Tramadol

 Q: Tramadol is frequently used in ICUs. It can cause respiratory depression?

A) Yes

B) No

Answer: A

Tramadol is a part of various post-operative protocols as an analgesic. Providers should be aware that it comes with some inherent risks like respiratory depression. It is available as intravenous injection, immediate-release, and extended-release tablets. In ICUs, its administration may concurrently occur with benzodiazepines or other CNS depressants. This can be potentially fatal in a non-intubated patient. Tramadol also increases the risk of seizures.

Staff should be instructed that tramadol tablet or capsule particularly extended-release should not be split, break, chew, crush, or dissolve. 

 #pharmacology 

#surgical-critical-care

 Reference: 

 1. Dhesi M, Maldonado KA, Maani CV. Tramadol. [Updated 2020 Aug 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537060/

2. Stamer UM, Stüber F, Muders T, Musshoff F. Respiratory depression with tramadol in a patient with renal impairment and CYP2D6 gene duplication. Anesth Analg. 2008 Sep;107(3):926-9. doi: 10.1213/ane.0b013e31817b796e. PMID: 18713907.

3. Minkowitz H, Leiman D, Lu L, et al. IV Tramadol - A New Treatment Option for Management of Post-Operative Pain in the US: An Open-Label, Single-Arm, Safety Trial Including Various Types of Surgery. J Pain Res. 2020;13:1155-1162. Published 2020 May 22. doi:10.2147/JPR.S251175