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Juraj Sprung - One of the best experts on this subject based on the ideXlab platform.
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Black Seed Oil and Perioperative Serotonin Syndrome: A Case Report.
A&A practice, 2019Co-Authors: Mary E. Warner, Juraj Sprung, Paul A Warner, Mark A. WarnerAbstract:Perioperative Serotonin Syndrome has been associated with a number of medications and herbal supplements. We report a patient who developed Serotonin Syndrome immediately after an endoscopic procedure in which the preoperative use of black seed oil appears to have played a role in stimulating the Syndrome. Black seed oil has not been previously reported in association with perioperative Serotonin Syndrome. Anesthesia professionals should be aware that patients taking black seed oil supplements may develop Serotonin Syndrome postoperatively.
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Serotonergic medications, herbal supplements, and perioperative Serotonin Syndrome
Canadian Journal of Anesthesia Journal canadien d'anesthésie, 2017Co-Authors: Mary E. Warner, Julian Naranjo, Emily M. Pollard, Toby N. Weingarten, Mark A. Warner, Juraj SprungAbstract:Objectif L’utilisation périopératoire d’agents sérotoninergiques augmente le risque de Syndrome sérotoninergique. Nous décrivons la survenue d’un Syndrome sérotoninergique suite à l’administration de fentanyl à deux patients prenant plusieurs agents sérotoninergiques. Éléments cliniques Deux patients prenant plusieurs médicaments sérotoninergiques ou suppléments à base de plantes médicinales (l’un de la fluoxétine, un supplément de curcuma et de l’acyclovir; l’autre de la fluxoétine et du trazodone) ont souffert d’un Syndrome sérotoninergique en période périopératoire alors qu’ils subissaient des interventions en clinique ambulatoire. Les deux patients ont subi une perte aiguë de conscience et une myoclonie généralisée après avoir reçu du fentanyl. Chez un patient, le Syndrome sérotoninergique s’est rapidement résolu suite à l’administration de naloxone. Chez l’autre, l’apparition du Syndrome sérotoninergique a été retardée et ne s’est manifestée qu’après le congé de la clinique; le Syndrome était probablement attribuable à l’utilisation peropératoire de midazolam pour la sédation. Conclusion Même de faibles doses de fentanyl administrées aux patients prenant plusieurs médicaments sérotoninergiques et suppléments à base de plantes médicinales peuvent déclencher un Syndrome sérotoninergique. La neutralisation rapide de la toxicité sérotoninergique chez un patient à l’aide de naloxone illustre la pathogenèse probablement médiée par des opioïdes du Syndrome sérotoninergique dans ce cas. Cela souligne également que la prise concomitante d’agents sérotoninergiques peut avoir un effet cumulatif qui provoque un Syndrome sérotoninergique. La présentation retardée du Syndrome sérotoninergique chez le patient ayant reçu une importante dose de midazolam suggère que les patients en clinique externe prenant plusieurs médicaments sérotoninergiques et recevant des benzodiazépines pourraient nécessiter un monitorage prolongé après leur intervention. Purpose 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. Clinical features 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. Conclusion 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.
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Serotonergic medications, herbal supplements, and perioperative Serotonin Syndrome.
Canadian journal of anaesthesia = Journal canadien d'anesthesie, 2017Co-Authors: Mary E. Warner, Julian Naranjo, Emily M. Pollard, Toby N. Weingarten, Mark A. Warner, Juraj SprungAbstract: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.
Mary E. Warner - One of the best experts on this subject based on the ideXlab platform.
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Black Seed Oil and Perioperative Serotonin Syndrome: A Case Report.
A&A practice, 2019Co-Authors: Mary E. Warner, Juraj Sprung, Paul A Warner, Mark A. WarnerAbstract:Perioperative Serotonin Syndrome has been associated with a number of medications and herbal supplements. We report a patient who developed Serotonin Syndrome immediately after an endoscopic procedure in which the preoperative use of black seed oil appears to have played a role in stimulating the Syndrome. Black seed oil has not been previously reported in association with perioperative Serotonin Syndrome. Anesthesia professionals should be aware that patients taking black seed oil supplements may develop Serotonin Syndrome postoperatively.
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Serotonergic medications, herbal supplements, and perioperative Serotonin Syndrome
Canadian Journal of Anesthesia Journal canadien d'anesthésie, 2017Co-Authors: Mary E. Warner, Julian Naranjo, Emily M. Pollard, Toby N. Weingarten, Mark A. Warner, Juraj SprungAbstract:Objectif L’utilisation périopératoire d’agents sérotoninergiques augmente le risque de Syndrome sérotoninergique. Nous décrivons la survenue d’un Syndrome sérotoninergique suite à l’administration de fentanyl à deux patients prenant plusieurs agents sérotoninergiques. Éléments cliniques Deux patients prenant plusieurs médicaments sérotoninergiques ou suppléments à base de plantes médicinales (l’un de la fluoxétine, un supplément de curcuma et de l’acyclovir; l’autre de la fluxoétine et du trazodone) ont souffert d’un Syndrome sérotoninergique en période périopératoire alors qu’ils subissaient des interventions en clinique ambulatoire. Les deux patients ont subi une perte aiguë de conscience et une myoclonie généralisée après avoir reçu du fentanyl. Chez un patient, le Syndrome sérotoninergique s’est rapidement résolu suite à l’administration de naloxone. Chez l’autre, l’apparition du Syndrome sérotoninergique a été retardée et ne s’est manifestée qu’après le congé de la clinique; le Syndrome était probablement attribuable à l’utilisation peropératoire de midazolam pour la sédation. Conclusion Même de faibles doses de fentanyl administrées aux patients prenant plusieurs médicaments sérotoninergiques et suppléments à base de plantes médicinales peuvent déclencher un Syndrome sérotoninergique. La neutralisation rapide de la toxicité sérotoninergique chez un patient à l’aide de naloxone illustre la pathogenèse probablement médiée par des opioïdes du Syndrome sérotoninergique dans ce cas. Cela souligne également que la prise concomitante d’agents sérotoninergiques peut avoir un effet cumulatif qui provoque un Syndrome sérotoninergique. La présentation retardée du Syndrome sérotoninergique chez le patient ayant reçu une importante dose de midazolam suggère que les patients en clinique externe prenant plusieurs médicaments sérotoninergiques et recevant des benzodiazépines pourraient nécessiter un monitorage prolongé après leur intervention. Purpose 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. Clinical features 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. Conclusion 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.
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Serotonergic medications, herbal supplements, and perioperative Serotonin Syndrome.
Canadian journal of anaesthesia = Journal canadien d'anesthesie, 2017Co-Authors: Mary E. Warner, Julian Naranjo, Emily M. Pollard, Toby N. Weingarten, Mark A. Warner, Juraj SprungAbstract: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.
Mark A. Warner - One of the best experts on this subject based on the ideXlab platform.
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Black Seed Oil and Perioperative Serotonin Syndrome: A Case Report.
A&A practice, 2019Co-Authors: Mary E. Warner, Juraj Sprung, Paul A Warner, Mark A. WarnerAbstract:Perioperative Serotonin Syndrome has been associated with a number of medications and herbal supplements. We report a patient who developed Serotonin Syndrome immediately after an endoscopic procedure in which the preoperative use of black seed oil appears to have played a role in stimulating the Syndrome. Black seed oil has not been previously reported in association with perioperative Serotonin Syndrome. Anesthesia professionals should be aware that patients taking black seed oil supplements may develop Serotonin Syndrome postoperatively.
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Serotonergic medications, herbal supplements, and perioperative Serotonin Syndrome
Canadian Journal of Anesthesia Journal canadien d'anesthésie, 2017Co-Authors: Mary E. Warner, Julian Naranjo, Emily M. Pollard, Toby N. Weingarten, Mark A. Warner, Juraj SprungAbstract:Objectif L’utilisation périopératoire d’agents sérotoninergiques augmente le risque de Syndrome sérotoninergique. Nous décrivons la survenue d’un Syndrome sérotoninergique suite à l’administration de fentanyl à deux patients prenant plusieurs agents sérotoninergiques. Éléments cliniques Deux patients prenant plusieurs médicaments sérotoninergiques ou suppléments à base de plantes médicinales (l’un de la fluoxétine, un supplément de curcuma et de l’acyclovir; l’autre de la fluxoétine et du trazodone) ont souffert d’un Syndrome sérotoninergique en période périopératoire alors qu’ils subissaient des interventions en clinique ambulatoire. Les deux patients ont subi une perte aiguë de conscience et une myoclonie généralisée après avoir reçu du fentanyl. Chez un patient, le Syndrome sérotoninergique s’est rapidement résolu suite à l’administration de naloxone. Chez l’autre, l’apparition du Syndrome sérotoninergique a été retardée et ne s’est manifestée qu’après le congé de la clinique; le Syndrome était probablement attribuable à l’utilisation peropératoire de midazolam pour la sédation. Conclusion Même de faibles doses de fentanyl administrées aux patients prenant plusieurs médicaments sérotoninergiques et suppléments à base de plantes médicinales peuvent déclencher un Syndrome sérotoninergique. La neutralisation rapide de la toxicité sérotoninergique chez un patient à l’aide de naloxone illustre la pathogenèse probablement médiée par des opioïdes du Syndrome sérotoninergique dans ce cas. Cela souligne également que la prise concomitante d’agents sérotoninergiques peut avoir un effet cumulatif qui provoque un Syndrome sérotoninergique. La présentation retardée du Syndrome sérotoninergique chez le patient ayant reçu une importante dose de midazolam suggère que les patients en clinique externe prenant plusieurs médicaments sérotoninergiques et recevant des benzodiazépines pourraient nécessiter un monitorage prolongé après leur intervention. Purpose 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. Clinical features 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. Conclusion 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.
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Serotonergic medications, herbal supplements, and perioperative Serotonin Syndrome.
Canadian journal of anaesthesia = Journal canadien d'anesthesie, 2017Co-Authors: Mary E. Warner, Julian Naranjo, Emily M. Pollard, Toby N. Weingarten, Mark A. Warner, Juraj SprungAbstract: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.
Emily M. Pollard - One of the best experts on this subject based on the ideXlab platform.
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Serotonin Syndrome in the Perioperative Setting.
The American journal of case reports, 2018Co-Authors: Nathan J. Smischney, Emily M. Pollard, Asha U. Nookala, Oludare O. OlatoyeAbstract:BACKGROUND Serotonin Syndrome is a life-threatening condition that can lead to neurologic complications and is associated with the use of serotonergic medications. As the use of antidepressant medications has increased, the incidence of perioperative Serotonin Syndrome has transitioned from a rare diagnosis to one that should be considered as a differential diagnosis for any patient displaying signs of neuroexcitation. CASE REPORT A 70-year-old man (ASA 2) with a history of vestibular migraines (treated with venlafaxine), gastroesophageal reflux disease, and benign prostatic hyperplasia presented to our institution for photoselective vaporization of the prostate. Upon review of prior anesthetic records, his medical chart was found to list a propofol allergy. In discussion with the patient, he stated the reaction was rigidity. The anesthesiologist and patient agreed this was not an allergy. Thus, the patient was induced with propofol and given ketamine and fentanyl boluses throughout the procedure. During emergence, the patient exhibited myoclonic jerks in the upper and lower extremities. He was given intravenous meperidine for postoperative shivering; minutes after administration, the myoclonic jerks and rigidity worsened. The anesthesia team raised concern about Serotonin Syndrome. Intravenous midazolam improved the patient's myoclonic jerks and rigidity. CONCLUSIONS Patients with a history of rigidity/movement disorders during the perioperative period may have experienced Serotonin toxicity. It is possible, as in our case, for this history to have been labelled as an allergy to a perioperative medication. Clinicians should remain vigilant for patients at risk of developing Serotonin Syndrome, such as those taking outpatient medications that increase neuronal Serotonin.
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Serotonergic medications, herbal supplements, and perioperative Serotonin Syndrome
Canadian Journal of Anesthesia Journal canadien d'anesthésie, 2017Co-Authors: Mary E. Warner, Julian Naranjo, Emily M. Pollard, Toby N. Weingarten, Mark A. Warner, Juraj SprungAbstract:Objectif L’utilisation périopératoire d’agents sérotoninergiques augmente le risque de Syndrome sérotoninergique. Nous décrivons la survenue d’un Syndrome sérotoninergique suite à l’administration de fentanyl à deux patients prenant plusieurs agents sérotoninergiques. Éléments cliniques Deux patients prenant plusieurs médicaments sérotoninergiques ou suppléments à base de plantes médicinales (l’un de la fluoxétine, un supplément de curcuma et de l’acyclovir; l’autre de la fluxoétine et du trazodone) ont souffert d’un Syndrome sérotoninergique en période périopératoire alors qu’ils subissaient des interventions en clinique ambulatoire. Les deux patients ont subi une perte aiguë de conscience et une myoclonie généralisée après avoir reçu du fentanyl. Chez un patient, le Syndrome sérotoninergique s’est rapidement résolu suite à l’administration de naloxone. Chez l’autre, l’apparition du Syndrome sérotoninergique a été retardée et ne s’est manifestée qu’après le congé de la clinique; le Syndrome était probablement attribuable à l’utilisation peropératoire de midazolam pour la sédation. Conclusion Même de faibles doses de fentanyl administrées aux patients prenant plusieurs médicaments sérotoninergiques et suppléments à base de plantes médicinales peuvent déclencher un Syndrome sérotoninergique. La neutralisation rapide de la toxicité sérotoninergique chez un patient à l’aide de naloxone illustre la pathogenèse probablement médiée par des opioïdes du Syndrome sérotoninergique dans ce cas. Cela souligne également que la prise concomitante d’agents sérotoninergiques peut avoir un effet cumulatif qui provoque un Syndrome sérotoninergique. La présentation retardée du Syndrome sérotoninergique chez le patient ayant reçu une importante dose de midazolam suggère que les patients en clinique externe prenant plusieurs médicaments sérotoninergiques et recevant des benzodiazépines pourraient nécessiter un monitorage prolongé après leur intervention. Purpose 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. Clinical features 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. Conclusion 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.
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Serotonergic medications, herbal supplements, and perioperative Serotonin Syndrome.
Canadian journal of anaesthesia = Journal canadien d'anesthesie, 2017Co-Authors: Mary E. Warner, Julian Naranjo, Emily M. Pollard, Toby N. Weingarten, Mark A. Warner, Juraj SprungAbstract: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.
Julian Naranjo - One of the best experts on this subject based on the ideXlab platform.
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Serotonergic medications, herbal supplements, and perioperative Serotonin Syndrome
Canadian Journal of Anesthesia Journal canadien d'anesthésie, 2017Co-Authors: Mary E. Warner, Julian Naranjo, Emily M. Pollard, Toby N. Weingarten, Mark A. Warner, Juraj SprungAbstract:Objectif L’utilisation périopératoire d’agents sérotoninergiques augmente le risque de Syndrome sérotoninergique. Nous décrivons la survenue d’un Syndrome sérotoninergique suite à l’administration de fentanyl à deux patients prenant plusieurs agents sérotoninergiques. Éléments cliniques Deux patients prenant plusieurs médicaments sérotoninergiques ou suppléments à base de plantes médicinales (l’un de la fluoxétine, un supplément de curcuma et de l’acyclovir; l’autre de la fluxoétine et du trazodone) ont souffert d’un Syndrome sérotoninergique en période périopératoire alors qu’ils subissaient des interventions en clinique ambulatoire. Les deux patients ont subi une perte aiguë de conscience et une myoclonie généralisée après avoir reçu du fentanyl. Chez un patient, le Syndrome sérotoninergique s’est rapidement résolu suite à l’administration de naloxone. Chez l’autre, l’apparition du Syndrome sérotoninergique a été retardée et ne s’est manifestée qu’après le congé de la clinique; le Syndrome était probablement attribuable à l’utilisation peropératoire de midazolam pour la sédation. Conclusion Même de faibles doses de fentanyl administrées aux patients prenant plusieurs médicaments sérotoninergiques et suppléments à base de plantes médicinales peuvent déclencher un Syndrome sérotoninergique. La neutralisation rapide de la toxicité sérotoninergique chez un patient à l’aide de naloxone illustre la pathogenèse probablement médiée par des opioïdes du Syndrome sérotoninergique dans ce cas. Cela souligne également que la prise concomitante d’agents sérotoninergiques peut avoir un effet cumulatif qui provoque un Syndrome sérotoninergique. La présentation retardée du Syndrome sérotoninergique chez le patient ayant reçu une importante dose de midazolam suggère que les patients en clinique externe prenant plusieurs médicaments sérotoninergiques et recevant des benzodiazépines pourraient nécessiter un monitorage prolongé après leur intervention. Purpose 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. Clinical features 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. Conclusion 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.
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Serotonergic medications, herbal supplements, and perioperative Serotonin Syndrome.
Canadian journal of anaesthesia = Journal canadien d'anesthesie, 2017Co-Authors: Mary E. Warner, Julian Naranjo, Emily M. Pollard, Toby N. Weingarten, Mark A. Warner, Juraj SprungAbstract: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.
