The management of cancer pain still poses a major challenge for clinicians. Tramadol is a centrally acting synthetic opioid analgesic. Its well-known side effects include nausea, vomiting, and dizziness; seizures are a rare side effect. Some reports have found that tramadol triggers seizure activity at high doses, whereas a few preclinical studies have found that this seizure activity is not dose-related. We herein present a case involving a patient with laryngeal cancer who developed seizures while on low-dose oral tramadol.

Spinal anestezi sonrası intraserebral hematom çok nadir görülen bir nöro-lojik komplikasyondur ve dura ponksiyonu sonrasında oluşan intraserebral hematomun mekanizması bilinmemektedir. Herhangi bir nörolojik ve koagülasyon bozukluğu olmayan ve transüretral prostatektomi planlanan 87 yaşındaki erkek hastaya spinal anestezi uygulandı. Spinal enjeksiyondan yaklaşık 2,5 saat sonra baş ağrısı, konuşmada bozulma ve somnolans gelişen hastanın beyin CT'de intraserebral hematom tespit edildi. Yoğun bakım ünitesinde entübe edilerek mekanik ventilasyona bağlandı. Hasta postoperatif 6. gün öldü. Spinal anestezi sonrası erken dönemde gelişen nörolojik bozuklukta geri dönüşsüz beyin hasarının gelişebileceği akla gelmeli ve zaman kaybetmeden radyolojik olarak araştırılmalıdır.Anahtar Kelimeler: Spinal anestezi, dura delinmesi, intraserebral hematom Intracerebral haematoma following spinal anaesthesia is a very uncommon neurologic complication and the mechanism of intracerebral haematoma following dural puncture is not known. An 87-year-old man, who did not have any neurologic or coagulation disorder, received spinal anaesthesia for transurethral prostatectomy. Approximately 2.5 hours after spinal injection, he developed headache, slurred speech and somnolence, and brain CT revealed intracerebral haematoma. The patient was admitted to the intensive care unit and was intubated and connected to mechanical ventilator. The patient died on the 6 th postoperative day. It should be kept in mind that irreversible brain damage can develop in neurological disorders that develop soon after spinal anaesthesia and that these should be promptly evaluated radiologically.Key Words: Spinal anaesthesia, dural puncture, intracerebral haematoma Introduction N eurological complications following spinal or epidural blocks have increasingly been reported in recent years. Neurological complications that can occur following spinal anaesthesia include headache, hearing loss, epidural, subdural or subarachnoid haemorrhage, epidural abscess, and intracranial hypotension (1-4). Among these complications, intracranial haemorrhage is a relatively uncommon but fatal complication (4). In the current case, we present development of intracerebral haematoma following spinal anaesthesia, which culminated with mortality. Case ReportThe patient was an 87-year-old man who had a history of hypertension for 10 years and chronic obstructive pulmonary disease for 8 years. He underwent transurethral prostatectomy surgery under spinal anaesthesia. He had no history of known cerebrovascular disease, head trauma or headache. Physical examination and neurologic evaluation of the patient were not significant. Blood tests including coagulation were within reference ranges.Oral antihypertensive medication was continued in the preoperative period. After cannulation of a peripheral vein, 500 mL of 0.9% isotonic saline was infused within 30 minutes in the premedication room. The patient was transferred to the operation room and routine monitoring was conducted. The patient's non-in...

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BackgroundHypoxemia caused high altitude leads to an increase and variability in CSF volume. The purpose of this prospective study was to detect the differences, if any, between moderately highlanders and lowlanders in terms of anaesthetic parameters under neuroaxial anaesthesia.MethodsConsecutive patients living at moderately high altitude (Erzurum, 1890 m above the sea level) and sea level (Sakarya, 31 m above the sea level) scheduled for elective lower extremity surgery with spinal anaesthesia were enrolled in this study (n = 70, for each group). Same anaesthesia protocol was applied for all patients. Spinal anaesthesia was provided with hyperbaric bupivacaine 0.5 %, 9 mg (1.8 mL) in all patients. Anaesthetic characteristics and hemodynamic parameters of patients were recorded. The findings obtained in two different altitudes were compared using appropriate statistical tests. If data was not normally distributed, comparisons were determined using the Mann–Whitney U-test. Comparisons were determined using the Independent T test when data was normally distributed and Fisher’s exact test was used to compare the percentage values.ResultsDuration of the block procedure (minutes) was significantly shorter at the sea level (14.34 ± 0.88) than at moderate altitude (20.38 ± 1.46) (P < 0.001). Motor block duration (minutes) was higher at the sea level compared to the moderate altitude (310.2 ± 104.2, 200.4 ± 103.2; respectively; P < 0.05). Also, the sensory block time (minutes) was higher at the sea level compared to moderate altitude (200.2 ± 50. minutes vs. 155.2 ± 60.7 min; respectively; P < 0.05). Moderate altitude group had significantly higher MABP values at baseline, during surgery and at postoperative 1st and 2nd hours than in the sea level group (P < 0.05, for all). Moderately high altitude group had lower heart rate values at baseline, during surgery and postoperative 1st and 2nd hours compared with the sea level group (P < 0.05). PDPH was seen more frequently (7.14 vs. 2.85 %; P < 0.05) at moderate altitude.ConclusionsHemodynamic variations and more anaesthetic requirements following the spinal anaesthesia may be observed at moderately high altitudes compared to the sea level.Trial registrationAustralian New Zealand Clinical Trials Registry: ACTRN12614000749606.