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vencuronium), followed by intubation & ventilation succinylcholine should be avoided due to increased risk of hyperkalemia, arrhythmias & rhabdomyolysis avoid use of NSAIDs (the increase in body temperature is due to muscular activity & is not CNS mediated) Clinical Case Postmortem In the case of Meredith: the patient's recent history was not adequately obtained prior to treatment the clinical signs associated with serotonergic syndrome went unrecognized (improper clinical diagnosis) a pain medication (meperidine) which can increase serotonergic effects was given to treat shivering & pain, increasing the severity of her condition restraining the patient (who was acting irrationally due to altered mental status) compounded her increased muscle rigidity, contributing to worsening of hyperthermia agents to treat her agitation (benzodiazepines), serotonergic stimulation (cyproheptadine), and autonomic instability were not given in a timely manner APPENDIX: Serotonergic Mechanisms Involved in Drug Interactions : a serotonin (5-HT Buspirone 1A ) partial agonist used for treating generalized anxiety disorder (GAD)