Abstract
BackgroundSerotonin syndrome is a rare but potentially severe disease, which is caused by hyperstimulation of serotonin receptors in the central nervous system. Several antidepressants exert their effect by modulating intrasynaptic serotonin concentration and anesthetics may affect the metabolism of serotonin, implicating to induce serotonin syndrome in patients taking those antidepressants.We present a case which provoked serotonin syndrome immediately after taking serotonin noradrenaline reuptake inhibitor (SNRI) in the postoperative period.Case presentationA 31-year-old female underwent laparoscopic ovarian cystectomy under general anesthesia with propofol, fentanyl, and remifentanil. She has been taking duloxetine, a SNRI for depression. She developed myoclonus seizure with an increase of blood pressure and heart rate after taking duloxetine on the day after the surgery, which was subsided by a non-selective serotonin receptor antagonist.ConclusionsAnesthesiologists should be aware of the risk of perioperative serotonin syndrome in patients taking antidepressants affecting serotonin metabolism.
Highlights
Serotonin syndrome is a rare but potentially severe disease, which is caused by hyperstimulation of serotonin receptors in the central nervous system
Anesthesiologists should be aware of the risk of perioperative serotonin syndrome in patients taking antidepressants affecting serotonin metabolism
We report a case which developed serotonin syndrome triggered by duloxetine, a serotonin noradrenaline reuptake inhibitor (SNRI) after general anesthesia with propofol, fentanyl, and remifentanil
Summary
Serotonin syndrome is relatively rare but a potentially life-threatening spectrum of drug-induced toxicity [1]. Case presentation A 31-year-old female (height 165.6 cm, weight 53.1 kg) was scheduled for laparoscopic ovarian cystectomy Her past medical history was depression, and she has been taking duloxetine, a SNRI 60 mg/day (in the morning) and mirtazapine, a noradrenergic and specific serotonergic antidepressant (NaSSA) 30 mg/day at bedtime for 1 year. Her mental status was stable and these medications was continued until the day of the surgery. Her heart rate and systolic blood pressure had raised to 140 beats/ min and over 160 mmHg, respectively.
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