ABSTRACT Schizophrenia is a complex psychiatric condition affecting 20 million people worldwide. There are safety risks associated with choosing an appropriate anesthetic agent. We carried out a systematic review considering anesthetic safety in patients with schizophrenia undergoing surgery or electroconvulsive therapy (ECT). Databases EMBASE, MEDLINE, PsycINFO, PsycArticles, and Cochrane were used. Searches were limited to the years from 2000 to 2020. The Appraisal tool for Cross-Sectional Studies (AXIS tool), and the Critical Appraisal Skills Programme (CASP), were used to assess the 8 relevant studies identified, which together provided data for a total of 204 schizophrenic patients. Thiopental demonstrated the most consistent and safe seizure duration of 35 seconds, with upper and lower limits within the safe parameters range, but propofol was found to have the shortest recovery time overall. The small sample size and prevalence of biases within the studies resulted in a lack of confidence in the evidence. Due to the lack of comparability, a single optimal anesthetic agent cannot be recommended; propofol appears to be hemodynamically stable, whereas thiopental seems to be the most consistent anesthetic across the studies, with regard to optimal motor seizure duration and hemodynamic stability. Further research is needed to examine the various parameters affected in schizophrenic patients to ensure a safe and effective outcome.
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