Serotonin syndrome triggered by postoperative administration of serotonin noradrenaline reuptake inhibitor (SNRI)

Abstract

Background: Serotonin syndrome is a rare but potentially severe disease, which is caused by hyperstimulation of serotonin receptors in the central nervous system. Several antidepressants exert their effect by modulating intrasynaptic serotonin concentration and anesthetics may affect the metabolism of serotonin, implicating to induce serotonin syndrome in patients taking those antidepressants. We present a case which provoked serotonin syndrome immediately after taking serotonin noradrenaline reuptake inhibitor (SNRI) in the postoperative period. Case presentation: A 31-year-old female underwent laparoscopic ovarian cystectomy under general anesthesia with propofol, fentanyl, and remifentanil. She has been taking duloxetine, a SNRI for depression. She developed myoclonus seizure with an increase of blood pressure and heart rate after taking duloxetine on the day after the surgery, which was subsided by a non-selective serotonin receptor antagonist. Conclusions: Anesthesiologists should be aware of the risk of perioperative serotonin syndrome in patients taking antidepressants affecting serotonin metabolism.

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

“…Duloxetine has an established safety profile and is generally well-tolerated. However, there are a number of significant severe adverse reactions including hypertensive crisis, Stevens-Johnson syndrome, serotonin syndrome, and fulminant liver failure that are of particular concern for anesthesiologists [19]. Recent research of duloxetine is largely centered on applications as an adjunct therapy in chronic pain management [20][21][22][23].…”

“…As previously discussed, differentiating between these diagnoses is important as management varies. Another challenge is that serotonin syndrome following surgery may have a delayed presentation, complicating diagnosis [19].…”