NMDA receptor antagonists are reported to be effective for improving depression. It remains unclear whether ketamine, which is an NMDA receptor antagonist, postoperatively affects the psychological state in depressed patients. We investigated the effect of 1.0 mg/kg of ketamine on postoperative outcomes in depressed patients.

Schizophrenic patients are at increased risk for perioperative complications, as their biological response to stress is impaired. The increased complications are associated with physical disorders, antipsychotic or hazardous health behaviors, and interactions between antipsychotics and anesthetic drugs. Thus, anesthesiologists must not only be aware of the perioperative problems of these patients but must also learn how to manage their perioperative course.

Objective: To investigate changes in plasma interleukin (IL)-6, cortisol or noradrenaline concentrations after surgery in elderly patients with postoperative confusion. Methods: We studied 80 patients aged 70–90 years undergoing abdominal surgery and measured plasma IL-6, cortisol or noradrenaline concentrations before surgery, at the end of surgery, and 24 and 48 h after surgery. Results: Plasma IL-6 concentrations in elderly patients with postoperative confusion were 83.2 ± 30.5, 49.3 ± 14.1 and 42.9 ± 19.4 pg·ml^–1 at the end of surgery, and 24 and 48 h after surgery, respectively, being significantly higher than in elderly patients without postoperative confusion (58.0 ± 37.5, 36.1 ± 20.0 and 28.2 ± 16.7 pg· ml^–1). Plasma cortisol concentrations in elderly patients with postoperative confusion (42.2 ± 7.8, 38.3 ± 8.3 and 33.1 ± 8.4 µg·dl^–1 at the end of surgery, and 24 and 48 h after surgery, respectively) were significantly higher than in elderly patients without postoperative confusion (32.9 ± 6.7, 30.4 ± 8.6 and 25.6 ± 6.5 µg·dl^–1, respectively). There were no significant differences in plasma norepinephrine concentrations at all sampling points between elderly patients with and without postoperative confusion. However, plasma IL-6 and cortisol concentrations were related in elderly patients with postoperative confusion (at the end of surgery and 24 and 48 h after surgery). However, there was no relationship between plasma IL-6 and cortisol concentrations 24 and 48 h after surgery in elderly patients without postoperative confusion. Conclusion: Elderly patients with postoperative confusion had increased plasma IL-6 and cortisol concentrations. The interaction between IL-6 and cortisol after surgery is associated with developing postoperative confusion in the elderly patients.

Chronic schizophrenic patients have increased current perception threshold and lower VAS pain scores in postoperative pain compared with control patients.

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