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Search engine queries as a metric of public interest in anesthesia

General and procedural anesthesia are routine in operative and emergency settings. Much of the existing literature related to patient knowledge of anesthesia relies on single-institution clinical settings and traditional methodologies, which entail either surveying patients or observing encounters between patients and providers. Recent narrative reviews on informed consent in adult and pediatric perioperative settings reveal that the informed consent process often inadequately provides patients with a satisfactory understanding of the risks associated with various types of sedation. One way to ascertain population-level interest in health care interventions is through the use of search engine queries, which may provide insight into areas of health communication requiring increased attention. A 2017 study of internet search trends pertaining to labor epidurals revealed a rapid increase in search queries, especially those related to side-effects and risks. An older study using internet keyword searches assessed general interest in anesthesia and determined that it was decreasing, although the study did not assess keywords related to public interest in anesthesia. It is unclear how internet search trends related to anesthesia have changed over time. Overall, internet search terms can help anesthesia providers understand which aspects of anesthesia are most pertinent to the general population, which in turn may guide the informed consent process with patients. In this regard, we sought to characterize thematic domains of search engine queries on Google related to anesthesia to identify interest at the population level. We conducted a retrospective study of Google Trends data (https://trends.google.com), which is a publicly available tool providing data on the relative popularity of queried terms by total search terms as they vary by geography and time. These data are provided as a relative search frequency (RSF) from 0 to 100, with 100 representing peak popularity of a term. A preliminary analysis of different search terms—e.g. anesthesia, anesthesiology, procedural sedation etc.— identified the search term “general anesthesia” as the most frequently searched term on Google for this topic in the United States. We utilized the “checklist for documentation of Google Trends” for reporting methods, as recommended by Nuti et al. for the purposes of reproduciblity. Trends in “general anesthesia” searches were assessed from 19 January 2014 to 12 January 2018 during which Google’s search engine market share of all search engines was approximately 86.9%. Data extracted include the RSF per week and “related queries”. Related queries are aggregated queried terms that individual users searched co-temporally in addition to “general anesthesia” over the given time period, which are divided into the metrics “Top” and “rising”. “Top” represents the most popular terms over the given time period, while “rising” represents terms with the largest increase in search frequency since the previous time period, represented as a percent change over time. Data were analyzed using descriptive statistics for RSF, as well as thematically for related queries. Statistical analyses were conducted using JASP, version 0.9.1 (JASP Team 2018). Reporting of this study conforms to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. This study of publicly available, deidentified data was deemed exempt for Institutional Review Board approval by Case Western Reserve University. Over the 260 weeks of data, the median RSF of “general anesthesia” was 72.5 (interquartile range, 66.0–79.3) out of 100. The most popular “top” related queries over this time period included questions related