**Surgery anaesthesia of the mentally ill: challenges and coping strategies**

In the medical field, surgical treatment of mental patients has been a complex and sensitive subject. Such patients often have cognitive, emotional and behavioural anomalies that pose many challenges to the surgical anaesthesia process. Ensuring the safety and well-being of patients while ensuring that the operation is carried out is an important issue for an anaesthetists. The physical and psychological characteristics of the mentally ill add to the complexity of surgical anesthesia. Physically, they may be subject to various levels of liver, kidney function impairment or endocrine system disorders as a result of long-term drug use, which may affect the metabolic and excretion of narcotic drugs and thus increase the risk of anesthesia. Mentally, the high level of emotional volatility of patients and the different perceptions of pain, fear and surgical processes may lead to incoherence or violent reactions during the induction, maintenance and awakening stages of anaesthesia, further increasing the difficulty of anaesthesia management. Faced with these challenges, anaesthetists need to adopt a series of fine and well-thought-out strategies. Pre-operative assessment is an essential link. Doctors need to have a complete picture of the patient ‘ s history, including the type of mental illness, the course of the disease, current drug use and possible drug interactions. At the same time, the physical state of the patient is assessed through detailed medical and laboratory examinations to provide a basis for the choice of anaesthesia programme. In addition, adequate communication with psychiatrists and patients ‘ families is essential to develop personalized anaesthesia plans and to ensure the comprehensiveness and safety of treatment programmes. In selecting an anaesthesia, doctors take into account the specific circumstances of the patient. For patients with stable and co-operative conditions, a general general or regional anesthesia can be used. However, more specific anaesthesia techniques, such as deep calm or nervous retardation, may be needed to reduce the stress of the patient and ensure the smooth operation of the operation. In the choice of an narcotic drug, doctors are required to balance the efficacy and safety of the drug and to select drugs that have little physical impact on the patient, which are quick to metabolize and which are easy to regulate in order to reduce the risk of anaesthesia-related complications. Monitoring and management of anaesthesia are also essential. Doctors are required to follow closely the vital signs of the patient, including heart rate, blood pressure, breathing frequency and blood oxygen saturation, and to detect and address possible anomalies in a timely manner. At the same time, doctors are required to exercise a high level of vigilance and to take the necessary precautions, such as the use of restraining belts and enhanced custody, to ensure the safety of patients with mental illnesses, such as hallucinations, delusions or manoeuvring. Post-operative management should also not be overlooked. Mentally ill persons may react with confusion, emotional volatility, etc. during anaesthesia, and doctors are required to give adequate attention and comfort, and to intervene with sedatives or antipsychiatrics, if necessary. At the same time, doctors are required to identify and properly treat possible anesthesia-related complications, such as respiratory inhibition, low blood pressure, etc., in order to facilitate early recovery. The surgical anaesthesia of the mentally ill is a challenging area. Anesthesiologists need to have solid expertise, extensive clinical experience and a high degree of responsibility to provide safe and effective anesthesia services to patients through careful pre-operative assessment, individualized anesthesia programmes, intensive surgical monitoring and management, and intensive post-operative care. Only in this way will it be possible to improve the quality of life of patients while safeguarding their lives, as well as to safeguard the protection of patients with mental illness for surgical treatment.