Preoperative Interview Research Articles

Prevention of psychosis following open-heart surgery.

The high risk of postoperative psychotic reaction occurring in patients who have undergone open-heart surgery has been attributed to several factors. The authors studied two of these—preoperative psychological state of the patient and environment in the recovery room—to determine their influence upon the incidence of postoperative reactions in two groups of heart-surgery patients. They conclude that a preoperative psychiatric interview, accompanied by individual recommendations for postoperative care, and minimization of the environmental stresses of the recovery room, lessen the risk of postoperative psychotic reaction among heart-surgery patients.

Pre-anesthetic evaluation of patients on a small obstetrical service.

THE PROVISION of adequate anesthesia coverage for a small obstetrical service presents several difficult problems. In our hospital, with no more than 400-600 deliveries per year, the exclusive assignment of an anesthesiologist to the obstetrical service is impractical and uneconomical because only 1 to 2 deliveries per 24 hours can be expected. This means that only on-call service is feasible. In the past the usual result was that the anesthesiologist did not have the opportunity for the equivalent of a preoperative evaluation and interview, and was often forced to administer anesthesia under emergency conditions. While serious mishaps are rare, such conditions are potentially very dangerous. Abnormalities which would have significant influence on the choice of anesthetic management for a particular patient may easily be overlooked. The lack of discussion between patient and anesthesiologist as to anesthetic management prior to the onset of labor puts both patient and anesthesiologist in a

OBSERVATIONS ON PSYCHIATRIC SEQUELAE TO SURGICAL OPERATIONS IN WOMEN

1. Fifty-one women, aged 20 to 55, were given a neuropsychiatric examination before major abdominal surgery, with special reference to anxiety concerning the operation, history of former psychiatric difficulties, marital maladjustment and sources of environmental stress. 2. Forty patients who had no somatic complications and whose convalescences were uneventful, were reexamined after an interval of from twelve to eighteen months. 3. Twenty-five of these patients showed no change in their psychiatric status. Two patients showed relief from former psychiatric complaints. 4. Thirteen patients showed a picture of restlessness, sleeplessness, agitation and pre-occupation with depressive thought content beginning from three to four weeks after the operation and lasting more than three months. 5. The relative frequency of this postoperative condition was much higher in pelvic operations than in cholecystectomies; it occurred more frequently in persons who had had depressive episodes in their former life. 6. The incidence of this condition in our series shows no significant relationship to the presence of preoperative anxiety, to sexual maladjustments or to environmental factors as elicited in the preoperative interview. 7. Reliable predictions as to postoperative psychiatric course will be possible only after more detailed studies.