抗精神病薬内服患者15例の術前術後管理経験

Pre- and Postoperative Management for 15 Psychotic Patients Receiving Neuroleptic Medication

　【抄録】　1979年度から1991年9月までの約13年間に当科に入院し，当該診療科で全身麻酔下に手術を施行された抗精神病薬内服患者15例の麻酔・手術について検討した。抗精神病薬は全例手術前日まで投与され，術後は経口摂取可能となった時点の早期より，術前と同一の服薬が再開されている。全身麻酔による合併症は2例に覚醒遅延がみられたのみであった。術後，精神不穏状態が3例にみられたが，脳腫瘍術後のせん妄状態と思われる1例を除けば，軽度なものであった。麻酔・手術による精神および身体的合併症は上記以外には特にみられず，全例が軽快した。自験例では，重篤なpoor risk症例やmajor surgeryが含まれていないが，抗精神病薬内服患者の麻酔・手術に対する影響を究明するためには，これらの症例や抗精神病薬内服患者の術後突然死例の詳細な病理学的な検索の集積が必要と考える。

　During the 13 years, from 1979 to September, 1991, we have encountered 15 psychotic patients under neuroleptic medication who had had surgical operation.

　All patients had been administered antipsychotic drugs up until the day of operation. Because some cases had psychotic features soonafter the operation and needed psychiatric aids, as soon as possible, the administration of antipsychotic drugs should be resumed postoperatively at the same dosage rate as before the operation. Prolonged drowsiness was observed in 2 cases as the anesthetic complication. Mild restlessness was seen in 3 cases in the postoperative period but they recovered soon. Except for those 5 cases, mental and physical complications were not apparent.

　To investigate the effect of general anesthesia and surgery in psychotic patients receiving neuroleptic medication, it is necessary to accumulate many cases who have received major surgery or those who have been evaluated as being in a high risk state for surgery in the preoperative period.