Serotonin Syndrome Following an Uncomplicated Orthopedic Surgery in a Patient With Post-Traumatic Stress Disorder.
Serotonin syndrome (SS) is a potentially life-threatening adverse drug reaction that may occur in patients treated with serotonin agonist medications. Medications responsible for serotonin syndrome include commonly prescribed antidepressants, anxiolytics, analgesics, and antiemetics. Veterans with post-traumatic stress disorder (PTSD) are at risk for polypharmacy with serotoninergic medications, given their psychological comorbidities and service-related musculoskeletal injuries. The perioperative period is a particularly vulnerable time owing to the use of high-dose anxiolytics and antiemetics frequently administered in this period, and places PTSD patients at higher risk of SS. Herein, we present the first case of SS in a young veteran with combat-related PTSD following an uncomplicated L5-S1 revision discectomy that highlights the unique set of clinical challenges and dilemmas faced when treating SS in a patient with severe postsurgical pain. As we are likely to encounter increasing numbers of veterans treated for PTSD who require multiple surgical procedures to treat their service-related injuries, health care providers need to be familiar with prevention, recognition, and the clinical challenges in the management of SS in the postoperative period.
Anesthesia Services, VA Medical Center, 4150 Clement Street, San Francisco, CA 94121.
Luiz Gustavo
LG
Schuch
Anesthesia Services, VA Medical Center, 4150 Clement Street, San Francisco, CA 94121.
Anita
A
Yip
Anesthesia Services, VA Medical Center, 4150 Clement Street, San Francisco, CA 94121.
Kiana Farah
KF
Nouri
Anesthesia Services, VA Medical Center, 4150 Clement Street, San Francisco, CA 94121.
Maren
M
Gregersen
Anesthesia Services, VA Medical Center, 4150 Clement Street, San Francisco, CA 94121.
Brian
B
Cason
Surgery Services, VA Medical Center, 4150 Clement Street, San Francisco, CA 94121.
Jasleen
J
Kukreja
Surgery Services, VA Medical Center, 4150 Clement Street, San Francisco, CA 94121.
Curtis
C
Wozniak
Anesthesia Services, VA Medical Center, 4150 Clement Street, San Francisco, CA 94121.
Marek
M
Brzezinski
D000328:Adult; D015283:Citalopram / Q000009:adverse effects / Q000627:therapeutic use; D017586:Diskectomy / Q000009:adverse effects; D064420:Drug-Related Side Effects and Adverse Reactions; D006801:Humans; D017116:Low Back Pain / Q000601:surgery; D008297:Male; D008803:Mianserin / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D000078785:Mirtazapine; D019637:Orthopedic Procedures / Q000009:adverse effects*; D017366:Serotonin Receptor Agonists / Q000009:adverse effects; D020230:Serotonin Syndrome / Q000150:complications / Q000209:etiology* / Q000523:psychology; D013313:Stress Disorders, Post-Traumatic / Q000188:drug therapy* / Q000523:psychology; D014728:Veterans / Q000523:psychology*
D017366:Serotonin Receptor Agonists; D015283:Citalopram; D008803:Mianserin; D000078785:Mirtazapine