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

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."

Biography
Prof Wang was born in Sheffield, Yorkshire. After attending Rowlinson School he went to Manchester University for both undergraduate and postgraduate clinical training in the late 1970s. He then spent eight years working as an NHS Clinical Psychologist at Withington Hospital initially treating patients with substance misuse followed by work with general and acute psychiatric patients. During this time he completed a part-time PhD which investigated the aetiology of phobias in alcohol-dependent patients. In 1988 he was appointed Clinical Co-Director and Honorary NHS Consultant on the integrated Clinical Psychology Course at the University of Hull. In 1997 he became Head of Department, and then in 2000 was made Honorary Clinical Professor in the Postgraduate Medical Institute, University of Hull. He was awarded the Fellowship of the British Psychological Society in 1999 in recognition of his research into psychological aspects of anaesthesia and his contributions to clinical psychology training.

Prof Wang has a commitment to his profession as well as to training, and in 2001 began a three-year stint in the Chair role of the Division of Clinical Psychology of the British Psychological Society. He is a registered clinical psychologist, neuropsychologist, health psychologist and cognitive-behavioural psychotherapist.

Prof Wang was appointed Professor of Clinical Psychology, Head of Clinical Section and Course Director at the University in May 2005.

Research Topic
Prof Wang has a longstanding research interest in psychological aspects of anaesthesia and in particular, the problem of anaesthetic awareness, which he is pursuing in Leicester alongside colleagues in the Academic Department of Anaesthesia, in addition to his work as Director of the Postgraduate Clinical Psychology Training Course.