Serotonin syndrome following left ventricular assist device implantation: A report and institution-specific strategy for prevention

Katzianer, David; Chism, Keira; Qureshi, Ataul; Watson, Ryan A.; Massey, H. Todd; Boyle, Andrew; Reeves, Gordon R.; Danelich, Ilya M.

doi:10.1016/j.jccase.2019.09.004

Cited by 5 publications

(5 citation statements)

References 10 publications

(13 reference statements)

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“…Up to date, there is no universal dosing regimen for MB in children. Similar to an adult population, a maximum dose of 2 mg kg -1 seems to be safe 60 .…”

Section: Methylene Blue In a Paediatric Populationmentioning

confidence: 86%

“…No adverse events were registered in all 7 patients 58 . Two other case reports describe the successful use of MB after an orthotopic heart transplantation 59 or in a 22-month-old girl with Noonan syndrome, biventricular hypertrophic cardiopathy and chronic respiratory failure who developed a severe septic shock 60 . Up to date, there is no universal dosing regimen for MB in children.…”

Section: Methylene Blue In a Paediatric Populationmentioning

confidence: 99%

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The role of methylene blue in the management of vasoplegic syndrome: a narrative review

Cottyn¹,

Roussel²,

Rex³

et al. 2022

Acta Anaest Belg

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Vasoplegic syndrome is an important clinical entity characterized by profound arterial hypotension refractory to vasopressor therapy. The underlying pathophysiology is characterized by a complex and multifactorial dysregulation of both vasodilatory and vasoconstrictive mechanisms. During the last decades, there is growing interest in using methylene blue as an adjunct therapy to treat vasodilatory shock. The present review evaluates the safety and efficacy of methylene blue in cardiac and transplant surgery, severe sepsis and septic shock, severe burn injury, paediatric intensive care, and intoxications. Although most of the currently available evidence reports a benefit in haemodynamic parameters and a decrease in vasopressor requirements following the administration of methylene blue, study designs are heterogeneous, and the overall level of evidence is low. Moreover, a clear and consistent benefit in morbidity and mortality is lacking. Large prospective randomized controlled trials are needed to evaluate the exact role and timing of methylene blue in the treatment of vasopressor refractory vasoplegia.

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“…Up to date, there is no universal dosing regimen for MB in children. Similar to an adult population, a maximum dose of 2 mg kg -1 seems to be safe 60 .…”

Section: Methylene Blue In a Paediatric Populationmentioning

confidence: 86%

Section: Methylene Blue In a Paediatric Populationmentioning

confidence: 99%

The role of methylene blue in the management of vasoplegic syndrome: a narrative review

Cottyn¹,

Roussel²,

Rex³

et al. 2022

Acta Anaest Belg

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“…Serotonin syndrome following administration of methylene blue for vasoplegia after cardiac surgery has been described before. 10-12…”

Section: Discussionmentioning

confidence: 99%

“…Serotonin syndrome was diagnosed on postoperative day 1, likely due combination of sertraline, fentanyl, and methylene blue. 10…”

Section: Discussionmentioning

confidence: 99%

Postoperative Serotonin Syndrome Following Methylene Blue Administration for Vasoplegia After Cardiac Surgery: A Case Report and Review of the Literature

Basta

2020

Semin Cardiothorac Vasc Anesth

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Serotonin syndrome is a potentially life-threatening condition associated with increased serotonergic activity in the central nervous system. The increasing incidence of this condition is thought to parallel the increasing use of serotonergic agents in medical practice. The selective serotonin reuptake inhibitors are perhaps the most commonly implicated group of medications associated with serotonin syndrome. This case report describes the occurrence of postoperative serotonin syndrome in a patient on long-term sertraline who underwent coronary artery bypass graft and was treated with methylene blue for perioperative vasoplegia. It delineates the various clinical features commonly encountered and illustrates the recommended management modalities, including prevention, for this potentially lethal medical emergency. With prompt diagnosis and expeditious treatment, the patient has had full recovery.

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“…Serotonin syndrome may also present intraoperatively, and may be due to interactions with a variety of agents routinely administered during anesthetics, such as methylene blue [80,81]. An abnormal response to anesthesia, including movement despite adequate depth of anesthesia, may be a sign of serotonin syndrome [82].…”

Section: Monoamine Oxidase Inhibitors (Moais) Moai-a Inhibitors Moai-b Inhibitorsmentioning

confidence: 99%

New Serotonin-Norepinephrine Reuptake Inhibitors and Their Anesthetic and Analgesic Considerations

Fanelli

Weller

Liu

2021

Neurology International

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Serotonin-norepinephrine reuptake inhibitors (SNRIs) inhibit the presynaptic neuronal uptake of serotonin and norepinephrine and prolong the effects of the monoamines in the synaptic cleft within the central nervous system, leading to increased postsynaptic receptor activation and neuronal activities. Serotonin-norepinephrine reuptake inhibitors can have multiple clinical indications, including as the first-line agents for the management of depression and anxiety, and as analgesics in the treatment of chronic pain. The effects of reuptake inhibition of norepinephrine and serotonin are often dose-dependent and agent-dependent. There are five FDA-approved serotonin-norepinephrine reuptake inhibitors (desvenlafaxine, duloxetine, levomilnacipran, milnacipran and sibutramine) currently being marketed in the United States. As the COVID-19 pandemic significantly increased the incidence and prevalence of anxiety and depression across the country, there are significantly increased prescriptions of these medications perioperatively. Thus, anesthesiologists are more likely than ever to have patients administered with these agents and scheduled for elective or emergency surgical procedures. A thorough understanding of these commonly prescribed serotonin-norepinephrine reuptake inhibitors and their interactions with commonly utilized anesthetic agents is paramount. There are two potentially increased risks related to the continuation of SNRIs through the perioperative period: intraoperative bleeding and serotonin syndrome. SNRIs have some off-label uses, more new indications, and ever-increasing new applications in perioperative practice. This article aims to review the commonly prescribed serotonin-norepinephrine reuptake inhibitors and the current clinical evidence regarding their considerations in perioperative anesthesia and analgesia.

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Serotonin syndrome following left ventricular assist device implantation: A report and institution-specific strategy for prevention

Cited by 5 publications

References 10 publications

The role of methylene blue in the management of vasoplegic syndrome: a narrative review

The role of methylene blue in the management of vasoplegic syndrome: a narrative review

Postoperative Serotonin Syndrome Following Methylene Blue Administration for Vasoplegia After Cardiac Surgery: A Case Report and Review of the Literature

New Serotonin-Norepinephrine Reuptake Inhibitors and Their Anesthetic and Analgesic Considerations

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