General anesthesia is a necessary component of many surgeries, producing controlled unconsciousness in patients that inhibits their experience of pain and their ability to make memories of events during the procedure. However, it also leaves patients unable to make adjustments for comfort or to communicate discomfort to the care team. There are several strategies that clinicians should incorporate to improve patient comfort under anesthesia that may seem relatively minor but positively impact outcomes, particularly regarding eye protection, temperature control, and patient positioning.
Under normal waking conditions, the hypothalamus maintains core body temperature within a narrow range, deploying mechanisms such as vasoconstriction, shivering, and sweating as needed. General anesthesia disrupts this system and expands the interthreshold range—the zone within which the body does not trigger autonomic temperature defenses—from roughly 0.3°C to as much as 4°C. Behavioral regulation is entirely lost in the unconscious patient. As a result, inadvertent intraoperative hypothermia, defined as a core temperature below 36°C, becomes a major concern for OR teams.
The consequences extend well beyond discomfort: hypothermia impairs coagulation and platelet function, increases the risk of wound infection, prolongs the action of anesthetic drugs, and is associated with a threefold increase in adverse cardiac outcomes. Active warming strategies—including forced-air warming blankets applied before and during surgery, pre-warming of intravenous fluids, and close intraoperative temperature monitoring—are effective countermeasures that current guidelines from bodies including NICE and the American College of Cardiology/American Heart Association endorse¹.
Ocular safety is a second area where minor protective measures can significantly improve patient comfort under general anesthesia. The factors that make the eyes vulnerable during general anesthesia are a direct consequence of the anesthetic state itself: the protective corneal reflex is stopped, and basal tear production decreases. Without intervention, corneal abrasion and conjunctival injury are meaningful risks, particularly during prolonged non-ophthalmic procedures. A comparative study of four eye-protection methods—hypoallergenic tape, paraffin-based ointment, polyacrylic acid gel, and methylcellulose artificial tears—found that all four offered broadly equivalent protection against corneal lesion severity and that no single method was clearly superior.
What the evidence does underscore is that some form of eye protection must be employed; the perioperative team should choose among validated methods based on the clinical context and exercise caution with certain preparations, as paraffin-based ointments have been associated with higher rates of photophobia in some studies2. The AORN positioning guideline further emphasizes the necessity of eye protection as a core component of safe intraoperative positioning, explicitly listing it among the basic principles perioperative teams must follow3.
Surgical positioning is the third domain in which minor adjustments can produce significant effects. Because anesthetized patients cannot respond to pain or discomfort, the perioperative team assumes total responsibility for their physical safety. The goals of correct positioning are to provide adequate surgical access while simultaneously maintaining physiologic alignment, promoting blood circulation, protecting nerve integrity, and preventing pressure injuries to skin, bones, and joints. Each common operative position—supine, Trendelenburg, prone, etc.—carries its own profile of risks.
The supine position, for instance, concentrates pressure on the occiput, scapulae, sacrum, and heels; elevating the heels from the table surface and placing padding under the lumbosacral area are straightforward interventions that reduce injury risk. The Trendelenburg position can increase intraocular pressure and lead to venous stasis edema of the face and airway, while the prone position introduces the possibility of ophthalmic injury, inadvertent airway device dislodgment, and compartment syndrome. For lengthy procedures, periodic reassessment of position and padding is recommended3.
Some research suggests that the auditory environment affects patients even when they are under general anesthesia. Although patients under adequate anesthesia do not consciously perceive or recall what they hear, the primary auditory cortex remains responsive to sound even during deep sedation. A systematic review and meta-analysis of 53 randomized controlled trials encompassing 4,200 patients concluded that playing music intraoperatively significantly reduced both postoperative pain and opioid requirements compared with control groups that had no music played.
Specifically, music was associated with a moderate-to-large reduction in pain within the first three hours after surgery and a meaningful decrease in opioid consumption in the first 24 hours after surgery. The proposed mechanism of this strategy involves an attenuation of the physiological stress response to surgery, including modulation of stress hormone levels4. These findings suggest that a calm auditory setting may have benefits for patients receiving surgery, though further research in this domain is warranted.
The patient’s comfortability under anesthesia is uniquely dependent on the knowledge, vigilance, and clinical judgment of the team surrounding them. Temperature monitoring and warming, eye protection, and meticulous positioning are valuable steps for ensuring patient comfort during anesthesia and evidence-based components of safe anesthetic care. Each of these steps requires relatively modest effort or resources but can meaningfully influence outcomes.
References
- Bindu, B., Bindra, A. & Rath, G. Temperature management under general anesthesia: Compulsion or option. J. Anaesthesiol. Clin. Pharmacol. 33, 306–316 (2017). https://doi.org/10.4103/joacp.JOACP_334_162.
- Ganidagli, S. et al. Eye protection during general anaesthesia: comparison of four different methods. Eur. J. Anaesthesiol. 21, 663–667 (2004). https://doi.org/10.1017/s0265021504228137
- Spruce, L. Positioning the patient. AORN J. 114, 75–84 (2021). https://doi.org/10.1002/aorn.13442
- Fu, V. X. et al. Perception of auditory stimuli during general anesthesia and its effects on patient outcomes: a systematic review and meta-analysis. Can. J. Anaesth. 68, 1231–1253 (2021). https://doi.org/10.1007/s12630-021-02015-0