Probable tramadol-induced atypical serotonin syndrome in a patient receiving selective serotonin reuptake inhibitor and stopped at 10 days before surgery: A case report

Kang, Yoo; Min, Jinhye; Chae, Young Keun; Lee, Sang Eun; Je, Ui Jin; Lee, Yong Kyung

Case Report

Anesthetic Pharmacology

Anesthesia and Pain Medicine 2014;9(2):115-118.
Published online April 30, 2014.

Probable tramadol-induced atypical serotonin syndrome in a patient receiving selective serotonin reuptake inhibitor and stopped at 10 days before surgery: A case report

Yoo Kang, Jinhye Min, Young Keun Chae, Sang Eun Lee, Ui Jin Je, Yong Kyung Lee

Department of Anesthesiology and Pain Medicine, Myongji Hospital, Goyang, Korea. mdtweety@kd.ac.kr

Received: 30 July 2013 • Revised: 3 September 2013

Abstract

Tramadol can increase the serum level of serotonin, causing serotonin syndrome, which is a potentially life-threatening condition. Serotonin syndrome occurs when tramadol is used in combination with other drugs that affect serotonin. A patient who had been taking selective serotonin reuptake inhibitor and stopped at 10 days before surgery experienced intermittent heart rate elevation, tremor of the upper extremities and mental change after receiving an infusion of tramadol for postoperative pain control. Although he did not show the typical triad of serotonin syndrome (systemic autonomic dysfunction, neuromuscular impairment and mental status change), the patient was suspected to have serotonin syndrome caused by tramadol.

Key Words: Postoperative pain control, Selective serotonin reuptake inhibitors, Serotonin syndrome, Tramadol