Matchanov Otakhon, Nelson Priscilla
Neurophysiology, New York Presbyterian Hospital , New York, New York.
Anesthesiology, Weill Cornell Medical College , New York, New York.
Neurodiagn J. 2020 Sep;60(3):165-176. doi: 10.1080/21646821.2020.1783182.
In perioperative settings where a patient under general anesthesia, presentation of serotonin syndrome might be far from the "classical" description of this potentially fatal condition. A patient who manifested signs of serotonin toxicity during an intravenous anesthetic, remifentanil, is presented. At the time of surgery, the patient was being treated with tramadol for pain management. The patient displayed myofasciculations on both gastrocnemius muscles confirmed electromyographically. All other conventional signs of serotonin syndrome were absent except hypotension and nystagmus. A presumptive diagnosis of serotonin syndrome was made intraoperatively. The symptoms resolved once remifentanil infusion was discontinued in the operating room without incident. Mild-to-moderate perioperative serotonin syndrome may manifest with myofasciculations in gastrocnemius muscles in the settings of no neuromuscular blockade. In spinal surgeries involving intraoperative EMG monitoring, the neuromonitoring team should be aware of this presentation and include serotonin syndrome in the differential diagnosis of unexplained EMG activity.
在全身麻醉患者的围手术期，血清素综合征的表现可能与这种潜在致命疾病的“经典”描述大相径庭。本文介绍了一名在静脉麻醉药瑞芬太尼使用期间出现血清素中毒迹象的患者。手术时，该患者正在接受曲马多治疗以控制疼痛。经肌电图证实，患者双侧腓肠肌出现肌束震颤。除低血压和眼球震颤外，血清素综合征的所有其他传统体征均未出现。术中做出了血清素综合征的推定诊断。在手术室停止输注瑞芬太尼后，症状顺利缓解，未发生任何意外。在没有神经肌肉阻滞的情况下，轻至中度围手术期血清素综合征可能表现为腓肠肌肌束震颤。在涉及术中肌电图监测的脊柱手术中，神经监测团队应意识到这种表现，并将血清素综合征纳入不明原因肌电图活动的鉴别诊断中。
