[Emergency caesarean section for a patient with chronic schizophrenia]

A 39-year-old female with chronic schizophrenia underwent an emergency caesarean section under general anesthesia at her 39th week of gestation. A diagnosis of schizophrenia was made at 28 years of age and since then oral antipsychotic drugs, haloperidol and levomepromazine had been given orally. She had only taken haloperidol 4 mg per day between the 12th week of gestation and the day of surgery. At the 39th week of gestation, she developed a marked excitement which would have caused fetal distress. We decided to terminate her gestation. As the excitement was diagnosed as psychokinesis, we avoided using phenothiazine which might affect fetus and administered haloperidol 5 mg intramuscularly 210 and 30 minutes before emergency caesarean section. Anesthesia was induced with intravenous thiopental 300 mg and suxamethonium 60 mg. Pentazocine 30 mg in combination with nitrous oxide 70% in oxygen was given for the maintenance of anesthesia. During operation blood pressure was 160-180/80-90 mmHg, the heart rate was 90-100 beats.min-1. Hypertension and tachycardia might have been partially due to preoperative haloperidol. The induction-delivery time was 4 minutes 30 seconds. Plasma haloperidol levels were 23.8 ng.ml-1 in maternal venous blood and 8.8 ng.ml-1 in umbilical vein just after the delivery. The Apgar score was 7 at one minute and 8 at five minutes after delivery. The baby developed slight muscle weakness and poor sucking for two days after delivery and this was supposedly due to effect of preoperative haloperidol.(ABSTRACT TRUNCATED AT 250 WORDS)