Serotonin syndrome manifesting as patient movement during total intravenous anesthesia with propofol and remifentanil

• Published in: Journal of clinical anesthesia 2013-02, Vol.25 (1), p.52-54
• Main Authors: Davis, Jennifer J., MD, Buck, Nathan S., MD, Swenson, Jeffrey D., MD, Johnson, Ken B., MD, Greis, Patrick E., MD
• Format: Article
• Language: English
• Subjects: Airway management; Analgesics; Anesthesia & Perioperative Care; Anesthesia, Intravenous - methods; Anesthetics, Intravenous - administration & dosage; Antidepressants; Biological and medical sciences; Catheters; Drug dosages; Drug overdose; Drug toxicity and drugs side effects treatment; Fluoxetine - adverse effects; Humans; Intraoperative Complications - chemically induced; Intraoperative Complications - diagnosis; Male; Medical sciences; Movement - drug effects; Myoclonus; Myoclonus - chemically induced; Narcotics; Opioids; Pain Medicine; Patients; Pharmacology. Drug treatments; Piperidines - administration & dosage; Propofol - administration & dosage; Serotonin; Serotonin syndrome; Serotonin Syndrome - diagnosis; Serotonin Syndrome - etiology; Serotonin Uptake Inhibitors - adverse effects; Surgery; Toxicity: nervous system and muscle; Young Adult
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/j.jclinane.2012.05.002

Abstract A patient who manifested signs of serotonin syndrome during an intravenous anesthetic with remifentanil and propofol is presented. The patient displayed lower extremity clonus, nystagmus, and diaphoresis. At the time of surgery, the patient was being treated with fluoxetine (a selective serotonin reuptake inhibitor). A presumptive diagnosis of serotonin syndrome was made intraoperatively and all opioids were discontinued. His symptoms resolved in the Postanesthesia Care Unit without incident.