Serotonin syndrome following spinal anaesthesia for elective caesarean delivery: a case report

Serotonin syndrome during the perioperative period is difficult to recognise, and its diagnosis can be challenging due to the variety of clinical features that may mimic more familiar conditions known to anaesthetists. Most cases of serotonin syndrome in the perioperative setting have been reported in the postoperative period, with none occurring during a caesarean delivery. We describe an unusual case of intraoperative serotonin syndrome that developed immediately following spinal anaesthesia in a patient undergoing an elective caesarean delivery. The patient, who was taking sertraline at the time of anaesthesia, developed pyrexia, diaphoresis, spontaneous rigidity, episodes of arrhythmias, became unresponsive and went into peri-arrest. We postulate plausible mechanisms, including the role of opioids, intrathecal bupivacaine, and acute stress that may have contributed to the onset of serotonin syndrome. The case underscores the importance of early identification of serotonin syndrome and its presentation in obstetric patients.