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Continuing Education in Anaesthesia, Critical Care & Pain Advance Access published online on February 28, 2008
Continuing Education in Anaesthesia, Critical Care & Pain, 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
Specialist Registrar in Anaesthesia

James LH French, FRCA
Specialist Registrar in Anaesthesia

David M Levy, FRCA
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.


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  		Fig. 1 Serotonin (5-HT): structure.

 
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 . . . [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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