Incidence Of Psychiatric Complications Research Articles

Effects of subanesthesia dose S-ketamine induction on postoperative psychiatric complications after gynecological surgery.

Ketamine may become an important drug for multimodal analgesia regime again because of its strong analgesic effects and retaining the advantage of spontaneous breathing. The present study was designed to explore the influences of different dosages of S-ketamine anesthesia induction regimes on psychiatric complications and postoperative prognosis in patients undergoing gynecological operations. In this prospective, triple-blinded, randomized, controlled study, patients undergoing elective gynecological surgery were randomized to one of three treatment groups: low-dose S-ketamine (LDSK) group (a 0.3 mg/kg bolus for anesthesia induction), minimal-dose S-ketamine (MDSK) group (a 0.2 mg/kg bolus for anesthesia induction), and placebo (CON) group (a saline bolus for anesthesia induction). The main outcome measures were as follows: intraoperative vital signs, extubation time, anesthesia recovery time and postanesthesia care unit (PACU) stay duration, incidence of psychiatric complications, Ramsay sedation scale (RSS) 1, 2, 24, and 48 h, postoperatively, and overall prognosis. One hundred and eightyfemale participants were finally included in this study from April 2021 to December 2021. Significant differences were not observed in age, height, weight, American Society of Anesthesiologists physical status classification, or history of mental illness between the groups. No statistically significant differences were discovered with regard to intraoperative vital signs, extubation time and PACU stay duration, incidence of psychiatric complications, andRSS scores at 1, 2, 24, and 48 h postoperatively in thethree groups. However, the visual analog scale (VAS) scores of the CON group at 10 min after extubation and at the time point leaving PACU were much higher than that of the LDSK and MDSK groups. The VAS scores at 48 h after surgery in the MDSK group were also lower than that of the CON group and the CON group had received more analgesic drug treatment in the surgical wards consequently. Postoperative nausea and vomiting (PONV) occurrence at 24and 48 h, postoperatively, increased sharply in the CON group than in the other two experimental groups, which led to an increase in the use of postoperative antiemetic drugs in this group. According to the postoperative satisfaction survey, patients in theCON group had lower medical satisfaction. Our data demonstrate that a small dosage of S-ketamine anesthesia induction can reduce postoperative pain and the incidence of PONV without increasing hemodynamic fluctuations or psychiatric complications.

Intravenous diazepam for psychiatric reactions following open-heart surgery.

The present study, based on a series of 79 consecutive unselected patients undergoing open-heart surgery with extracorporeal circulation at the Quebec Institute of Cardiology, was undertaken to determine the occurrence and severity of postoperative psychiatric complications, to discuss some of the factors involved in their pathogenesis, and to test the effectiveness of intravenous diazepam in their prevention and control. The 79 patients were divided into two groups: a control group of 37 subjects and a treatment group of 42 subjects. In the treatment group only, the usual postoperative analgesic medication was completed by intravenous doses of diazepam 2.5 to 5 mg. six times a day given between the doses of narcotics. Both groups were comparable as to the age, sex, height, weight, anaesthetic risk, degree of hypothermia, bypass time, duration of anaesthesia, and type of cardiac lesion. Our results are as follows: (a) The incidence of psychiatric complications was 35.1 per cent (13 cases) in the control group and 4.7 per cent (two cases) in the treatment group, (b) There were eight minor and five major reactions in the control group in comparison to two minor and no major disturbances in the treatment group, (c) Postoperative mechanical ventilatory support was carried out more frequently in the treatment group (92.0%) than in the control group (62.1%), yet the occurrence of psychiatric reactions was 5.1 per cent in the treatment group as compared to 56.5 per cent in the control group. It is concluded that the postoperative use of intravenous diazepam as an adjunct to the usual analgesic medication has markedly reduced the incidence and severity of psychiatric complications after intracardiac surgery with cardiopulmonary bypass. In the treatment group, the use of intravenous diazepam has resulted in better patient behaviour, and an improved patient-nurse and patient-doctor relationship. Because of the amnesic properties of this drug, the I.C.U. is no longer described as a “torture chamber” to prospective patients.