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Awareness Under Anaesthesia: Psychologists Investigating Consciousness During Operations Reveal Techniques To Identify Wakefulness

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It is the stuff of nightmares – you are under anaesthetic during an operation but you are fully conscious. Aware of every incision – yet unable to communicate that fact.

Now a leading Professor of Clinical Psychology at the University of Leicester shares his views and findings on awareness in anaesthesia during his inaugural lecture on Tuesday 24 January. Professor Michael Wang, of the School of Psychology at the University of Leicester, gave the lecture, Dissecting Consciousness on the Operating Theatre Table. He said: “My research has important implications for understanding the human psyche from a clinical point of view, by casting light on how some types of psychological disturbance may be caused, not just in the operating theatre, but in other circumstances as well.” “Psychologists have made, and continue to make, significant contributions to the study and practice of anaesthesia. Moreover the induction of general anaesthesia provides opportunity to investigate the nature of consciousness using experimental methods and systematic observation in the operating theatre.” Professor Wang said episodes of full awareness with explicit recall during operations with general anaesthesia are more common than many realise. He added: “The common reason for failure to identify intra-operative awareness is the paralyzing effects of muscle relaxants. Contrary to traditional belief there are no reliable clinical signs to enable the identification of wakefulness.” Studies conducted by Prof Wang and Dr Ian Russell (Hull Royal Infirmary) have made use of the isolated forearm technique to determine levels of consciousness during general anaesthesia, which allows communication despite the muscle paralysis. The isolated forearm technique simply involves applying a tourniquet to the forearm just before the paralysing drug is administered. This allows the patients to move his/her hand when asked to if he/she is sufficiently conscious to do so. The technique has been pioneered by Dr Russell and Prof Wang. “Often patients will demonstrate high levels of consciousness during an operation but without conscious recall afterwards. This is because many anaesthetic drugs interfere with memory. I and colleagues have also investigated benzodiazepine sedation as another clinical circumstance in which there may be dissociation between unconscious and conscious recall. There is an intriguing literature in which patients have developed psychological disturbance following operations with general anaesthesia in which the patient has no conscious recall, but the nature of the disturbance is indicative of inadequate anaesthesia. Experimental studies that attempt to investigate the mechanisms by which this may occur are reviewed.”(Source: University of Leicester: January 2006.)


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Posted On: 10 February, 2006
Modified On: 16 January, 2014

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