Key result
Administration of methadone and fentanyl in an 18-year-old male on fluoxetine triggered perioperative serotonin syndrome, which resolved after supportive care and fluoxetine washout.
Why the study?
Serotonin syndrome is a serious toxidrome associated with significant morbidity when undiagnosed or improperly managed.
Case Report (n=1)
No
Highlights the risk of serotonin syndrome when combining SSRIs with certain opioids like methadone and fentanyl during anesthesia.
May warrant caution with methadone/fentanyl in SSRI patients perioperatively; single case leaves open systematic risk assessment.
Serotonin Syndrome (SS) is a serious toxidrome associated with significant morbidity when undiagnosed or improperly managed. We report a perioperative case of serotonin syndrome in an adolescent male on fluoxetine (selective serotonin reuptake inhibitor-SSRI) therapy secondary to an intraoperative combined opioid analgesic regiment. He received low dose methadone and fentanyl for induction for a LeFort osteotomy, the presumed trigger for his perioperative SS. This study demonstrates the essential need for anesthesiologists’ vigilance regarding identifying SS, risk factors of SS and implementation of immediate and effective management.
No takes yet. Share an insight, caveat, or question.
Bergbower et al. (2021) conducted a case report in Serotonin Syndrome (n=1). Methadone and fentanyl was evaluated on Development of Serotonin Syndrome. Administration of methadone and fentanyl in an 18-year-old male on fluoxetine triggered perioperative serotonin syndrome, which resolved after supportive care and fluoxetine washout.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: