Surgery Today

, Volume 27, Issue 5, pp 387–391 | Cite as

Surgical treatment of patients with psychiatric disorders: A review of 21 patients

  • Yoshihiko Tsuji
  • Hiroaki Ohue
  • Hiroshi Ikuta
  • Osamu Kinoshita
  • Fumio Shibagaki
Original Articles

Abstract

Between January 1985 and September 1994, 21 patients with psychiatric disorders underwent various forms of surgery at our hospital. There were 12 men and 9 women with an average age of 57.6 years. The coexisting psychiatric disorders were schizophrenia in 15 patients, depression in 2, dementia in 2, mental retardation with epilepsy in 1, and Parkinson's disease in 1. All the patients had been receiving neuroleptic medications for a long period. The indications for surgery were: cholelithiasis in 6 patients, acute appendicitis in 4, perforation of the small intestine in 3, incarceration of an inguinal hernia in 2, and esophageal cancer, stomach cancer, bleeding from a gastric ulcer, perforation of a duodenal ulcer, strangulating ileus, and burns in 1 patient each, respectively. All of the patients who underwent elective surgery were given epidural anesthesia with or without general anesthesia. Antipsychotic medications were given until just prior to surgery and recommenced concurrent with the first meal. Abnormal behavior was observed in 11 patients (52.4%) postoperatively, but all the patients were discharged in accordance with recovery from their surgical disorder. Intra- and postoperative hypotension resistant to intravenous catecholamine administration was recognized in 9 patients (42.9%), and this peculiar complication should be borne in mind when patients with psychiatric disorders require surgical management.

Key Words

perioperative care surgical operations psychotropic drugs catecholamine-resistant hypotension mental disorders 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Petrie WM, Wood M (1982) Drugs and the central nervous system. In: Wood M, Wood AJJ (eds) Drugs and anesthesia. Williams and Wilkins, Baltimore, pp 615–645Google Scholar
  2. 2.
    Simpson GM, Pi EH, Sramek JJ (1981) Adverse effects on antipsychotic agents. Drugs 21:138–151PubMedGoogle Scholar
  3. 3.
    Alexander CS, Nino A (1969) Cardiovascular complications in young patients taking psychotropic drugs. Am Heart J 78:757–769PubMedCrossRefGoogle Scholar
  4. 4.
    Kudoh A, Murakawa T, Ishihara H, Matsuki A (1992) Autonomic nervous function and plasma catecholamine levels of perioperative patients treated with antipsychotic drugs (in Japanese with English abstract). Masui 41:320–325PubMedGoogle Scholar
  5. 5.
    Kurata E, Fujino T, Takashiba T, Fujino M, Hiramatsu Y, Maeda Y, Yamane T, Kagiyama Y, Kanaya S, Ito M, Arita M (1982) Effects of psychotherapeutic drugs on cardiovascular system and catecholamine release. Jpn Circ J 46:833Google Scholar
  6. 6.
    Roizen MF (1986) Anesthesic implications of concurrent diseases. In: Miller RD (eds) Anesthesia second edition. Churchill Livingstone, New York, pp 255–356Google Scholar
  7. 7.
    Hollister LE, Kosek JC (1965) Sudden death during treatment with phenothiazine derivatives. JAMA 192:1035–1038PubMedGoogle Scholar
  8. 8.
    Leestma JE, Koenig KU (1968) Sudden death and phenothiazine. Arch Gen Psychiatr 18:137–148Google Scholar
  9. 9.
    Mizutani J, Taki K, Namikawa K, Syojima T, Kawamura R, Doiguchi M, Yamaguchi T (1990) Pre- and postoperative management for patients with schizophrenia (in Japanese with English abstract). Nippon Rinsyo Gekaigakkai Zasshi (J Jpn Soc Clin Surg) 51:1597–1600Google Scholar

Copyright information

© Springer-Verlag 1997

Authors and Affiliations

  • Yoshihiko Tsuji
    • 1
  • Hiroaki Ohue
    • 1
  • Hiroshi Ikuta
    • 1
  • Osamu Kinoshita
    • 2
  • Fumio Shibagaki
    • 1
  1. 1.Department of SurgeryMitsu Municipal HospitalHyogoJapan
  2. 2.Department of AnesthesiologyMitsu Municipal HospitalHyogoJapan

Personalised recommendations