiology residents and were asked 'Would you consent to spinal anaesthesia if this method was appropriate for a surgical procedure to be performed on you?' The total numbers of 'yes' and 'no' answers were determined and then analysed with respect to gender, length of time in anaesthesia practice (gauged in 5 yr period), training level and academic status. Specialists were categorized into one of two groups according to their involvement in teaching and research activities. Group 1 consisted of specialists who did not work in the academic environment; Group 2 consisted of specialists in academic positions. Group 2 was sub-classified according to level of academic position (senior vs. junior) as Group 2a (department chiefs in state-run teaching hospitals, associate and full professors in university teaching hospitals) and Group 2b (assistant department chiefs and assistant professors). Respondents who answered 'no' were not prompted but asked to list their reason(s) for refusal. These were grouped as seen in Table 1. The totals were ranked in order of frequency, and the distribution of reasons in females was compared to that in males.
The χ2-square test was used for statistical analysis and P < 0.05 was considered significant. Two hundred and four (68%) respondents answered 'yes' and 96 (32%) answered 'no'. Of the males, 102 (77%) responded 'yes' and 30 (23%) said 'no'. The corresponding figures for the females were 102 (61%) and 66 (39%). In both genders, the rates of 'no' and 'yes' answers were different (P < 0.01).
One hundred and fifty-seven of the respondents were residents and 143 were specialists. Significantly more residents (77%) than specialists (58%) answered 'yes' (P < 0.001). When the specialists were categorized according to academic and non-academic status, and by level of academic position, there were no significant differences between the groups regarding 'yes' rate (P > 0.05) (Table 2). The percentage of 'yes' answers decreased as the number of years in anaesthesia practice increased. The rate in the 0-5 yr category was significantly higher than the rates in the other categories (P < 0.001) (Table 3).
Of the 96 respondents who refused spinal anaesthesia, 53 cited one reason and 43 cited more than one reason. Twenty-four individuals gave two reasons, 14 gave three reasons and five gave more than three reasons. The wish to be unaware of what was happening during surgery was the most frequent reason, followed by fear of nerve damage, fear of infection, anticipation of feeling uncomfortable during the procedure and fear of headache. There was a difference (P < 0.001) between males and females regarding the distribution of these first five frequently cited reasons (Table 1).
The proportion of 'yes' answers given by the anaesthesiologists in this study was higher than we expected. Two possible reasons for this are the type of question we asked, and the theoretical nature of the survey. The results might have been different had the surgery actually been real, or had we asked whether they would prefer spinal anaesthesia to general or epidural anaesthesia. However, our aim was to ask a single-choice question that elicited a prompt, perhaps instinctive, answer so that we could detect any bias against spinal anaesthesia. If the person answered 'no', then we investigated his or her reason(s).
Previous surveys concerning the use of spinal anaesthesia have indicated a preference for general anaesthesia over spinal technique. For example, investigations by Sosis and colleagues  and Shevde and Panagopoulos  showed that 80% and 98% of patients, respectively, preferred general to spinal anaesthesia for the same type of surgery. In contrast, a survey of anaesthesiologists by Katz  showed that 68% of respondents chose regional over general anaesthesia for their own elective surgical procedures. Broadman and colleagues in an unpublished survey (http://www.csen.com/anaesthesia/survey.htm) asked 665 anaesthesiologists 'What kind of anaesthesia you will choose for yourself if you are a patient?' with a 11.6% response rate and found that 79.16% chose regional anaesthesia. But in this survey no specific technique of regional anaesthesia was mentioned.
An interesting finding from our study was the significantly lower 'yes' rates among experienced anaesthesiologists. Seventy-seven per cent of those who were undertaking postgraduate education at the time of the survey (residency lasts 4-5 yr in Turkey) responded 'yes', whereas the corresponding rate in anaesthesiologists who had completed their training was 58% (P < 0.0001). Eldor  predicted that the shift within the profession towards regional techniques would also cause a shift in public recognition and appreciation of anaesthesiology and anaesthesiologists. Our finding that spinal anaesthesia was more acceptable to the younger generation may be a reflection of a shift within the profession towards regional techniques, and particularly spinal anaesthesia.
In conclusion, our survey of 300 anaesthesiologists with different lengths of time in practice, levels of training and academic status revealed that 68% would consent to spinal anaesthesia if it were appropriate for a surgery they needed. For those who said 'no', the most common reason was that they did not want to be aware of what was happening during surgery.
Department of Anaesthesiology; Baskent University Faculty of Medicine; Ankara, Turkey
Department of Biostatistics; Baskent University Faculty of Medicine; Ankara, Turkey
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