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      Journal of Pain Research (submit here)

      This international, peer-reviewed Open Access journal by Dove Medical Press focuses on reporting of high-quality laboratory and clinical findings in all fields of pain research and the prevention and management of pain. Sign up for email alerts here.

      52,235 Monthly downloads/views I 2.832 Impact Factor I 4.5 CiteScore I 1.2 Source Normalized Impact per Paper (SNIP) I 0.655 Scimago Journal & Country Rank (SJR)

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      Tramadol use in a patient with Brugada syndrome and morphine allergy: a case report

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          Abstract

          Brugada syndrome is a rare syndrome characterized by arrhythmias and sudden death, particularly in younger individuals. A mutation in a gene encoding the human cardiac sodium channels is responsible for this syndrome. In the literature, there are several case reports of Brugada syndrome in association with the use of several anesthetic agents. Herein, we present our anesthetic practice and the use of tramadol in a 75-year-old female patient who underwent pulmonary lobectomy under general anesthesia and was diagnosed with Brugada syndrome.

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          Brugada syndrome 2012.

          Paola Berne, Josep Brugada (2012)
          Brugada syndrome (BS) is a cardiac disorder characterized by typical ECG alterations, and it is associated with a high risk for sudden cardiac death (SCD), affecting young subjects with structurally normal hearts. The prevalence of this disorder is still uncertain, presenting marked geographical differences. The syndrome has a genetic basis, and several mutations have been identified in genes encoding subunits of cardiac sodium, potassium, and calcium channels, as well as in genes involved in the trafficking or regulation of these channels. Most BS patients are asymptomatic, but those who develop symptoms present with syncope and/or SCD secondary to polymorphic ventricular tachycardia and/or ventricular fibrillation. Risk stratification is still challenging, especially in cases of asymptomatic BS patients. This is a brief review of recent advances in our understanding of the genetic and molecular bases of BS, arrhythmogenic mechanisms and clinical course, as well as an update of the tools for risk stratification and treatment of the condition.
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            Tramadol, fentanyl and sufentanil but not morphine block voltage-operated sodium channels.

            Martin Leuwer, Jörg Ahrens, Nilufar Foadi … (2006)
            Lidocaine-like sodium channel blocking drugs provide pain relief either by interrupting impulse conduction in neurons when applied locally in high concentrations or, when given systemically, by suppressing high-frequency ectopic discharges due to preferential drug binding to inactivated channel states. Lidocaine-like actions of opioids have frequently been demonstrated clinically. However, drug binding to resting and inactivated channel conformations has been studied systematically only in the case of meperidine. The aim of this in vitro study was to investigate the effects of four currently used opioids on heterologously expressed neuronal (NaV(1.2)) voltage-gated sodium channels. Block of sodium currents was studied at hyperpolarized holding potentials and at depolarized potentials inducing either fast- or slow-inactivation. Sufentanil, fentanyl and tramadol but not morphine reversibly suppressed sodium inward currents at high concentrations (half-maximum blocking concentrations (IC50) 49+/-4, 141+/-6 and 103+/-8 microM) when depolarizations were started from hyperpolarized holding potentials. Short depolarizations inducing fast-inactivation and long prepulses inducing slow-inactivation significantly (*p < or = 0.001) increased the blocking potency for these opioids. 15% slow inactivated channels reduced the respective IC50 values to 5+/-3, 12+/-2 and 21+/-2 microM. These results show that: (1) Sufentanil, fentanyl and tramadol block voltage-gated sodium channels with half-maximum inhibitory concentrations similar to the IC50 reported for meperidine. (2) Slow inactivation--a physiological mechanism to suppress ectopic activity in response to slow shifts in membrane potential--increases binding affinity for sufentanil, fentanyl and tramadol. (3) Morphine has no such effects.
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              Anesthetic management of patients with Brugada syndrome: a case series and literature review.

              Bradly J Narr, Steven J. Ackerman, Toby Weingarten … (2011)
              To review the anesthetic management and perioperative outcomes of patients diagnosed with Brugada syndrome (BrS) who were treated at a single centre and to compare those results with a comprehensive review of the existing literature. A retrospective chart review of anesthesia records from patients diagnosed with BrS at the Mayo Clinic was undertaken with the emphasis on administered drugs, ST segment changes, and occurrence of complications, including death, hemodynamic instability, and dysrhythmias. Eight patients were identified who underwent a total of 17 operative procedures from 2000 through 2010. A total of 20 significant ST segment elevations were recorded in four patients, several of which occurred in close temporal relation to anesthetic drug administration. These elevations resolved uneventfully. There were no recorded dysrhythmias, and recovery from anesthesia proceeded uneventfully. A literature review of patients with BrS yielded 52 anesthetics in 43 patients. The only recorded complications included unmasking of a Brugada ECG pattern, one episode of polymorphic ventricular tachycardia, which converted spontaneously to sinus rhythm, and one episode of postoperative ventricular fibrillation in the setting of epidural anesthesia. In this series and in the literature, BrS patients tolerated anesthesia without untoward disease-related complications. Propofol and local anesthetics carry a theoretical risk of arrhythmogenic potential in BrS patients, but clear evidence is lacking. However, awareness of their potential to induce arrhythmias warrants caution, especially with propofol infusions. Factors that might exacerbate ST segment elevations and subsequently lead to dysrhythmias (e.g., hyperthermia, bradycardia, and electrolyte imbalances, such as hyper- and hypokalemia and hypercalcemia) should be avoided or corrected.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Pain Res
                Journal ID (iso-abbrev): J Pain Res
                Journal ID (publisher-id): Journal of Pain Research
                Title: Journal of Pain Research
                Publisher: Dove Medical Press
                ISSN (Electronic): 1178-7090
                Publication date Collection: 2018
                Publication date (Electronic): 12 January 2018
                Volume: 11
                Pages: 191-194
                Affiliations
                Ege University School of Medicine, Department of Anesthesiology and Reanimation, Izmir, Turkey
                Author notes
                Correspondence: Cengiz Sahutoglu, Ege Universitesi Tip Fakultesi, Anesteziyoloji ve Reanimasyon AD, 35100, Bornova, Izmir, Turkey, Tel +90 232 390 2143, Fax +90 232 339 7687, Email csahutoglu@ 123456yahoo.com
                Article
                Publisher ID: jpr-11-191
                DOI: 10.2147/JPR.S150905
                PMC ID: 5769782
                SO-VID: e712b2b5-fc62-404b-a690-9e69dccf5e3d
                Copyright © © 2018 Sahutoglu et al. This work is published and licensed by Dove Medical Press Limited
                License:

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                History
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Anesthesiology & Pain management
                Keywords: brugada syndrome,tramadol,arrhythmia,analgesia,general anesthesia,postoperative complications,cardiac conduction defect
                Data availability:
                ScienceOpen disciplines: Anesthesiology & Pain management
                Keywords: brugada syndrome, tramadol, arrhythmia, analgesia, general anesthesia, postoperative complications, cardiac conduction defect

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