Takata Junko, Arashi Tomoko, Abe Ayako, Arai Shoko, Haruyama Naoko
Department of Anesthesiology, Tokyo Metropolitan Police Hospital, 4-22-1 Nakano, Nakano-ku, Tokyo, 164-8541, Japan.
JA Clin Rep. 2019 Aug 27;5(1):55. doi: 10.1186/s40981-019-0275-5.
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.
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.
Anesthesiologists should be aware of the risk of perioperative serotonin syndrome in patients taking antidepressants affecting serotonin metabolism.
血清素综合征是一种罕见但可能严重的疾病，由中枢神经系统中血清素受体的过度刺激引起。几种抗抑郁药通过调节突触内血清素浓度发挥作用，而麻醉剂可能影响血清素的代谢，这意味着服用这些抗抑郁药的患者可能诱发血清素综合征。我们报告一例在术后服用血清素去甲肾上腺素再摄取抑制剂（SNRI）后立即引发血清素综合征的病例。
一名31岁女性在丙泊酚、芬太尼和瑞芬太尼全身麻醉下接受腹腔镜卵巢囊肿切除术。她一直在服用度洛西汀，一种用于治疗抑郁症的SNRI。术后第二天服用度洛西汀后，她出现肌阵挛性发作，血压和心率升高，通过非选择性血清素受体拮抗剂得以缓解。
麻醉医生应意识到服用影响血清素代谢的抗抑郁药的患者围手术期发生血清素综合征的风险。
