Opioid-Free Total Intravenous Anesthesia in a Schizophrenia Patient with Retrosternal Goiter

Introduction: Schizophrenia patients on serotonergic antipsychotics serotonin syndrome (SS) with opioids or 5-HT3 antagonists, alongside postoperative delirium and respiratory compromise related to Opioids.Green anesthesia minimizes environmental risks.Case report: A female in her early 40s with schizophrenia and type 2 diabetes, on Aripiprazole, Quetiapine and Trihexyphenidyl, underwent thyroidectomy for a retrosternal goiter using opioid-free Total Intravenous Anesthesia (TIVA), avoiding Granisetron to reduce SS risk.No tracheomalacia or PONV occurred; minimal analgesics were needed, declined post-op.Discussion: This approach prevented SS, delirium, cognitive decline and respiratory complications by avoiding opioid and 5-HT3 receptor interactions. Conclusion:Opioid-free TIVA is safe and sustainable for high-risk patients.