Surgeon and inventor Catherine Mohr tours the history of surgery (and its pre-painkiller, pre-antiseptic past), then demos some of the newest tools for surgery through tiny incisions, performed using nimble robot hands. Fascinating — but not for the squeamish.
Don’t forget that much of the work done on surgical robotics is done by biomedical/mechanical/electrical engineers, chemists. These are the people behind the scenes that make the new awesome technology work.
The authors of this systematic review included only the serious mental illness of schizophrenia, bipolar disorder, major depressive disorder (MDD), and posttraumatic stress disorder (PTSD). As if the other mental illnesses are not serious?
Well lets stop moaning their initiative is praiseworthy. They performed a systematic literature search of Medline (1966–August 2007) and a review of the studies was conducted to determine the knowledge base on clinical outcomes of surgery among persons diagnosed with serious mental illness.
After selection they found 10 articles reporting perioperative medical, surgical, or psychiatric complications with schizophrenia and 2 for depression.
Patients with schizophrenia undergoing surgery were reported in 2 Case series, 4 Cohort studies and 4 Randomized controlled trials. For depression their were 2 cohort studies.
a very limited knowledge base regarding postoperative clinical complications and perioperative risk management among patients previously diagnosed with serious mental illness
patients with schizophrenia undergoing elective and emergency operations may have more advanced surgical disease at presentation
patients with schizophrenia have higher postoperative complication rates
patients with schizophrenia have a deteriorating psychiatric status if psychotropic medications are discontinued preoperatively, and increased postoperative mortality
patients with schizophrenia have reduced pain perception may impair or delay patients’ ability to report symptoms of postoperative infection
psychiatric patients usually have several different kind of medications especially elderly
for those with substance abuse disorders in remission, clinicians are presented with the challenge of managing postoperative pain without exacerbating or reactivating addiction
increased rates of delirium and confusion in the postoperative period have been reported in patients with schizophrenia. Delirium is associated with higher mortality, longer hospital stay, and impairment at hospital discharge
their deficits in self-care and engagement in unhealthy lifestyle behaviors are well documented suggesting that adverse sequelae of surgery may be especially problematic for this group
psychiatric patients have high rates of cardiovascular, gastrointestinal, and respiratory
psychiatric medications should be continued, if possible, during the perioperative period
much more research is needed regarding anesthetic and analgesic care and other issues of perioperative risk management to reduce complications
because there is evidence of increased postoperative complications in patients with serious mental illness, and given schizophrenia patients’ risk for cardiac irregularities, obesity, and respiratory disorders it also seems advisable to involve psychiatric consultation services in perioperative management of these patients
It seems advisable to involve psychiatric consultation services, that is to me the most important implication of this systematic review, what do you think?
Are the mentally ill neglected during the perioperative period? Let me know in the comments.
Laurel A. Copeland, John E. Zeber, Mary Jo Pugh, Eric M. Mortensen, Marcos I. Restrepo, Valerie A. Lawrence (2008). Postoperative Complications in the Seriously Mentally Ill
A Systematic Review of the Literature Annals of Surgery, 248 (1), 31-38 DOI: 18580204