Delirium, Hyperthermia & Hypertensive Crisis after Uncomplicated Total Hip Arthroplasty in an HIV-Seropositive Patient on Highly Active Antiretroviral Therapy: A Case of Serotonin Syndrome after Meperidine Administration

This challenging case highlights the complex management of a 59-year old HIVseropositive man who underwent an uncomplicated revision total hip replacement with spinal anesthesia and propofol sedation. In the PACU, the patient developed delirium, hypertension, and hyperthermia after meperidine administration that warranted medical evaluation; the patient did not sustain residual sequelae. Meperidine administration may be associated with the occurrence of serotonin syndrome and may be excabertaed in HIV+ patients on highly active antiretroviral therapeutic agents. Total joint replacements are high risk procedures in all patients, however, additional considerations are warranted in HIV+ patients who develop complications secondary to co-existing morbidities and antiretroviral regimens that may impact anesthetic care