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      Seizures after intravenous tramadol given as premedication

      case-report

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          Abstract

          A 35-year-old, 50-kg female with a history of epilepsy was scheduled for elective breast surgery (fibroadenoma) under general anaesthesia. She was given glycopyrrolate 0.2 mg, ondansetron 4 mg and tramadol 100 mg i.v. as premedication. Within 5 min, she had an acute episode of generalised tonic–clonic seizure that was successfully treated with 75 mg thiopentone i.v. and after 30 min, she was given general anaesthesia with endotracheal intubation. Surgery, intra-operative period, extubation and post-operative period were uneventful. We conclude that tramadol may provoke seizures in patients with epilepsy even within the recommended dose range.

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          Tramadol intoxication: a review of 114 cases.

          Mohammad Abdollahi, K Soltaninejad, G Sasanian … (2008)
          Tramadol as a centrally acting analgesic is extensively used in the management of moderate to severe pain. It slightly affects opioid receptors and inhibits the reuptake of norepinephrin and serotonin in the CNS. There are reports about toxicity and abuse of tramadol. The objective of the present study was to evaluate epidemiology of intentional tramadol intoxications. All poisoning cases that admitted to Loghman-Hakim Hospital Poison Center from April to May 2007 were studied. A total of 114 cases (82 men and 32 women) of intentional tramadol intoxications with the median age of 23.66 +/- 6.87 years (range 16-54 years) were identified. Other illicit drugs were found to be used in combination with tramadol in some of the cases, which among them benzodiazepines were the most common. Tramadol overdose has been one of the most frequent causes of drug poisoning in the country in the recent years, especially in male young adults with history of substance abuse and mental disorders. Nausea, vomiting, Central Nervous System (CNS) depression, tachycardia, and seizure are the most common findings in this kind of poisoning. Cardiopulmonary arrest was found as the cause of death in cases who had ingested more than 5000 mg tramadol.
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            Tramadol: seizures, serotonin syndrome, and coadministered antidepressants.

            V Sansone (2009)
            This ongoing column is dedicated to the challenging clinical interface between psychiatry and primary care-two fields that are inexorably linked.Tramadol (Ultram(®)) is a commonly prescribed analgesic because of its relatively lower risk of addiction and better safety profile in comparison with other opiates. However, two significant adverse reactions are known to potentially occur with tramadol-seizures and serotonin syndrome. These two adverse reactions may develop during tramadol monotherapy, but appear much more likely to emerge during misuse/overdose as well as with the coadministration of other drugs, particularly antidepressants. In this article, we review the data relating to tramadol, seizures, and serotonin syndrome. This pharmacologic intersection is of clear relevance to both psychiatrists and primary care clinicians.
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              Tramadol and seizures: a surveillance study in a managed care population.

              Michael D. Blough, D Shatin, Blair Anderson … (2000)
              To investigate the occurrence of tramadol-associated seizures. Retrospective cohort and case-control studies. UnitedHealth Group-affiliated independent practice model health plans, from different regions of the United States, contracting with large networks of physicians. Analysis of administrative data from a large U.S. managed care population. A cohort of 9218 adult tramadol users and 37,232 concurrent nonusers. Fewer than 1% of users (80) had a presumed incident seizure claim after the first tramadol prescription. Risk of seizure claim was increased 2- to 6-fold among users adjusted for selected comorbidities and concomitant drugs. Risk was highest among those aged 25-54 years, those with more than four tramadol prescriptions, and those with history of alcohol abuse, stroke, or head injury. A case-control study among users was conducted to validate incident seizure outcomes from medical records. Only eight cases were confirmed, and all had cofactors associated with increased seizure risk. In a general population, risk of seizure may be associated with long-term therapy with tramadol or the presence of cofactors, or confined to a small sensitive population subset.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Indian J Anaesth
                Journal ID (iso-abbrev): Indian J Anaesth
                Journal ID (publisher-id): IJA
                Title: Indian Journal of Anaesthesia
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 0019-5049
                ISSN (Electronic): 0976-2817
                Publication date (Print): Jan-Feb 2012
                Volume: 56
                Issue: 1
                Pages: 55-57
                Affiliations
                [1]Department of Anaesthesiology and Critical Care, RNT Medical College and Associated Group of Hospitals, Udaipur, Rajasthan, India
                Author notes
                Address for correspondence: Dr. Lalit Kumar Raiger, Dilshad Bhawan, 69 Chetak Circle, Udaipur, Rajasthan 313 001, India. E-mail: drlalitkumar@ 123456hotmail.com
                Article
                Publisher ID: IJA-56-55
                DOI: 10.4103/0019-5049.93345
                PMC ID: 3327072
                PubMed ID: 22529421
                SO-VID: 470a9255-7d72-4326-9321-c032d704f0f7
                Copyright © Copyright: © Indian Journal of Anaesthesia
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Anesthesiology & Pain management
                Keywords: tramadol-induced seizures,tramadol,seizures,serotonin syndrome
                Data availability:
                ScienceOpen disciplines: Anesthesiology & Pain management
                Keywords: tramadol-induced seizures, tramadol, seizures, serotonin syndrome

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