[Anesthetic management for electroconvulsive therapy in the patients with a history of neuroleptic malignant syndrome].

We report three patients with a history of neuroleptic malignant syndrome for whom modified electroconvulsive therapy (m-ECT) was scheduled. Two patients suffered from schizophrenia, and one suffered from depression. Their symptoms, such as hyperthermia, consciousness disturbance, myotonus, tremor, sweating, and tachycardia, improved gradually with administration of dantrolene and fluid infusion. However, their psychotic state was exacerbated. Therefore, m-ECT was scheduled. When patients were restless at the hospital ward, they were sedated with propofol and transferred to the operating room. General anesthesia was induced with thiopental 2.5-5 mg x kg(-1). After loss of consciousness, vecuronium bromide 0.01 mg x kg(-1) followed by a dose of 0.1 mg x kg(-1) was administered and ventilation was assisted using a face mask and 100% oxygen. After the ECT stimulus, the patients were sedated with propofol until full recovery from muscle relaxation. Although anesthesia time (mean 38 min) was slightly longer (19 min) than in those anesthetized with thiopental and suxamethonium chloride, m-ECT was performed safely and effectively.

Prediction of postoperative delirium after abdominal surgery in the elderly.

PURPOSE: Indications for the surgical treatment of elderly patients have been increasing. Postoperative central nervous system dysfunction, including delirium, is one of the most common complications in elderly surgical patients. The relationship between patient factors, including cerebral oxygen saturation, and the incidence of postoperative delirium was evaluated. METHODS: Twenty American Society of Anesthesiologists (ASA) physical status I-II patients, older than 65 years, scheduled for elective abdominal surgery were enrolled in the study. The patients' cognitive function was assessed, using the Hasegawa dementia score (HDS) and kana-hiroi test, on the day before surgery and then again 1 week after the surgery. Regional cerebral oxygen saturation (rSO2) was continuously monitored during the surgery, using near-infrared spectroscopy (INVOS 3100). General anesthesia was induced with 3 mg x kg(-1) thiopental and 5% sevoflurane. After tracheal intubation, the sevoflurane concentration was adjusted to maintain the bispectral index (BIS) value between 45 and 60. Postoperative delirium was diagnosed if DSM IV criteria were present and the patient scored 12 or more points on the Delirium Rating Scale. RESULTS: After surgery, 5 (25%) patients developed delirium. The age in the delirium (+) group (76 +/- 4 years) was significantly higher than that in delirium (-) group (68 +/- 3 years). Preoperative and postoperative HDS did not differ between the groups. The score on the preoperative kana-hiroi-test in the delirium (+) group (16 +/- 5) was significantly lower than that in the delirium (-) group (32 +/- 10). There were no significant differences between preoperative and postoperative kana-hiroi test scores in either group. Baseline rSO2 in the delirium (+) group (60 +/- 5%) was significantly lower than that in the delirium (-) group (66 +/- 7%). However, there were no significant differences between the groups in the rSO2 after the start of surgery. CONCLUSION: Patients' age, low preoperative kana-hiroi test score, and low preoperative rSO2 were important risk factors for postoperative delirium.