Honestly, there’s no definitive purpose. It’s sort of like a learned thing for the anesthesiologist to say. Yes, it can help determine consciousness but there are other ways to do those.
Backwards is because counting forwards can be done very fast so you might count upto 10 in 1.5 seconds whereas counting back from 10 usually takes 5 secs or so.
It’s similar to doctor/ nurse saying take a deep breath while giving an injection
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