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Continuing Education in Anaesthesia, Critical Care & Pain Advance Access originally published online on February 28, 2008
Continuing Education in Anaesthesia, Critical Care & Pain 2008 8(2):43-45; doi:10.1093/bjaceaccp/mkn006
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© The Board of Management and Trustees of the British Journal of Anaesthesia [2008]. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Serotonin and anaesthesia

Sadasivan Chinniah, FRCA, James L.H. French, FRCA and David M. Levy, FRCA
Specialist Registrar in Anaesthesia
Specialist Registrar in Anaesthesia
Consultant Anaesthetist
Nottingham University Hospitals NHS Trust
Queen's Medical Centre
Nottingham
NG7 2UH, UK
Fax: +44 115 978 3891 E-mail: dmlevy@nhs.net

Key Words: Serotonin (5-hydroxytryptamine, 5-HT) is a monoamine neurotransmitter synthesized in the central nervous system (CNS), gastrointestinal tract, and platelets. • 5-HT has diverse physiological and pathophysiological effects. Specific agonists and antagonists at various receptor subtypes are used pharmacologically. • Selective 5-HT reuptake inhibitors (SSRIs), the most commonly prescribed antidepressant, should not be omitted in the perioperative period. Withdrawal reactions are common. • 5-HT toxicity (serotonin syndrome), triggered by excessive serotonin concentrations in the CNS, causes autonomic, neurological, and cognitive dysfunction. Coma and hyperthermia are extreme manifestations. • 5-HT is one possible mediator of the widespread endothelial dysfunction in pre-eclampsia.

The first 10% of the full text of this article appears below.

Serotonin (5-hydroxytryptamine, 5-HT) is a monoamine neurotransmitter (Fig. 1) synthesized in serotonergic neurones in the central nervous system (CNS), enterochromaffin cells in the gastrointestinal tract, and platelets.

5-HT is involved in a number of physiological systems of relevance to the anaesthetist, including vascular reactivity, bronchomotor tone, platelet aggregation, pain modulation, and nausea and vomiting. The exact sites and modes of action of 5-HT remain ill-defined and elusive.

Many patients presenting for anaesthesia are taking medications with 5-HT agonist or antagonist activity. There is the potential for interaction with drugs administered in the perioperative period that modulate 5-HT activity. Toxic effects of excessive CNS 5-HT concentrations can precipitate intensive care unit (ICU) admission.


   Physiology
 
Synthesis

5-HT is produced by hydroxylation and decarboxylation of L-tryptophan in nerve terminals, and is stored in synaptic vesicles.1 It is found in the gastrointestinal tract, in platelets and . . . [Full Text of this Article]

Functions


   Antidepressants
 
Serotonin syndrome


   Migraine
 

   Gastro-intestinal tract
 
Postoperative nausea and vomiting

Carcinoid syndrome


   Pre-eclampsia/eclampsia
 

   Cardiology
 

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