Fentanyl-induced rigidity during emergence from general anesthesia potentiated by venlafexine

Abstract

P Pu ur rp po os se e: : To present and discuss a case of opioid-induced rigidity with low-dose fentanyl during recovery from anesthesia.C Cl li in ni ic ca al l f fe ea at tu ur re es s: : A 41-yr-old woman underwent laparotomy for total abdominal hysterectomy and bilateral salpingo-oophorectomy under general anesthesia. She received a total of 500 µg of fentanyl by iv intermittent boluses during the three-hour anesthetic. During emergence from anesthesia, while intubated, the patient presented with rigidity. No changes in ventilatory parameters were measured during the episode. The only notable predisposing factor was treatment with venlafexine, an antidepressant that modifies serotonin and norepinephrine levels. She was successfully treated with iv naloxone 20 µg. The rest of the postoperative period was uneventful.

Serotonin Syndrome Precipitated by Fentanyl During Procedural Sedation

“…A recent human case report noted muscle rigidity in a patient chronically taking venlafaxine after she was given i.v. fentanyl during surgery (though she had also received a single dose of intramuscular meperidine just before the procedure) (14). That patient's physical examination was significant for hyperreflexia and ankle clonus.…”

Serotonin syndrome

“…30,31 Severe reactions and fatalities have been reported with pethidine, tramadol and fentanyl. 32 The fatal outcome in the Libby Zion case is widely attributed to severe serotonin toxicity as a result of administration of pethidine while she was taking phenelzine. 3 Morphine analogues (morphine, codeine, dihydrocodeine, buprenorphine) do not inhibit serotonin reuptake and serotonin toxicity has not been reported with those drugs.…”

Hipertermia maligna no Brasil: análise da atividade do hotline em 2009

“…Although MH may occur postoperatively, it is unlikely that fever alone characterizes MH 25 . Another cause for excluding MH diagnosis in hotline calls in 2009 was an isolated reaction characterized by muscle rigidity after opioid use, a rare event associated with high doses, which occurs during induction or recovery and may show improvement after naloxone or neuromuscular block 26 . Regarding MH episode presentation in our country, there are similarities with those reported in other countries.…”