Patients sometimes overestimate their ability to handle the unfamiliar stimuli of the operating room, said Dr. Stavros G. Memtsoudis, a researcher and professor of anesthesiology at Weill Cornell Medical College.

“The patient will keep asking, ‘What is my heart doing? Is that beep normal? Is this normal?’ I might say, ‘If you’d rather go to sleep you can, because I can see your blood pressure is going up because you’re so stressed and you’ll bleed more,’” said Dr. Memtsoudis, who is also an anesthesiologist at Hospital for Special Surgery, an orthopedic center in New York where regional anesthesia is common. He also keeps on hand headphones, music selections and video glasses to soothe anxious awake patients.

And when it is the assistant’s turn to try a technique, Dr. Michael L. Marin, a professor and chairman of the surgery department at Mount Sinai Medical Center, is particularly judicious. Rather than risk unsettling the patient with what might be a typical instruction to a resident — “See if you can find your way through it” — Dr. Marin may be more circumspect: “We need to adjust this piece over here.”

Throughout, he is both trying to assure the awake patient, and educate residents and fellows about the importance of doing so. “You have to recognize that the patient may be listening intently and they’re nervous,” said Dr. Marin, who specializes in aortic aneurysm repair. “Sometimes I’ll go overboard and say, ‘That’s perfect!’ or ‘It came together exactly the way we wanted!’

“That makes patients feel much better,” he said. “They want to know you are confident, focused and in control. They are not really interested in hearing doctors joke about the drinking they did last night.”

Dr. Ilyas, the hand surgeon, who is also an associate professor of orthopedic surgery at Thomas Jefferson University in Philadelphia, began routinely offering awake options to patients about four years ago. Among other advantages, he said, patients enjoy having a better understanding of their medical problem. And because they are awake and can follow direction, Dr. Ilyas can test their mobility right away to learn whether he needs to do further repair.

“You get more ownership and appreciation of the treatment from patients,” he said.

Now when he gives patients the choice to be awake or asleep, Dr. Ilyas said, about 80 percent are opting to be awake.

But when Dr. Ilyas himself needs surgery, he is still rather old-fashioned.

“I don’t want to be awake and worrying about it,” he said. “When I had a vasectomy I had the awake option. But I said, ‘Nope! I’d rather be asleep. I’m good, thanks.’”