Does naloxone prevent seizure in tramadol intoxicated patients?

Tramadol poisoning has increased in recent years. Seizure is one of the side-effects of tramadol toxicity. There is a controversy about possible preventive effect of naloxone in tramadol poisoning induced seizure. Therefore, this study was performed to compare seizure incidence in tramadol poisoning patients who received and did not receive naloxone, as an opioid antagonist. This study involved prospective data collection followed by retrospective analysis on 104 tramadol poisoning patients who were admitted in a referral poisoning center. The incidences of seizure were compared between patients received naloxone and those did not. Outcome was considered as survived without or with complications and death. Logistic Regression analysis was used to determine the effects of different variables on seizure incidence. 70 [67.3%] of the patients were men. The mean age of the patients was 26.3 +/- 9 years old. 18.3% of the patients received naloxone in their treatment period. Seizure incidence was significantly higher among tramadol poisoning patients who did not receive naloxone compare with those received naloxone [14.1% vs. 5.1%]. Among different variable studied, age had a significant effect on predicting of seizure [odds ratio = 2.09; 95% of confidence interval: 1.82-2.26; P value, 0.004]. Although the seizure incidence was lower in patients with tramadol poisoning who received naloxone, the logistic regression did not support the preventive effect of naloxone on seizure in tramadol poisoning cases

Prevalence of delirium in opium users after coronary artery bypass graft surgery

Background: Postoperative cognitive dysfunction, especially delirium commonly occurs after cardiac surgery. Clinical evidences suggest an increase in delirium in opium abusers after Coronary Artery Bypass Graft [CABG] surgery. In this study, the prevalence of delirium in addict [opium user] and nonaddict patients after CABG were compared

Methods: In a cross-sectional study after obtaining institutional approval and informed consent, 325 patients candidate for elective CABG were included in the study. All patients with history of opium abuse met the criteria for opioid dependence using Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition definitions. Delirium after CABG was assessed in addict [opium user] and nonaddict patients up to a maximum of 5 days after surgery with the Intensive Care Delirium Screening Checklist

Results: A total of 325 patients were evaluated [208 without and 117 with a history of opium abuse]. Postoperative delirium occurred within 72 h after surgery in 44.31% of all patients. There was a significant difference in the prevalence of postoperative delirium between the opium users [80.7%] and nonaddict patients [25%] in the intensive care unit [P < 0.001]. Opium addiction was a risk factor for postoperative delirium after CABG Surgery

Conclusions: Delirium after CABG surgery is more prevalent in opium users compared with nonaddict patients. Therefore, opium abuse is a possible risk factor for postoperative delirium in cardiac surgical patients

General health status in a cohort of Iranian patients with intentional self poisoning: a preventive approach

Prevention of suicide is one of the most important issues of community medicine in the world. Because of high accessibility of people to different drugs in our society, one of the easiest ways of suicide is intentional self poisoning. In this study, demographic factors and health status of the patients with intentional self poisoning were evaluated. A cross sectional study was conducted in the poisoning referral center on 384 patients aged 15-40 years who committed intentional self poisoning. Information was gathered using two questionnaires about demographic characteristics and the general health status of the patients. 70.5% of the patients had easy accessibility to drugs. Most of the patients were women [62.5%] and single [51%]. History of psychological disease was demonstrated in 82.5% of patients. In terms of general health status, the most common problems were social dysfunction [97.57%] and depression [88.9%]. Easy accessibility to drugs and psychological problems may increase the risk of intentional self poisoning. Being religious and the consequent hopefulness may have a positive protecting effect for the prevention of intentional self-poisoning

Role of Benzodiazepines in the management of agitation due to inappropriate use of naltrexone

Agitation is an early symptom of the acute opioid withdrawal syndrome in addicts that may start by inappropriate use of naltrexone. The current drug interventions are not efficient or need critical care as well. This study compares the clinical role of midazolam and diazepam for the management of agitation due to inappropriate use of naltrexone. In this double-blind randomized controlled clinical trial, 44 agitated addicts, who did not use any type of benzodiazepine, not on systematic central nervous system depressant drugs, without any known hypersensitivity to diazepam, midazolam, or any other component of their formulation and had no evidence for the need of critical care, were enrolled. An i.v. stat dose of 0.1 mg/kg diazepam and 0.1 mg/kg stat dose of midazolam and a 0.1 mg/kg/h infusion of these drugs were administered for different groups of patients, respectively. Agitation scores were recorded at 30, 60, 120 min after the start of drug administration using Richmond Agitation Sedation Scale score. A significant difference between the mean onset of agitation control in midazolam group [at 67 min] and diazepam group [at 81 min] was recorded. The difference of mean agitation score in the midazolam and diazepam group was only significant at 120 min. There was a negative correlation between agitation score and time elapsed from naltrexone administration to admission. Midazolam and diazepam may not be considered suitable and perfect pharmacologic agents for the initial controlling of agitation induced by naltrexone.