Delayed Recovery from General Anaesthesia: A Post-operative Diagnostic Dilemma and Implications of ICU Management of Serotonin Toxicity. Case report: Comment

This case report by Naik et al. of probable serotonin toxicity in a patient previously taking venlafaxine, who was then given intravenous methylthionimium (aka methylene blue) during a parathyroid surgical procedure (1), is a typical example of a perennial problem in medical publishing. The case is unremarkable, except for the fact that it is of concern that methylene blue was given at all, bearing in mind that such interactions have been well documented for nearly a decade. Neither was it, nor should it have been, a ‘diagnostic dilemma’. Therefore it is also of concern that methylene blue was not recognized as the culprit in the interaction until after a significant (life endangering) delay.