Abstract
We experienced 5 cases of mental agitation occurring after long-term operation. We studied how these patients were managed postoperatively with regard to mental treatment for psychological stress due to lengthy operation and doses of anesthetics.
Mental symptoms in these patients included excitation in 2 cases, depression in 1, delirium in and insomnia in 1 case. Anxiety due to malignant tumor was the greatest causative factor for these symptoms with transference to mental distrubances.
Because of the lengthy operations with a mean time of 14 hours 21 min, mental and physical stresses of anesthesia and operation combined to disturb the patient's organic metabolism, causing mental disturbances. 4 of 5 patients received heavy amounts (3-5) mg of fentanyl, during surgery, and thus excitation seen postoperatively in these patients was suggested as a withdrawal symptom of narcotic drugs.
Because the surgical time for maxillofacial malignant tumors tends to be long and the amount of anesthetics for operational maintenance tends to be large, these procedure cause more marked postoperative mental disturbances in comparison to surgical pocedures for other tumors. It is thus recommended to obtain a detailed anamnesis pre-operatively with careful perioperative psychological care, and to choose the most suitable method of anesthesia and anesthetic agent according to the psychological status of the patient.
