Open Access Open Access  Restricted Access Subscription or Fee Access

Predicting factors for electrocardiographic findings in patients with tramadol-induced seizure

Payman Asadi, MD, Vahid Mosnef Kasmaei, MD, Seyyed Mahdi Zia Ziabari, MD, Seyed Hashem Pourshafiei, Nazanin Noori Roodsari, MD, Faezeh Emami Sigaroudi, MD, Seyed Ahmad Naseri Alavi, MD

Abstract


Background: Seizure and electrocardiographic (ECG) abnormalities are of the most common complications of tramadol toxicity.

Objective: This study aimed to show the prevalence and predictive value of various factors for ECG findings in patients with tramadol-induced seizures.

Method: In a descriptive cross-sectional study, 146 patients with tramadol-induced seizures referred to Poursina Hospital, Guilan, Iran, between June and November 2018 were enrolled. The clinical manifestations, such as blood pressure, respiratory rate, and pulse rate (PR), and ECG parameters, including PR interval, QRS duration, R wave in aVR lead, and corrected QT interval, were assessed. Appropriate statistical tests were used to analyze the data.

Results: We showed that tramadol dose was significantly higher in patients with abnormal ECG findings compared with those with normal ECG pattern both upon admission (p = 0.001) and after 6 hours of admission (p = 0.001). The results found the predictive value of tramadol dose for abnormal ECG patterns upon admission (odds ratio (OR) 1.014, 95 percent CI 1.008 to 1.020) and 6 hours later (OR 1.008, 95 percent CI 1.003 to 1.013) in these patients. In addition, it was revealed that PR was a strong predictor of abnormal ECG findings in patients with tramadol-induced seizures upon admission (OR 1.085, 95 percent CI 1.038 to 1.134). Nevertheless, age only predicted abnormal findings 6 hours later (OR 1.104, 95 percent CI 1.019 to 1.195).

Conclusion: Tramadol dose, age, PR, and seizures frequency could be used as indicators of abnormal ECG findings in patients with tramadol-induced seizures.

Key points: The results of our study showed a high prevalence of sinus tachycardia, terminal S and R waves in aVR lead terminal S wave, and the combination of these abnormalities in this subset of patients.


Keywords


tramadol, seizure, electrocardiogram

Full Text:

PDF

References


Ahmadimanesh M, Shadnia S, Rouini MR, et al.: Correlation between plasma concentrations of tramadol and its metabolites and the incidence of seizure in tramadol-intoxicated patients. Drug Metab Pers Ther. 2018; 33(2): 75-83.

Asadi PM, Kasmaei V, Ziabari SZ, et al.: Prevalence of tramadol consumption in first seizure patients: A one-year cross-sectional study. Emergency. 2015; 3(4): 159-161.

Taghaddosinejad F, Mehrpour O, Afshari R, et al.: Factors related to seizure in tramadol poisoning and its blood concentration. J Med Toxicol. 2011; 7(3): 183-188.

Nasiri N, Abedi L, Hajebi A, et al.: Population size estimation of tramadol misusers in urban population in Iran: Synthesis of methods and results. Addict Health. 2019; 11(3): 173-182.

Rahimi HR, Soltaninejad K, Shadnia S: Acute tramadol poisoning and its clinical and laboratory findings. J Res Med Sci. 2014; 19(9): 855-859.

Talaie H, Panahandeh R, Fayaznouri M, et al.: Dose-independent occurrence of seizure with tramadol. J Med Toxicol. 2009; 5(2): 63-67.

Alizadeh Ghamsari A, Dadpour B, Najari F: Frequency of electrocardiographic abnormalities in tramadol poisoned patients: A brief report. Emergency. 2016; 4(3): 151-154.

Emamhadi M, Sanaei-Zadeh H, Nikniya M, et al.: Electrocardiographic manifestations of tramadol toxicity with special reference to their ability for prediction of seizures. Am J Emerg Med. 2012; 30(8): 1481-1485.

Hafezi Moghadam P, Zarei N, Farsi D, et al.: Electrocardiographic changes in patients with tramadol-induced idiosyncratic seizures. Turk J Emerg Med. 2016; 16(4): 151-154.

Zipes DP, Libby P, Bonow RO, et al.: Braunwald's Heart Disease E-Book: A Textbook of Cardiovascular Medicine. Amsterdam: Elsevier Health Sciences, 2018.

Wagner GS: Marriott's Practical Electrocardiography. Philadelphia, PA: Lippincott Williams & Wilkins, 2001.

Haeseler G, Foadi N, Ahrens J, et al.: Tramadol, fentanyl and sufentanil but not morphine block voltage-operated sodium channels. Pain. 2006; 126(1-3): 234-244.

Hafezi Moghadam P, Zarei N, Farsi D, et al.: Electrocardiographic changes in patients with tramadol-induced idiosyncratic seizures. Turk J Emerg Med. 2016; 16(4): 151-154.

Elwahab A, Elslam WA, Khalifa EAE: Cardiac manifestations of acute tramadol poisoning with special reference to their ability for predection of seizures, apnea and prognosis. Egypt J Forensic Sci Appl Toxicol. 2013; 220(1248): 1-15.




DOI: https://doi.org/10.5055/jom.2022.0718

Refbacks

  • There are currently no refbacks.