[Preoperative assessment, preparation and prospect of prognosis in schizophrenic patients]

Schizophrenic patients are at increased risk for perioperative complications such as hypotension and hypothermia during anesthesia, postoperative ileus, confusion and pneumonia. In addition, schizophrenic patients are predisposed to developing pulmonary thromboembolism, torsade de pointes, water intoxication and rhabdomyolysis. The increased complications are associated with physical disorders, antipsychotic agents, hazardous health behaviors, and interactions between antipsychotic agents and anesthetic drugs. Increased cortisol, norepinephrine and cytokine concentrations are considered as possible cause of postoperative confusion and ileus. Anesthesia with ketamine, propofol and fentanyl decreased the frequency of the postoperative confusion in schizophrenic patients. Epidural anesthesia with local anesthesia in schizophrenic patients undergoing abdominal surgery minimized postoperative ileus. Antipsychotic drugs administrated to schizophrenic patients should be continued before anesthesia for decreasing postoperative confusion. Thus, anesthesiologists must not only be aware of the perioperative problems of these patients but must also learn how to manage their perioperative course.