Safety of tramadol as a pre-induction agent

To study the safety profile of intravenous use of tramadol immediately before induction of general anesthesia. Prospective, observational study. January 2005 to October 2007. Combined Military Hospital Multan, Military Hospital Rawalpindi and Railway Hospital Rawalpindi. 600 patients of ASA-I to ASA-III, aged 10.-50 years, undergoing elective surgery were selected for the study under convenient sampling. Children less than 10 years were excluded. Morbidly obese and patients with history of syncope, convulsive syncope, panic attacks and other convulsive events were excluded. Ladies undergoing caesarian section were also excluded from the study. The patients were injected 1.5mg/kg body weight, but not exceeding 100mg of tramadol [100mg of the drug diluted to 10 ml] intravenously, slowly over a period of two minutes as a part of pre-induction regimen. Patients were monitored for any untoward signs and symptoms for 10 min and all observations were recorded. The main complications / side-effects observed were nausea / vomiting, sweating, heart sinking and seizures in that order. Out of 600 patients, 47 [7.83%] patients complained of nausea alone and 9 [1.5%] patients had a bout of vomiting, 23 [3.88%] patients were observed to have sweating, 31 [5.17%] female patients complained of heart sinking and 2 [0.33%] patients had had seizure activity. We conclude that although the use of IV tramadol as a pre-induction agent is associated a low risk of side effects, but due to its potential to cause seizure activity, it is best avoided in the environments where adequate resuscitative measures are not available

Audit of spinal anaesthesia

Between 1st January 2002 to 10th October 2002, 50 cases underwent spinal anaesthesia for transvesical prostatectomy, inguinal herniorhaphy, transabdominal or vaginal hysterectomy and C-sections at HIT Hospital Taxila. Two cases had to be provided full fledged general anaesthesia. During the initial stages eight cases were given sedation with 1-2 mg of midazolam and analgesia with 5 mg of nalbuphine and 50% O[2] and 50% N[2]O. To five cases, sedation and analgesia was provided near the conclusion of operation. Two male patients of inguinal herniorhaphy developed urinary retention. One patient complained of backache. No patient developed postdural puncture cephalgia, meningitis or other complications. The analgesia extended into postoperative period