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

doi:10.5055/jom.2022.0718

Authors

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 https://orcid.org/0000-0002-3602-4966

DOI:

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

Keywords:

tramadol, seizure, electrocardiogram

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.

Author Biographies

Payman Asadi, MD

Associate Professor, Clinical Research Development Unit of Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran

Vahid Mosnef Kasmaei, MD

Associate Professor, Clinical Research Development Unit of Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran

Seyyed Mahdi Zia Ziabari, MD

Associate Professor, Clinical Research Development Unit of Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran

Seyed Hashem Pourshafiei

Clinical Research Development Unit of Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran

Nazanin Noori Roodsari, MD

Associate Professor, Clinical Research Development Unit of Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran

Faezeh Emami Sigaroudi, MD

Clinical Research Development Unit of Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran

Seyed Ahmad Naseri Alavi, MD

Faculty of Medicine, Department of Neurosurgery, Tabriz University of Medical Sciences, Tabriz, Iran

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