Serotonin syndrome

Abstract

Introduction: The serotonin syndrome is a rare condition and includes an adverse reaction to the administration of a certain pharmacological group.
Objective: To show the clinical-anesthesiological evolution of a patient with serotonin syndrome.
Clinical case: A 37-year-old patient with a history of epilepsy, treated with sodium valproate. The patient was admitted to the hospital for second and third degree burns on both lower limbs for debridement and skin implant. The patient was treated with tramadol (50 mg every 6 hours), folic acid (5 mg every d), fluoxetine (20 mg every day), thiamin (100 mg every day), and vitamin C (500 mg every day). General anesthesia with laryngeal mask was administered. Induction with fentanyl (100 μg), ketamine (20 mg), propofol (150 mg). Laryngeal mask number 4 was placed. Spontaneous respiration in PSVPro modality with O₂, air and sevoflurane (CAM 0.6 %). When the surgical asepsis began, clonus was evident in both lower limbs. No hemodynamic or temperature changes (36.1 °C). Gasometry: metabolic alkalosis. Normal Ionogram. 5 mg of midazolam were administered. In the postoperative period, the laryngeal mask was removed. TA: 106/60. Pulse: 95 beats/min. Temperature: 35.8 °C, sat Hb: 98 %. Sustained clonus inducible to minimal bilateral stimulus, orbital clonus and hyperreflexia was found. The patient remained in the recovery room for two hours and was released for the special care room with instructions.
Conclusions: The evolution was satisfactory. When a patient arrives urgently, it is recommended to assess the coexisting diseases and their treatment; not doing so can bring fatal consequences.