Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Letter Case Reports
Epidural blood patch treatment for headache caused by a ruptured Tarlov cyst.
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Perioperative use of serotonergic agents increases the risk of serotonin syndrome. We describe the occurrence of serotonin syndrome after fentanyl use in two patients taking multiple serotonergic agents. ⋯ Even small doses of fentanyl administered to patients taking multiple serotonergic medications and herbal supplements may trigger serotonin syndrome. Prompt reversal of serotonin toxicity in one patient by naloxone illustrates the likely opioid-mediated pathogenesis of serotonin syndrome in this case. It also highlights that taking serotonergic agents concomitantly can produce the compounding effect that causes serotonin syndrome. The delayed presentation of serotonin syndrome in the patient who received a large dose of midazolam suggests that outpatients taking multiple serotonergic drugs who receive benzodiazepines may require longer postprocedural monitoring.
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Editorial Comment
We must ask relevant questions and answer with meaningful outcomes.
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The accuracy of patient prognostication varies extensively in studies of select populations. Prognostication is an important component of patient selection for elective surgery. This retrospective study assessed patient prognostication prior to elective surgery by comparing the observed with the expected number of deaths in such patients. ⋯ The observed number of deaths within one year of elective surgery is significantly lower than expected, with minimal inter-surgeon variation. These results suggest that patient selection for major elective non-cardiac surgery identified individuals with better than expected survival and whose survival was not adversely influenced by their surgery.