• Akira Kudoh, Hajime Takase, Yoko Takahira, Hiroshi Katagai, and Tomoko Takazawa.
• Department of Anesthesiology, Hakodate Watanabe Hospital, Hakodate, Japan.
• J Clin Anesth. 2003 Sep 1; 15 (6): 455-62.

Study ObjectiveTo investigate whether epidural analgesia with local anesthetics affects postoperative confusion in schizophrenic patients or the relationships between cortisol or interleukin-6 (IL-6) and postoperative confusion.DesignProspective, randomized study.SettingHakodate Watanabe Hospital and Hirosaki National Hospital.Patients105 patients who were scheduled to undergo abdominal surgery with general anesthesia.InterventionsThe schizophrenic patients were rendomly divided into two groups: patients in Group A received epidural anesthesia and patients in Group B did not receive epidural anesthesia.Measurements And Main ResultsPostoperative confusion during the first 48 hours after the end of operation occurred in 7 of 33 patients (21%) in Group A and 10 of 33 patients (30%) in Group B. There were no significant differences in the frequency of postoperative confusion between Groups A and B. Plasma cortisol concentrations in schizophrenic patients in Group A were significantly lower 15 minutes after incision and the end of surgery than those levels of patients in Group B; however, there was no significant difference between groups in plasma cortisol concentrations after anesthesia. Plasma IL-6 concentrations (51.7 +/- 22.0 and 31.4 +/- 8.2 pg mL(-1)) in patients with postoperative confusion at the end of surgery and 24 hours after surgery were significantly higher than those levels (34.4 +/- 16.2 and 16.9 +/- 7.7 pg mL(-1)) in patients without postoperative confusion.ConclusionsEpidural anesthesia does not significantly decrease the frequency of postoperative confusion in schizophrenic patients. Plasma IL-6 concentrations at the end of the operation and 24 hours after surgery in schizophrenic patients with postoperative confusion were significantly higher than those concentrations in patients without postoperative confusion.

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