1
|
Miyamoto S, Ntege EH, Chinen Y, Goto T, Shirakawa J, Goto S, Kawano T, Shimizu Y, Nakanishi K, Nakamura H. An unusual case of oral surgical management in a patient with isovaleric acidemia and schizophrenia: A case report. Biomed Rep 2022; 17:64. [PMID: 35815189 PMCID: PMC9260163 DOI: 10.3892/br.2022.1547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/09/2022] [Indexed: 11/06/2022] Open
Abstract
Oral/dental surgical care in patients with chronic medical comorbidities, such as isovaleric acidemia (IVA), can be challenging. In addition to technical complications, different comorbidities also present a complex range of concerning factors/challenges, which can increase the incidence of morbidity and mortality associated with surgery. IVA, a congenital error of metabolism, is a rare organic acidemia with a predisposition towards acute acidosis and life-threatening metabolic decompensation during stressful conditions, such as prolonged fasting and surgery. In addition, schizophrenia, a major neurological disorder, can result in manifestation of severe dental or periodontal conditions, including pericoronitis. The condition is associated with significant risk factors of postoperative complications, such as dangerous behaviors and adverse interactions between antipsychotic drugs and anesthetic agents. A case of comorbid dental disease with two coexisting chronic and life-threatening medical conditions, one of which is rare, is an unusual encounter in oral/dental surgery that is seldomly published. Moreover, implementing a safe and effective surgical intervention in such patients requires several informed considerations. However, only a few reported experiences or guidelines exist, reporting appropriate perioperative management strategies to minimize risks. Hence, in this case report, our experience of managing one of these rare encounters of a 20-year-old man who suffered from bilaterally partially erupted third molars, associated with chronic pericoronitis and dental caries of both the maxilla wisdom teeth with coexisting IVA and schizophrenia comorbidities is described. Additionally, the presentation and anticipated complications of the comorbid disorders of the patient are briefly reviewed. In this case, the pericoronitis and dental caries were treated by surgically removing the impacted third molars and the antagonist maxilla wisdom teeth under regional anesthesia and application of antibiotics for 3 days. The patient recovered without any postoperative complications after 1 year of follow-up.
Collapse
Affiliation(s)
- Sho Miyamoto
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Edward Hose Ntege
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Yasutsugu Chinen
- Department of Child Health and Welfare (Pediatrics), Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Takahiro Goto
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Jumpei Shirakawa
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Shimpei Goto
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Toshihiro Kawano
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Yusuke Shimizu
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Koichi Nakanishi
- Department of Child Health and Welfare (Pediatrics), Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Hiroyuki Nakamura
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| |
Collapse
|
2
|
Tanaka M, Okamoto M, Yamashita K. Cardiac surgery for patients with schizophrenia: clinical experience of six patients. Surg Today 2022; 52:567-573. [PMID: 34480648 PMCID: PMC8948118 DOI: 10.1007/s00595-021-02369-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/03/2021] [Indexed: 11/07/2022]
Abstract
PURPOSE The incidence of schizophrenia in Japan is 0.7%, which is similar to the worldwide incidence. The mortality rate of patients with schizophrenia is reported to be higher than that of the general population, and cardiovascular disease is high among the causes of death. Hence, strategies for cardiovascular surgery for patients with schizophrenia are necessary. METHODS We studied six patients with schizophrenia (five males, one female) who underwent cardiac surgery in our hospital between April 2008 and December 2019. RESULT The mean age was 63.6 years. The surgical procedures were coronary artery bypass grafting (CABG) (n = 4), CABG concomitant with valve procedures (n = 1), and resection of myxoma (n = 1). There were no major cardiovascular complications and no other fatal complications. The mean observation period was 1510.6 ± 1430.1 (140-4068) days, the mean post-operative hospital stay was 17.8 ± 3.5 (13-22) days, and there was no mortality within 30 days after surgery. During the observation period, one patient died. The survival rate was 83.3% at 1, 3, and 5 years. CONCLUSION Cardiac surgery for patients with schizophrenia is possible with careful monitoring of indications and perioperative management.
Collapse
Affiliation(s)
- Mutsuo Tanaka
- Department of Cardiovascular Surgery, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuou-ku, Kumamoto, 860-0008, Japan.
| | - Minoru Okamoto
- Department of Cardiovascular Surgery, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuou-ku, Kumamoto, 860-0008, Japan
| | - Kensho Yamashita
- Department of Psychiatry, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuou-ku, Kumamoto, 860-0008, Japan
| |
Collapse
|
3
|
Oprea AD, Keshock MC, O'Glasser AY, Cummings KC, Edwards AF, Zimbrean PC, Urman RD, Mauck KF. Preoperative Management of Medications for Psychiatric Diseases: Society for Perioperative Assessment and Quality Improvement Consensus Statement. Mayo Clin Proc 2022; 97:397-416. [PMID: 35120702 DOI: 10.1016/j.mayocp.2021.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 10/15/2021] [Accepted: 11/09/2021] [Indexed: 10/19/2022]
Abstract
There is a lack of guidelines for preoperative management of psychiatric medications leading to variation in care and the potential for perioperative complications and surgical procedure cancellations on the day of surgery. The Society for Perioperative Assessment and Quality Improvement identified preoperative psychiatric medication management as an area in which consensus could improve patient care. The aim of this consensus statement is to provide recommendations to clinicians regarding preoperative psychiatric medication management. Several categories of drugs were identified including antidepressants, mood stabilizers, anxiolytics, antipsychotics, and attention deficit hyperactivity disorder medications. Literature searches and review of primary and secondary data sources were performed for each medication/medication class. We used a modified Delphi process to develop consensus recommendations for preoperative management of individual medications in each of these drug categories. While most medications should be continued perioperatively to avoid risk of relapse of the psychiatric condition, adjustments may need to be made on a case-by-case basis for certain drugs.
Collapse
Affiliation(s)
- Adriana D Oprea
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT.
| | - Maureen C Keshock
- Anesthesiology Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Avital Y O'Glasser
- Division of Hospital Medicine, Department of Medicine, Oregon Health & Science University, Portland, OR
| | | | - Angela F Edwards
- Department of Anesthesiology, Wake Forest School of Medicine, Winston Salem, NC
| | - Paula C Zimbrean
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA
| | - Karen F Mauck
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| |
Collapse
|
4
|
Elvir-Lazo OL, White PF, Cruz Eng H, Yumul F, Chua R, Yumul R. Impact of chronic medications in the perioperative period -anesthetic implications (Part II). Postgrad Med 2021; 133:920-938. [PMID: 34551658 DOI: 10.1080/00325481.2021.1982298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background: This review article discusses the pharmacodynamic effects of the most commonly used chronic medications by patients undergoing elective surgical procedures, namely cardiovascular drugs (e.g., beta blockers, alpha-2 agonist, calcium channel blockers, ACE inhibitors, diuretics, etc.), lipid-lowering drugs, gastrointestinal medications (H2-blockers, proton pump inhibitors), pulmonary medications (inhaled β-agonists, anticholinergics,), antibiotics (tetracyclines, clindamycin and macrolide, linezolid.), opioids and non-opioids analgesics (NSAIDs, COX-2 inhibitors, acetaminophen), gabapentanoids, erectile dysfunction (ED) drugs, psychotropic drugs (tricyclic antidepressants [TCAs], monoamine oxidase inhibitors [MAOI], selective serotonin reuptake inhibitors [SSRIs], serotonin norepinephrine reuptake inhibitors [SNRIs], and cannabinol-containing drugs). In addition, the potential adverse drug-interactions between these chronic medications and commonly used anesthetic drugs during the perioperative period will be reviewed. Finally, recommendations regarding the management of chronic medications during the preoperative period will be provided.Materials and Methods: An online search was conducted from January 2000 through February 2021 with the Medline database through PubMed and Google Scholar using the following search terms/keywords: "chronic medications in the perioperative period", and "chronic medications and anesthetic implications." In addition, we searched for anesthetic side effects associated with the major drug groups.Results and Conclusions: An understanding of the pharmacodynamic effects of most used chronic medications is important to avoid untoward outcomes in the perioperative period. These drug interactions may result in altered efficacy and toxicity of the anesthetic medications administered during surgery. These drug-drug interactions can also affect the morbidity, mortality, recovery time of surgical patients and acute relapse of chronic illnesses which could lead to last minute cancellation of surgical procedures. Part II of this two-part review article focuses on the reported interactions between most commonly taken chronic medications by surgical patients and anesthetic and analgesic drugs, as well as recommendations regarding the handling these chronic medications during the perioperative period.
Collapse
Affiliation(s)
| | - Paul F White
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,The White Mountain Institute, The Sea Ranch, CA, USA
| | - Hillenn Cruz Eng
- Adena Health System, department of anesthesiology, Chillicothe, OH, US
| | - Firuz Yumul
- Department of family medicine, Skagit Regional Health, Family Medicine, Arlington, WA, USA
| | - Raissa Chua
- Department of Internal Medicine, Huntington Hospital, Prasadena, CA, USA
| | - Roya Yumul
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,David Geffen School of Medicine-UCLA, Charles R, Drew University of Medicine and Science, Los Angeles, CA, USA
| |
Collapse
|
5
|
Kumar CM, Palte HD, Chua AWY, Sinha R, Shah SB, Imani F, Jalali ZM. Anesthesia Considerations for Cataract Surgery in Patients with Schizophrenia: A Narrative Review. Anesth Pain Med 2021; 11:e113750. [PMID: 34336627 PMCID: PMC8314087 DOI: 10.5812/aapm.113750] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/02/2021] [Accepted: 04/03/2021] [Indexed: 12/28/2022] Open
Abstract
Schizophrenia is ranked among the top 10 global burdens of disease. About 1% of people meet the diagnostic criteria for this disorder over their lifetime. Schizophrenic patients can develop cataract, particularly related to age and medications, requiring surgery and anesthesia. Many concerning factors, including cognitive function, anxiety, behavioral issues, poor cooperation and paroxysmal movements, may lead to general anesthesia as the default method. Antipsychotic agents should be continued during the perioperative period if possible. Topical/regional anesthesia is suitable in most schizophrenic patients undergoing cataract surgery. It reduces potential drug interactions and many postoperative complications; however, appropriate patient selection is paramount to its success. General anesthesia remains the primary technique for patients who are considered unsuitable for the topical/regional technique. Early involvement of a psychiatrist in the perioperative period, especially for patients requiring general anesthesia, is beneficial but often under-utilized. This narrative review summarizes the anesthetic considerations for cataract surgery in patients with schizophrenia.
Collapse
Affiliation(s)
- Chandra M. Kumar
- Department of Anaesthesia, Khoo Teck Puat Hospital, Yishun, Singapore
- Newcastle University Medical School, Johor, Malaysia
- Corresponding Author: Department of Anaesthesia, Khoo Teck Puat Hospital, Yishun, Singapore.
| | - Howard D. Palte
- Department of Anaesthesia, Bascom Palmer Eye Institute, University of Miami, Miami, USA
| | - Alfred W. Y. Chua
- Department of Anaesthesia, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Renu Sinha
- Department of Anaesthesia, All India Institute of Medical Sciences, New Delhi, India
| | - Shreya B. Shah
- Department of Anaesthesia, All India Institute of Medical Sciences, New Delhi, India
| | - Farnad Imani
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra M. Jalali
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
- Corresponding Author: Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
6
|
Stamenkovic DM, Selvaraj S, Venkatraman S, Arshad A, Rancic NK, Dragojevic-Simic VM, Miljkovic MN, Cattano D. Anesthesia for patients with psychiatric illnesses: a narrative review with emphasis on preoperative assessment and postoperative recovery and pain. Minerva Anestesiol 2020; 86:1089-1102. [DOI: 10.23736/s0375-9393.20.14259-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
7
|
Mistry T, Balavenkatasubhramanian J, Gurumoorthi P, Shankar B. Perioperative care in a patient with acute psychosis: Challenges and management. BALI JOURNAL OF ANESTHESIOLOGY 2020. [DOI: 10.4103/bjoa.bjoa_24_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
8
|
Kaye AD, Kline RJ, Thompson ER, Kaye AJ, Terracciano JA, Siddaiah HB, Urman RD, Cornett EM. Perioperative implications of common and newer psychotropic medications used in clinical practice. Best Pract Res Clin Anaesthesiol 2018; 32:187-202. [PMID: 30322459 DOI: 10.1016/j.bpa.2018.06.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 06/19/2018] [Indexed: 11/16/2022]
Abstract
Psychotropic medications are widely prescribed by clinicians as both primary therapy for a variety of psychiatric and neurodegenerative diseases and as adjunctive analgesics for use in the perioperative period. It is critical to understand various modes of action, drug-drug interactions, side effects, and clinical implications. Health care providers must understand how these medications interact with anesthetics, as well as other drugs used in perioperative care. We review relevant psychiatric and neurodegenerative diseases, psychotropic medications used to treat them, and how these medications interact with anesthetics and drugs used in perioperative care. We will also discuss emerging psychotropic drugs and the challenges they may create during the perioperative period. Future direction of investigation into the role of these drugs during the perioperative period and implications is also discussed.
Collapse
Affiliation(s)
- Alan D Kaye
- Department of Anesthesiology, LSU Health Sciences Center, Room 656, 1542 Tulane Ave., New Orleans, LA, 70112, USA.
| | - Ryan J Kline
- Department of Anesthesiology, LSU Health Science Center - New Orleans, 1542 Tulane Avenue, Room 659, New Orleans, LA, 70112, USA.
| | - Elliott R Thompson
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA.
| | - Aaron J Kaye
- Medical University of South Carolina, Charleston, SC, 29425, USA.
| | - Justin A Terracciano
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA.
| | - Harish B Siddaiah
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA.
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA.
| | - Elyse M Cornett
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA.
| |
Collapse
|
9
|
Hassidim A, Bratman Morag S, Giladi M, Dagan Y, Tzadok R, Reissman P, Dagan A. Perioperative complications of emergent and elective procedures in psychiatric patients. J Surg Res 2017; 220:293-299. [DOI: 10.1016/j.jss.2017.07.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 06/19/2017] [Accepted: 07/17/2017] [Indexed: 12/01/2022]
|
10
|
Constance LSL, Lansing MG, Khor FK, Muniandy RK. Schizophrenia and anaesthesia. BMJ Case Rep 2017; 2017:bcr-2017-221659. [PMID: 29170175 DOI: 10.1136/bcr-2017-221659] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Administering anaesthesia for elderly patients with chronic schizophrenia has always been a great challenge to anaesthetists. These patients will usually be on multiple antipsychotic drugs for many years and may lead to delayed awakening, cardiovascular instability, arrhythmias and sudden cardiac death during general anaesthesia. This case report is about the perioperative anaesthetic management of an elderly schizophrenic patient undergoing removal of femur implant. This article will explore important drug interactions and available options for a successful anaesthesia.
Collapse
Affiliation(s)
| | - Meryl Grace Lansing
- Medical Based Department, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
| | - Foo Kiang Khor
- Medical Based Department, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
| | | |
Collapse
|
11
|
Mozer AB, Speicher JE, Anciano CJ. Thoracic Surgery Considerations in the Mentally Ill or Handicapped Patient. Thorac Surg Clin 2017; 28:59-68. [PMID: 29150038 DOI: 10.1016/j.thorsurg.2017.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Increasing prevalence of mentally ill and handicapped populations requiring surgical thoracic interventions has brought to light their worse associated morbidity and mortality. Baseline functional status, caretaker environment, and mental limitations in day to day life have an impact in the short and long term from these interventions. Aggressive perioperative care, multispecialty approach, technical aspects, palliative procedures, and ethical considerations all play a part in improving outcomes. In this article real cases are presented illustrating points of care and situations for discussion.
Collapse
Affiliation(s)
- Anthony B Mozer
- General Surgery Resident, Department of Surgery, East Carolina University, 600 Moye Boulevard, Greenville, NC 27834, USA
| | - James E Speicher
- Thoracic and Foregut Surgery, Department of Cardiovascular Sciences, East Carolina University, 115 Heart Drive, Greenville, NC 27834, USA
| | - Carlos J Anciano
- Thoracic and Foregut Surgery, Department of Cardiovascular Sciences, East Carolina University, 115 Heart Drive, Greenville, NC 27834, USA; Minimally Invasive Thoracic Surgery, Department of Cardiovascular Sciences, East Carolina University, 115 Heart Drive, Greenville, NC 27834, USA.
| |
Collapse
|
12
|
Neuregulin-1 mutant mice indicate motor and sensory deficits, indeed few references for schizophrenia endophenotype model. Behav Brain Res 2017; 322:177-185. [PMID: 28089851 DOI: 10.1016/j.bbr.2017.01.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 01/05/2017] [Accepted: 01/10/2017] [Indexed: 11/23/2022]
Abstract
Neuregulins (Nrg) are a gene family that binds to tyrosine kinase receptors of the ErbB family. The protein of Nrg1 is to be involved in heart formation, migration of neurons, axonal pathfinding and synaptic function. A relation between Nrg1 and schizophrenia is assumed. Chronic impairment in schizophrenia is characterized by different positive and negative symptoms. Detectable markers of this disease in human and in animal models are activity, social behavior and sensory processing. In this study we compared heterozygous Nrg1 mutant mice in behavior and quantification of dopaminergic and serotoninergic neurons with wild type-like littermates. In the Nrg1 mutant mice the epidermal growth factor-like domain is replaced by the neomycin resistance gene. We found significant differences in locomotor and pain perception behavior. No differences were found in specific schizophrenia social interaction and prepulse inhibition behavior. The number of dopaminergic and serotoninergic neurons did not differ in the investigated regions ventral tegmental area, substantia nigra, periaqueductal grey and raphe nuclei. In conclusion, this analyzed Nrg1 mutant mice model did not serve as a complete schizophrenia model. Particular aspects of schizophrenia disease in locomotor and sensory behavior deficits could represent in this Nrg1 mutant mice. Beside several different models could Nrg1 deficiency represent an endophenotype of schizophrenia disease.
Collapse
|
13
|
Gylvin SH, Jørgensen CC, Fink-Jensen A, Kehlet H. Psychiatric disease as a risk factor in fast-track hip and knee replacement. Acta Orthop 2016; 87:439-43. [PMID: 26900724 PMCID: PMC5016900 DOI: 10.3109/17453674.2016.1151292] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Recent studies suggest that patients with psychiatric disorders tend to do worse than patients without a psychiatric diagnosis when undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA). Whether this is due to their psychiatric condition, pharmacological treatment, a combination of the two, or something else has not been thoroughly analyzed-and there are no internationally accepted guidelines for perioperative management of psychiatric patients. This overview summarizes our current knowledge on perioperative risks in patients with preoperative psychiatric disorders and the possible role of psychotropic drugs in the perioperative course. This will be useful when planning future strategies for improvement of surgical outcome following hip and knee arthroplasty.
Collapse
Affiliation(s)
- Silas Hinsch Gylvin
- Surgical Pathophysiology Section, Rigshospitalet, Copenhagen,,Lundbeck Foundation Center for Fast-track Hip and Knee Arthroplasty,,Correspondence:
| | - Christoffer Calov Jørgensen
- Surgical Pathophysiology Section, Rigshospitalet, Copenhagen,,Lundbeck Foundation Center for Fast-track Hip and Knee Arthroplasty
| | - Anders Fink-Jensen
- Neuropsychiatry Laboratory, Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen,,Psychiatric Center Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Kehlet
- Surgical Pathophysiology Section, Rigshospitalet, Copenhagen,,Lundbeck Foundation Center for Fast-track Hip and Knee Arthroplasty
| |
Collapse
|
14
|
Demirkilic U, Kadan M, Doganci S, Bolcal C, Yildirim V, Alhan C. Unrecognized indication for robot-assisted cardiac surgery: Patients with acute psychotic disorders. MINIM INVASIV THER 2015; 25:117-9. [DOI: 10.3109/13645706.2015.1119701] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
15
|
Cardiovascular risk profile before coronary artery bypass graft surgery in relation to depression and anxiety disorders: An age and sex propensity matched study. Aust Crit Care 2015; 28:24-30. [DOI: 10.1016/j.aucc.2014.04.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 01/08/2014] [Accepted: 04/22/2014] [Indexed: 12/18/2022] Open
|
16
|
Liao CC, Chang PY, Yeh CC, Hu CJ, Wu CH, Chen TL. Outcomes after surgery in patients with previous stroke. Br J Surg 2014; 101:1616-22. [PMID: 25224956 DOI: 10.1002/bjs.9639] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 06/27/2014] [Accepted: 07/30/2014] [Indexed: 01/09/2023]
Abstract
BACKGROUND Limited information is available on the association between a medical history of stroke and postoperative outcomes. This study investigated the outcomes following non-neurological surgery in patients with previous stroke. METHODS Using Taiwan's National Health Insurance Research Database, a nationwide cohort study was conducted of patients who underwent non-neurological surgery between 2008 and 2010 with a medical history of stroke in the 24-month period before operation. Patients who had non-neurological surgeries without previous stroke were selected as controls by the propensity score-matched pair method. Thirty-day postoperative complications and in-hospital mortality were compared between the two groups. RESULTS Some 1 426 795 adults underwent major inpatient non-neurological surgery, of whom 45 420 had a medical history of previous stroke. Patients with previous stroke who underwent surgery had an increased risk of postoperative pneumonia, septicaemia, acute renal failure, acute myocardial infarction, pulmonary embolism and 30-day in-hospital mortality (adjusted rate ratio (RR) 1·79, 95 per cent c.i. 1·61 to 1·99). Compared with controls, patients with previous stroke due to intracerebral haemorrhage (RR 3·41, 2·97 to 3·91), and those who were treated in intensive care (RR 2·55, 2·24 to 2·90) or underwent neurosurgery (RR 2·49, 2·12 to 2·92), had an increased 30-day in-hospital mortality rate. Postoperative mortality also increased with stroke-related co-morbidities, and with stroke 1-6 months before surgery (RR 3·31, 2·91 to 3·75). CONCLUSION Patients with previous stroke had a higher risk of adverse postoperative outcomes; their 30-day in-hospital mortality rate was nearly twice that of patients without previous stroke.
Collapse
Affiliation(s)
- C C Liao
- Department of Anaesthesiology, Health Policy Research Centre, Taipei Medical University Hospital, Taipei, Taiwan; Health Policy Research Centre, Taipei Medical University Hospital, Taipei, Taiwan; School of Medicine, Taipei Medical University, Taipei, Taiwan; Department of School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
| | | | | | | | | | | |
Collapse
|
17
|
Yılmaz KB, Akıncı M, Şeker D, Güller M, Güneri G, Kulaçoğlu H. Factors affecting the safety of drains and catheters in surgical patients. ULUSAL CERRAHI DERGISI 2014; 30:90-2. [PMID: 25931902 DOI: 10.5152/ucd.2014.2564] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 03/02/2014] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Drains and catheters are used for both prophylactic and therapeutic reasons in clinical practice. This study aimed to investigate the factors that affect safety of drains, catheters, nasogastric tube and central venous line in patients who underwent surgery. MATERIAL AND METHODS Two hundred and four consecutive patients who were operated at the general surgery clinics under general anesthesia were included in the study. Factors that affect the safety of drains and catheter were followed and recorded prospectively. RESULTS During follow-up period, 12 (5.8%) patients have experienced problems regarding safety of drains/catheters. The mean age of patients who were followed-up in terms of security problems was 63.1 (39-86) years. Eight (66.7%) patients had been operated emergently, and four (33.3%) patients electively. Three (25%) patients had psychiatric/neurological co-morbidities and 3 (25%) patients were confused due to anesthesia/intensive care unit treatment when the drain safety was broken. Eight (66.7%) patients withdrew the drains or catheters by themselves, in 2 (16.7%) patients the drains spontaneously came out and in 2 (16.7%) patients the wrong drain was withdrawn. One patient had dementia, one patient had Alzheimer's disease and one patient was being followed-up with a diagnosis of schizophrenia. In three (25%) patients the abdominal drain, in four (33.3%) patients nasogastric tube, in one (8.3%) patient intubation tube, in one (8.3%) patient central venous catheter, and in three (25%) patients multiple drains were removed. CONCLUSION The inaccurate use of drains or re-intervention for an unintentionally removed drain causes problems regarding patient safety. Close monitoring of surgical patients in terms of security, and submission of additional measures for patients with confusion and neurological/psychiatric disorders are of great importance.
Collapse
Affiliation(s)
- Kerim Bora Yılmaz
- Clinic of General Surgery, Dışkapı Teaching and Training Hospital, Ankara, Turkey
| | - Melih Akıncı
- Clinic of General Surgery, Dışkapı Teaching and Training Hospital, Ankara, Turkey
| | - Duray Şeker
- Clinic of General Surgery, Dışkapı Teaching and Training Hospital, Ankara, Turkey
| | - Müjdat Güller
- Clinic of General Surgery, Dışkapı Teaching and Training Hospital, Ankara, Turkey
| | - Gürkan Güneri
- Clinic of General Surgery, Dışkapı Teaching and Training Hospital, Ankara, Turkey
| | - Hakan Kulaçoğlu
- Clinic of General Surgery, Dışkapı Teaching and Training Hospital, Ankara, Turkey
| |
Collapse
|
18
|
|
19
|
Abstract
OBJECTIVE To validate the global features of postoperative adverse outcomes for surgical patients with schizophrenia. BACKGROUND Patients with schizophrenia were known to have a higher risk of complications during hospitalization. Quality of care has become the key factor in reducing their potential mortality afterwards. METHODS We present a population-based study of 8967 schizophrenic patients receiving major surgery from the Taiwan National Health Insurance Research Database within the years 2004 and 2007 compared with 35,868 surgical patients without mental disorders. Eight major postoperative complications and mortality after complications were evaluated among schizophrenic patients with different severity. RESULTS Schizophrenic patients had significantly higher risk for postoperative complications, including acute renal failure, pneumonia, bleeding, septicemia, stroke, and 30-day postoperative mortality (adjusted OR = 2.70; 95% CI: 2.08-3.49), than surgical patients without mental disorders. Among surgical patients with 1 to 2, 3 to 18, 19 to 48, and more than 49 schizophrenia-related outpatient visits within 24-month period preoperatively, the adjusted ORs of 30-day mortality ranged from 1.95 (95% CI: 1.25-3.02) to 3.97 (95% CI: 2.66-5.92) in a frequency-dependent pattern when compared with controls. When compared with surgical patients with schizophrenia-related outpatient services only, OR of 30-day postoperative mortality increased from 2.54 (95% CI: 1.93-3.34) to 3.69 (95% CI: 2.25-6.03) in surgical patients with preoperative hospitalization or emergency visit because of schizophrenia. CONCLUSIONS Surgical patients with schizophrenia showed significantly higher postoperative adverse outcome rates with risk of 30-day mortality nearly threefold when compared with patients without mental disorders. Our findings suggest the urgency revising the protocol of postoperative care for this specific population.
Collapse
|
20
|
Chellam S, Rajwade DS, Tavri SO. Emergency anaesthetic management of a severely anaemic, chronic schizophrenic patient with history of neuroleptic malignant syndrome. Indian J Anaesth 2013; 55:621-3. [PMID: 22223911 PMCID: PMC3249874 DOI: 10.4103/0019-5049.90624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Administering anaesthesia to a patient with chronic schizophrenia is a challenge due to the increased risk of various perioperative complications. Neuroleptic agents are highly effective drugs used for the treatment of psychiatric disorders, but are rarely associated with neuroleptic malignant syndrome (NMS). Here, we describe the successful anaesthetic management of a patient of chronic schizophrenia with past history of NMS who presented in emergency with active bleeding per rectum and haemoglobin of 3 gm%.
Collapse
Affiliation(s)
- Shrividya Chellam
- Department of Anesthesia, Bhabha Atomic Research Center Hospital, Mumbai, Maharashtra, India
| | | | | |
Collapse
|
21
|
Rivera RA, Nguyen MT, Martinez-Osorio JI, McNeill MF, Ali SK, Mansi IA. Preoperative medical consultation: maximizing its benefits. Am J Surg 2012; 204:787-97. [DOI: 10.1016/j.amjsurg.2012.02.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Revised: 02/01/2012] [Accepted: 02/01/2012] [Indexed: 12/23/2022]
|
22
|
Khawam EA, Tess AV, Pozuelo L. Assessing and Managing Psychiatric Disease. Perioper Med (Lond) 2012. [DOI: 10.1002/9781118375372.ch17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
|
23
|
Tully PJ, Cardinal T, Bennetts JS, Baker RA. Selective Serotonin Reuptake Inhibitors, Venlafaxine and Duloxetine are Associated With in Hospital Morbidity but Not Bleeding or Late Mortality After Coronary Artery Bypass Graft Surgery. Heart Lung Circ 2012; 21:206-14. [DOI: 10.1016/j.hlc.2011.12.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Revised: 12/14/2011] [Accepted: 12/18/2011] [Indexed: 12/21/2022]
|
24
|
Abstract
Many patients with psychiatric illnesses are prescribed long-term drug treatment, and the anaesthesiologist must be aware of potential interactions with anaesthetic agents. Psychotropic drugs often given in combination with each other or with other non-psychiatric drugs generally exert profound effects on the central and peripheral neurotransmitter and ionic mechanisms. Hence, prior intake of these drugs is an important consideration in the management of the patient about to undergo anaesthesia and surgery. This article highlights the effects of anaesthetics on patients taking antipsychotics, tricyclic antidepressants, monoamine oxidase inhibitors and lithium carbonate. The risk that should be considered in the perioperative period are the extent of surgery, the patient's physical state, anaesthesia, the direct and indirect effects of psychotropics, risk of withdrawal symptoms and risk of psychiatric recurrence and relapse.
Collapse
Affiliation(s)
- Joginder Pal Attri
- Department of Anaesthesia, Govt. Medical College, Amritsar, Punjab, India
| | - Neeru Bala
- Department of Psychiatry, Govt. Medical College, Amritsar, Punjab, India
| | - Veena Chatrath
- Department of Anaesthesia, Govt. Medical College, Amritsar, Punjab, India
| |
Collapse
|
25
|
Abstract
Despite the recent attention to patient safety and quality of care, no prior studies have addressed outcomes of hospitalization for pneumonia among patients with schizophrenia. This study investigated the extent to which clinical outcomes of pneumonia were different among patients with schizophrenia. This study used data from the Taiwan National Health Insurance Research Database. Of the total of 81,599 patients admitted with a principal diagnosis of pneumonia from 2002 to 2004, 949 had previously been admitted with a principal or secondary diagnosis of schizophrenia within the 2 years of their index pneumonia admission. We randomly selected 2847 pneumonia patients matched with the study group in terms of gender, age, year of admission, length of stay, and Charlson Comorbidity Index score as the comparison cohort. Conditional logistic regression models were used for analysis. Findings indicated a higher prevalence of adverse outcomes among patients with schizophrenia. Patients with schizophrenia were independently associated with a 1.81 times greater risk of intensive care unit admission (95% confidence interval [CI] = 1.37-2.40), a 1.37 times greater risk of acute respiratory failure (95% CI = 1.08-1.88), and a 1.34-fold greater risk of mechanical ventilation (95% CI = 1.04-1.92) after adjusting for characteristics of patients, physicians, hospitals, and potential clustering effects. Adjusted odds ratios were further evident among those treated in private hospitals and in regional/district hospitals. Significant barriers to prompt and appropriate medical care for pneumonia persist for patients with schizophrenia. Careful monitoring of physical health and proper integration between psychiatrists and physicians should be stressed to reduce poor clinical outcomes in this vulnerable population.
Collapse
Affiliation(s)
- Yi-Hua Chen
- School of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Hsiu-Chen Lin
- Department of Pediatric Infection, Taipei Medical University and Hospital, Taipei, Taiwan
| | - Herng-Ching Lin
- School of Health Care Administration, Taipei Medical University, 250 Wu-Hsing Street, Taipei 110, Taiwan,To whom correspondence should be addressed; tel: 886-2-2736-1661 ext 3613, fax: 886-2-2378-9788, e-mail:
| |
Collapse
|
26
|
Weiss A, Movahed R, Dym H. Schizophrenia: current therapy and review. J Oral Maxillofac Surg 2010; 69:192-8. [PMID: 21055859 DOI: 10.1016/j.joms.2010.06.178] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Revised: 05/22/2010] [Accepted: 06/18/2010] [Indexed: 10/18/2022]
Abstract
Schizophrenia is a disorder that affects a significant portion of the population. This case report and review article discusses potential causes and pathophysiology. The treatment of schizophrenia is outlined in detail, followed by a discussion of the perioperative management of schizophrenic patients, highlighting important information to keep in mind when treating this patient population.
Collapse
Affiliation(s)
- Adam Weiss
- Department of Oral and Maxillofacial Surgery, The Brooklyn Hospital Center, Brooklyn, NY, USA.
| | | | | |
Collapse
|
27
|
|
28
|
|
29
|
Li Y, Glance LG, Cai X, Mukamel DB. Adverse hospital events for mentally ill patients undergoing coronary artery bypass surgery. Health Serv Res 2008; 43:2239-52. [PMID: 18665856 DOI: 10.1111/j.1475-6773.2008.00875.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
CONTEXT Patients with mental disorders show higher burden of coronary heart disease, and may face special safety issues during in-hospital cardiac care. OBJECTIVES To compare the postoperative complication rate between patients with and without mental disorders undergoing isolated coronary artery bypass graft (CABG) surgery. DESIGN, SETTING, AND PATIENTS Retrospective analyses of New York state hospital claims between 1997 and 2004 (N=135,701). Complications were defined using the Agency for Healthcare Research and Quality Patient Safety Indicators (AHRQ PSI). PRINCIPAL FINDINGS Mental disorders were significantly associated with higher anesthesia complications (adjusted odds ratio [AOR]=6.44, p < .001), decubitus ulcer (AOR=1.42, p = .006), postoperative hip fracture (AOR = 3.29, p < .001), and overall complication rate representing nine PSIs (AOR = 1.27, p < .001). CONCLUSIONS Mentally ill patients undergoing CABG surgery are more likely to experience potentially preventable complications and injuries. The mechanism underlying this observation warrants further study.
Collapse
Affiliation(s)
- Yue Li
- Department of Medicine, ECMC, Clinical Center CC-163, State University of New York at Buffalo, 462 Grider Street, Buffalo, NY 14215, USA.
| | | | | | | |
Collapse
|
30
|
Postoperative complications in the seriously mentally ill: a systematic review of the literature. Ann Surg 2008; 248:31-8. [PMID: 18580204 DOI: 10.1097/sla.0b013e3181724f25] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine the knowledge base on clinical outcomes of surgery among persons diagnosed with serious mental illness. BACKGROUND Despite a burgeoning literature during the last 20 years regarding perioperative risk management, little is known about intraoperative and postoperative complications among patients with schizophrenia and other serious mental illnesses. METHODS A systematic literature search of Medline (1966-August 2007) and review of studies was conducted. Eligible studies were of any design with at least 10 patients diagnosed with serious mental illness, reporting perioperative medical, surgical, or psychiatric complications. RESULTS The search identified 1367 potentially relevant publications; only 12 met eligibility criteria. Of 10 studies of patients with schizophrenia, 9 had fewer than 100 patients, whereas one large retrospective study reported higher rates of postoperative complications among 466 schizophrenia patients compared with 338,257 controls. These studies suggest that patients with schizophrenia, compared with those without mental illness, may have higher pain thresholds, higher rates of death and postoperative complications, and differential outcomes (eg, confusion, ileus) by anesthetic technique. Two studies evaluated outcomes in patients with major depressive disorder and found higher rates of postoperative delirium and postoperative confusion. Both schizophrenia and depression patients experienced more postoperative confusion or delirium when psychiatric medications were discontinued preoperatively. We identified no studies of perioperative outcomes in patients with bipolar or posttraumatic stress disorder. CONCLUSIONS There are few studies of perioperative outcomes in patients with serious mental illness. Future research should assess surgical risks among patients with serious psychiatric conditions using rigorous methods and well-defined clinical outcomes.
Collapse
|
31
|
Becker A, Grecksch G, Schröder H. Pain sensitivity is altered in animals after subchronic ketamine treatment. Psychopharmacology (Berl) 2006; 189:237-47. [PMID: 17016710 DOI: 10.1007/s00213-006-0557-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2006] [Accepted: 08/08/2006] [Indexed: 12/20/2022]
Abstract
RATIONALE Clinical observations have shown that pain sensitivity is altered in some schizophrenic patients. OBJECTIVES To study alterations in pain sensitivity, the ketamine model in schizophrenia research was employed. MATERIALS AND METHODS Rats were subchronically injected with the dissociative anaesthetic ketamine (Ket, ten injections of 30 mg/kg, one injection per day over a period of 10 days). Two weeks after treatment completion, the animals' pain sensitivity was assayed in the hot plate test and they were subjected to electrical stimulation of the tail root. In addition, the effect of morphine was studied. RESULTS In group-housed animals, there was no difference between Ket-injected animals and control rats as measured in both nociceptive tests. In singly housed Ket-injected rats, pain threshold was increased in the electrical stimulation test. This suggests that stress due to single housing might be essential for modifications of pain sensitivity. Moreover, the antinociceptive effect of morphine was modified after single housing. Interestingly, the effect of morphine on locomotor activity was similar in both groups. In group-housed rats, mu receptor binding was unchanged in the frontal cortex, whereas Ket-injected animals had decreased levels in the hippocampus. In singly housed animals, mu receptor binding in Ket-injected rats increased in the frontal cortex and decreased in the hippocampus. (35)S-GTPgamma-S binding increased in the frontal cortex in both singly housed groups, but remained unchanged in the hippocampus. CONCLUSIONS The data suggest that the ketamine model might be useful for studying altered pain sensitivity in schizophrenia. Moreover, the data suggest that modifications in mu opioid receptor binding contribute to this phenomenon.
Collapse
Affiliation(s)
- Axel Becker
- Faculty of Medicine, Institute of Pharmacology and Toxicology, Otto-von-Guericke University Magdeburg, 39120, Magdeburg, Germany.
| | | | | |
Collapse
|