-Case Reports-

Importance of Early Diagnosis and Treatment of Perioperative Catatonia: A Case Report

Yuki Genda^1,2, Hiroshi Mase^1,2 and Atsuhiro Sakamoto¹

¹Department of Anesthesiology, Nippon Medical School, Tokyo, Japan
²Department of Surgical Intensive Care, Nippon Medical School, Tokyo, Japan

Symptoms of catatonia include silence, motionlessness, and postural retention. Although it is important to detect and treat catatonia early, before it becomes severe, postoperative cases have inherent risks that hinder diagnosis and treatment. A 60-year-old man with schizophrenia underwent endoscopic/thoracoscopic esophagectomy and was extubated in the operating room. In the intensive care unit (ICU), he had stiffness in the neck, ankles, and knees, catalepsy during passive knee flexion, mild disturbance of consciousness, mild creatine kinase elevation, and respiratory depression. Intravenous diazepam was administered for diagnosis, and the patient's rapid improvement indicated catatonia. He was intubated and started on lorazepam; tapering produced no recurrence of symptoms. The patient was extubated and transferred to the general ward on postoperative Day 2. Because this patient was extubated in the operating room and was managed postoperatively in the ICU with a full-time doctor, his symptoms were easily recognized and early diagnosis was possible. Thus, we were able to administer drug therapy quickly and adequately and perform forward management that accounted for postoperative risks, thereby achieving a favorable outcome.

J Nippon Med Sch 2024; 91: 347-350

Keywords
catatonia, postoperative risks, benzodiazepine therapy

Correspondence to
Yuki Genda, Department of Surgical Intensive Care, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
y-genda@nms.ac.jp

Received, December 25, 2022
Accepted, March 15, 2023