Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Can J Anaesth. 2017 Sep;64(9):940-946. doi: 10.1007/s12630-017-0918-9. Epub 2017 Jun 30.
Perioperative use of serotonergic agents increases the risk of serotonin syndrome. We describe the occurrence of serotonin syndrome after fentanyl use in two patients taking multiple serotonergic agents.
Two patients who had been taking multiple serotonergic medications or herbal supplements (one patient taking fluoxetine, turmeric supplement, and acyclovir; the other taking fluoxetine and trazodone) developed serotonin syndrome perioperatively when undergoing outpatient procedures. Both experienced acute loss of consciousness and generalized myoclonus after receiving fentanyl. In one patient, the serotonin syndrome promptly resolved after naloxone administration. In the other patient, the onset of serotonin syndrome was delayed and manifested after discharge, most likely attributed to the intraoperative use of midazolam for sedation.
Even small doses of fentanyl administered to patients taking multiple serotonergic medications and herbal supplements may trigger serotonin syndrome. Prompt reversal of serotonin toxicity in one patient by naloxone illustrates the likely opioid-mediated pathogenesis of serotonin syndrome in this case. It also highlights that taking serotonergic agents concomitantly can produce the compounding effect that causes serotonin syndrome. The delayed presentation of serotonin syndrome in the patient who received a large dose of midazolam suggests that outpatients taking multiple serotonergic drugs who receive benzodiazepines may require longer postprocedural monitoring.
围手术期使用 5-羟色胺能药物会增加发生 5-羟色胺综合征的风险。我们描述了两例正在服用多种 5-羟色胺能药物或草药补充剂（一名患者同时服用氟西汀、姜黄补充剂和阿昔洛韦；另一名患者服用氟西汀和曲唑酮）的患者在接受门诊手术时使用芬太尼后发生 5-羟色胺综合征的情况。两名患者在接受芬太尼后均出现急性意识丧失和全身肌阵挛。其中 1 例患者在给予纳洛酮后 5-羟色胺综合征迅速缓解。另 1 例患者的 5-羟色胺综合征延迟发作，并在出院后出现，可能与术中使用咪达唑仑镇静有关。
即使给服用多种 5-羟色胺能药物和草药补充剂的患者使用小剂量芬太尼也可能引发 5-羟色胺综合征。1 例患者在给予纳洛酮后迅速逆转 5-羟色胺毒性，表明在这种情况下，5-羟色胺综合征可能是阿片类药物介导的发病机制。这也突出表明同时服用 5-羟色胺能药物会产生导致 5-羟色胺综合征的复合效应。接受大剂量咪达唑仑的患者出现 5-羟色胺综合征延迟发作表明，接受苯二氮䓬类药物的同时服用多种 5-羟色胺能药物的门诊患者可能需要更长时间的术后监测。
