Abstract
It has been pointed out that schizophrenic patients tend to become disquieted and agitated before or after the operation, and suffer from serious postoperative complications including sudden death, presumably in relation to the long-term medication of antipsychotic drugs.
A clinical study on the general anesthetic management of five schizophrenic patients is reported. Among them, three were male and two were female, and four were in their forties. Although preoperative evaluation revealed complications of obesity in 3 cases, diabetes mellitus, arrhythmia, emphysematous bulla, or liver dysfunction in one case, all of which were slight and had no trouble during general anesthetic management. Main antipsychotic drugs, which had been administered, were phenothiazines, butylophenones, and benzamide ; their medication periods were for 1 to 23 years. After consultation with psychiatrists in charge, the administration of these drugs was continued through the hospital stay in a maintenance dose in 3 cases. Operations were excision of malignant tumors in 3 cases, extirpation of a benign palatal tumor in one case, and open reduction for mandibular fracture in one case. Anesthesia time was from lhr 55 min to 12 hr 45 min. Anesthetic procedures were of inhalation anesthetics and combination of neurolept anesthesia (NLA) and inhalation anesthetics in 2 and 3 cases, respectively. They were managed with particular attention paid to acid base balance and electrolytes along with ordinary monitoring. The early postoperative course was favorable in all cases. Only in one case, however, the patient became disquieted with auditory hallucination on the 23 rd postoperative day and was transferred to the psychiatry clinic.
Consequently, under the conditions of desirable cooperation with the psychiatrist in charge and of a good management system in the inpatient department such as careful and frequent observation, smooth general anesthetic management of schizophrenic patients could be performed regardless of the anesthetic and operative procedures.
