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Perioperative Diagnosis and Treatment of Serotonin Syndrome Following Administration of Methylene Blue

Patient: Male, 67 Final Diagnosis: Serotonin syndrome Symptoms: Agitation • muscular spasticity, deficient muscular control • nystygmus • sweating • tachycardia Medication: Methylene Blue Clinical Procedure: Total abdominal colectomy Specialty: Anesthesiology OBJECTIVE: Unusual clinical course BACKG...

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Autores principales: Francescangeli, James, Vaida, Sonia, Bonavia, Anthony S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: International Scientific Literature, Inc. 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4917068/
https://www.ncbi.nlm.nih.gov/pubmed/27210537
http://dx.doi.org/10.12659/AJCR.897671
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author Francescangeli, James
Vaida, Sonia
Bonavia, Anthony S.
author_facet Francescangeli, James
Vaida, Sonia
Bonavia, Anthony S.
author_sort Francescangeli, James
collection PubMed
description Patient: Male, 67 Final Diagnosis: Serotonin syndrome Symptoms: Agitation • muscular spasticity, deficient muscular control • nystygmus • sweating • tachycardia Medication: Methylene Blue Clinical Procedure: Total abdominal colectomy Specialty: Anesthesiology OBJECTIVE: Unusual clinical course BACKGROUND: Serotonin syndrome (SS) involves serotonergic hyperactivity caused by excessive activation of 5-HT2A receptors. As the use of antidepressants increases, so does the population of patients at risk for developing this complication. The diagnosis is made based on current serotonergic medication use in conjunction with certain clinical signs. The severity of the clinical presentation may vary, especially when the complication occurs while the patient is under general anesthesia. As a result, the incidence of SS is likely underreported and treatment may be delayed, leading to life-threatening complications. CASE REPORT: A 67-year-old, American Society of Anesthesiologist physical status 3 male with multiple medical comorbidities, including anxiety/depression and chronic neck pain, presented for an elective laparoscopic total abdominal colectomy for colonic inertia. His intraoperative course was significant for SS likely triggered by the administration of methylene blue, which only became clinically apparent during anesthetic emergence. We considered and systematically ruled out other potential causes of his clinical condition. His management was primarily supportive, using hydration and benzodiazepine administration, and resulted in full neurologic recovery. CONCLUSIONS: SS is an underdiagnosed condition with limited treatment options beyond symptom management. Thus, vigilance, early diagnosis, and cessation of offending medications are of utmost importance. Anesthesiologists managing at-risk surgical patients must have a high clinical suspicion of perioperative SS if their patients exhibit tachycardia, hypertension, and hyperthermia together with clonus, agitation, diaphoresis, or hypertonia. These signs may be masked by general anesthesia and may only manifest themselves upon anesthetic emergence.
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spelling pubmed-49170682016-06-30 Perioperative Diagnosis and Treatment of Serotonin Syndrome Following Administration of Methylene Blue Francescangeli, James Vaida, Sonia Bonavia, Anthony S. Am J Case Rep Articles Patient: Male, 67 Final Diagnosis: Serotonin syndrome Symptoms: Agitation • muscular spasticity, deficient muscular control • nystygmus • sweating • tachycardia Medication: Methylene Blue Clinical Procedure: Total abdominal colectomy Specialty: Anesthesiology OBJECTIVE: Unusual clinical course BACKGROUND: Serotonin syndrome (SS) involves serotonergic hyperactivity caused by excessive activation of 5-HT2A receptors. As the use of antidepressants increases, so does the population of patients at risk for developing this complication. The diagnosis is made based on current serotonergic medication use in conjunction with certain clinical signs. The severity of the clinical presentation may vary, especially when the complication occurs while the patient is under general anesthesia. As a result, the incidence of SS is likely underreported and treatment may be delayed, leading to life-threatening complications. CASE REPORT: A 67-year-old, American Society of Anesthesiologist physical status 3 male with multiple medical comorbidities, including anxiety/depression and chronic neck pain, presented for an elective laparoscopic total abdominal colectomy for colonic inertia. His intraoperative course was significant for SS likely triggered by the administration of methylene blue, which only became clinically apparent during anesthetic emergence. We considered and systematically ruled out other potential causes of his clinical condition. His management was primarily supportive, using hydration and benzodiazepine administration, and resulted in full neurologic recovery. CONCLUSIONS: SS is an underdiagnosed condition with limited treatment options beyond symptom management. Thus, vigilance, early diagnosis, and cessation of offending medications are of utmost importance. Anesthesiologists managing at-risk surgical patients must have a high clinical suspicion of perioperative SS if their patients exhibit tachycardia, hypertension, and hyperthermia together with clonus, agitation, diaphoresis, or hypertonia. These signs may be masked by general anesthesia and may only manifest themselves upon anesthetic emergence. International Scientific Literature, Inc. 2016-05-23 /pmc/articles/PMC4917068/ /pubmed/27210537 http://dx.doi.org/10.12659/AJCR.897671 Text en © Am J Case Rep, 2016 This work is licensed under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)
spellingShingle Articles
Francescangeli, James
Vaida, Sonia
Bonavia, Anthony S.
Perioperative Diagnosis and Treatment of Serotonin Syndrome Following Administration of Methylene Blue
title Perioperative Diagnosis and Treatment of Serotonin Syndrome Following Administration of Methylene Blue
title_full Perioperative Diagnosis and Treatment of Serotonin Syndrome Following Administration of Methylene Blue
title_fullStr Perioperative Diagnosis and Treatment of Serotonin Syndrome Following Administration of Methylene Blue
title_full_unstemmed Perioperative Diagnosis and Treatment of Serotonin Syndrome Following Administration of Methylene Blue
title_short Perioperative Diagnosis and Treatment of Serotonin Syndrome Following Administration of Methylene Blue
title_sort perioperative diagnosis and treatment of serotonin syndrome following administration of methylene blue
topic Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4917068/
https://www.ncbi.nlm.nih.gov/pubmed/27210537
http://dx.doi.org/10.12659/AJCR.897671
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