Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-26T22:09:00.318Z Has data issue: false hasContentIssue false
  • English
  • Français

Regular tramadol use does not affect the propofol dose requirement for induction of anaesthesia

Published online by Cambridge University Press:  01 September 2007

H. Kokki ,
J. Wennervirta ,
M. Laisalmi  and
A. Vakkuri
H. Kokki
Affiliation:
Kuopio University Hospital, Department of Anaesthesiology and Intensive Care, Kuopio, Finland University of Kuopio, Department of Pharmacology and Toxicology, Kuopio, Finland
J. Wennervirta
Affiliation:
Helsinki University Hospital, Jorvi Hospital, Department of Anaesthesiology and Intensive Care Medicine, Helsinki, Finland
M. Laisalmi
Affiliation:
Kuopio University Hospital, Department of Anaesthesiology and Intensive Care, Kuopio, Finland
A. Vakkuri*
Affiliation:
Helsinki University Hospital, Surgical Hospital, Department of Anaesthesiology and Intensive Care Medicine, Helsinki, Finland
*
Correspondence to: Anne Vakkuri, Department of Anaesthesiology and Intensive Care, Surgical Hospital, Helsinki University Hospital, P.O. Box 263, FI-00029 HUS, Helsinki, Finland. E-mail: [email protected]; Tel: +358 50 427 0653; Fax: +358 9 47188609
Get access

Summary

Background and objectives

An increased risk of awareness during general anaesthesia in patients receiving tramadol has been reported. We studied whether tramadol affects the amount of propofol required for induction of anaesthesia.

Methods

In this prospective controlled study, we evaluated 46 patients, half of whom used tramadol regularly. Entropy indices, state entropy and response entropy, were used to assess the level of hypnosis. Patients were anaesthetized with a propofol infusion (1 mg kg−1 min−1) until they first became unconscious, and further until they developed a burst suppression pattern in the electroencephalogram. The doses of propofol needed to reach these end-points were recorded.

Results

The amount (median, (range)) of propofol required for loss of consciousness was 2.0 (1.0–5.5) mg kg−1 and 2.4 (0.9–8.3) mg kg−1 (P = 0.95) in the tramadol users and controls, respectively. The amount of propofol required for burst suppression was 5.8 (3.9–12.7) mg kg−1 and 6.4 (2.9–15.1) mg kg−1 (P = 0.89) in the tramadol users and controls. There was no difference between the groups in state entropy and response entropy during different stages of induction of anaesthesia.

Conclusions

Tramadol did not affect the dose of propofol required to achieve loss of consciousness or burst suppression pattern in electroencephalogram during induction of general anaesthesia. However, there was a ninefold inter-individual variation in propofol dose requirement for loss of consciousness and a fivefold variation for reaching burst suppression. Due to extensive inter-individual variability, monitoring the level of hypnosis during general anaesthesia using propofol may enhance the correct dosage.

Keywords

TRAMADOLPROPOFOLELECTROENCEPHALOGRAM, bispectral indexENTROPYDRUG INTERACTIONS
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 9 , September 2007 , pp. 776 - 781
Copyright
Copyright © European Society of Anaesthesiology 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.http://raportit.nam.fi/raportit/kulutus/laakekulutus.htm: National Agency for Medicines in Finland.Google Scholar
2.Raffa, RB, Friderichs, E, Reimann, W et al. . Opioid and nonopioid components independently contribute to the mechanism of action of tramadol, an ‘atypical’ opioid analgesic. J Pharmacol Exp Ther 1992; 260: 275–285.Google Scholar
3.Grond, S, Sablotzki, A. Clinical pharmacology of tramadol. Clin Pharmacokinet 2004; 43: 879–923.CrossRefGoogle ScholarPubMed
4.Lehmann, KA, Horrichs, G, Hoeckle, W. The significance of tramadol as an intraoperative analgesic. A randomized double-blind study in comparison with placebo. Anaesthesist 1985; 34: 11–19.Google ScholarPubMed
5.Coetzee, JF, Maritz, JS, du Toit, JC. Effect of tramadol on depth of anaesthesia. Br J Anaesth 1996; 76: 415–418.CrossRefGoogle ScholarPubMed
6.Vaughan, DJ, Shinner, G, Thornton, C, Brunner, MD. Effect of tramadol on electroencephalographic and auditory-evoked response variables during light anaesthesia. Br J Anaesth 2000; 85: 705–707.CrossRefGoogle ScholarPubMed
7.Hallberg, E, Wadalius, M. Minskad effect av propofol vid kombination med tramadol. Information från Läkemedelsverket 2002; 13: 6.Google Scholar
8.Viertiö-Oja, H, Maja, V, Särkelä, M et al. . Description of the entropy algorithm as applied in the Datex-Ohmeda S/5 Entropy Module. Acta Anaesthesiol Scand 2004; 48: 154–161.CrossRefGoogle ScholarPubMed
9.Vakkuri, A, Yli-Hankala, A, Talja, P et al. . Time–frequency balanced spectral entropy as a measure of anesthetic drug effect in central nervous system during sevoflurane, propofol, and thiopental anesthesia. Acta Anaesthesiol Scand 2004; 48: 145–153.CrossRefGoogle ScholarPubMed
10.Vanluchene, AL, Vereecke, H, Thas, O et al. . Spectral entropy as an electroencephalographic measure of anesthetic drug effect: a comparison with bispectral index and processed midlatency auditory evoked response. Anesthesiology 2004; 101: 34–42.CrossRefGoogle ScholarPubMed
11.Goyal, P, Puri, GD, Pandey, CK, Srivastva, S. Evaluation of induction doses of propofol: comparison between endstage renal disease and normal renal function patients. Anaesth Intensive Care 2002; 30: 584–587.CrossRefGoogle ScholarPubMed
12.Mustola, ST, Baer, GA, Neuvonen, PJ, Toivonen, KJ. Requirements of propofol at different end-points without adjuvant and during two different steady infusions of remifentanil. Acta Anaesthesiol Scand 2005; 49: 215–221.CrossRefGoogle ScholarPubMed
13.Smith, I, White, PF, Nathanson, M, Gouldson, R. Propofol. An update on its clinical use. Anesthesiology 1994; 81: 1005–1043.Google ScholarPubMed
14.McCleane, GJ, Fogarty, DF, Watters, CH. Factors that influence the induction dose of propofol. Anaesthesia 1991; 46: 59–61.CrossRefGoogle ScholarPubMed
15.Schnider, TW, Minto, CF, Shafer, SL et al. . The influence of age on propofol pharmacodynamics. Anesthesiology 1999; 90: 1502–1516.CrossRefGoogle ScholarPubMed
16.Fodale, V, Tescione, M, Roscitano, C et al. . Effect of tramadol on bispectral index during intravenous anaesthesia with propofol and remifentanil. Anaesth Intensive Care 2006; 34: 36–39.CrossRefGoogle ScholarPubMed
17.Fodale, V, Pratico, C, Tescione, M et al. . Tramadol does not modify the bispectral index during anaesthesia with sevoflurane and remifentanil. Br J Anaesth 2005; 95: 212–215.CrossRefGoogle Scholar
18.de Wolff, MH, Leather, HA, Wouters, PF. Effects of tramadol on minimum alveolar concentration (MAC) of isoflurane in rats. Br J Anaesth 1999; 83: 780–783.CrossRefGoogle ScholarPubMed
19.De Witte, JL, Schoenmaekers, B, Sessler, DI, Deloof, T. The analgesic efficacy of tramadol is impaired by concurrent administration of ondansetron. Anesth Analg 2001; 92: 1319–1321.CrossRefGoogle ScholarPubMed
20.Tauzin-Fin, P, Sesay, M, Delort-Laval, S, Krol-Houdek, MC, Maurette, P. Intravenous magnesium sulphate decreases postoperative tramadol requirement after radical prostatectomy. Eur J Anaesthesiol 2006: 1–5.Google ScholarPubMed
21.Gnanadesigan, N, Espinoza, RT, Smith, R, Israel, M, Reuben, DB. Interaction of serotonergic antidepressants and opioid analgesics: is serotonin syndrome going undetected? J Am Med Dir Assoc 2005; 6: 265–269.CrossRefGoogle ScholarPubMed
22.Mahlberg, R, Kunz, D, Sasse, J, Kirchheiner, J. Serotonin syndrome with tramadol and citalopram. Am J Psychiatry 2004; 161: 1129.CrossRefGoogle ScholarPubMed
23.Gardner, JS, Blough, D, Drinkard, CR et al. . Tramadol and seizures: a surveillance study in a managed care population. Pharmacotherapy 2000; 20: 1423–1431.CrossRefGoogle Scholar
24.Islander, G, Vinge, E. Severe neuroexcitatory symptoms after anaesthesia – with focus on propofol anaesthesia. Acta Anaesthesiol Scand 2000; 44: 144–149.CrossRefGoogle ScholarPubMed
25.Walder, B, Tramer, MR, Seeck, M. Seizure-like phenomena and propofol: a systematic review. Neurology 2002; 58: 1327–1332.CrossRefGoogle ScholarPubMed
26.DeFriez, CB, Wong, HC. Seizures and opisthotonos after propofol anesthesia. Anesth Analg 1992; 75: 630–632.CrossRefGoogle ScholarPubMed
27.Sandin, RH, Enlund, G, Samuelsson, P, Lennmarken, C. Awareness during anaesthesia: a prospective case study. Lancet 2000; 355: 707–711.CrossRefGoogle ScholarPubMed
28.Ruppen, W, Ruesch, S, Shupfer, G, Christen, P. Propofol and questionable lack of sedation. Acta Anaesthesiol Scand 2005; 49: 425–426.CrossRefGoogle ScholarPubMed
29.Nordstrom, O, Engstrom, AM, Persson, S, Sandin, R. Incidence of awareness in total i.v. anaesthesia based on propofol, alfentanil and neuromuscular blockade. Acta Anaesthesiol Scand 1997; 41: 978–984.CrossRefGoogle ScholarPubMed