Serotonin Syndrome in the Perioperative Setting

Area of Science:

• Anesthesiology
• Pharmacology
• Neurology

Background:

• Serotonin syndrome is a potentially fatal condition linked to serotonergic medications, increasing perioperative risks.
• Increased antidepressant use elevates the incidence of perioperative serotonin syndrome, necessitating its consideration in neuroexcitation cases.

Observation:

• A 70-year-old male patient on venlafaxine presented for prostate surgery.
• A reported propofol "allergy" was clarified as rigidity, not a true allergy.
• The patient developed myoclonic jerks and rigidity during emergence, worsening after meperidine administration.

Findings:

• The patient's symptoms suggested serotonin syndrome, a condition exacerbated by meperidine.
• Intravenous midazolam effectively treated the myoclonic jerks and rigidity.

Implications:

• Perioperative rigidity or movement disorders in patients on serotonergic drugs may signify serotonin toxicity, not allergies.
• Clinicians must maintain vigilance for serotonin syndrome risk factors, including outpatient medication use, to ensure patient safety.