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Anesth Analg 2008; 107:926-929
© 2008 International Anesthesia Research Society
doi: 10.1213/ane.0b013e31817b796e
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PATIENT SAFETY

Respiratory Depression with Tramadol in a Patient with Renal Impairment and CYP2D6 Gene Duplication

Ulrike M. Stamer, MD*, Frank Stüber, MD*, Thomas Muders, MD*, and Frank Musshoff, PhD{dagger}

From the *Department of Anesthesiology and Intensive Care Medicine, and {dagger}Institute of Forensic Medicine, University of Bonn, Bonn, Germany.

Address correspondence and reprint requests to Ulrike M. Stamer, Department of Anesthesiology and Intensive Care Medicine, University of Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany. Address e-mail to ulrike.stamer{at}ukb.uni-bonn.de.

Abstract

We observed opioid-related respiratory depression in a patient receiving tramadol via patient-controlled analgesia. Predisposing factors were the patient's genetic background and renal impairment. Complete recovery occurred after naloxone administration, thus confirming opioid intoxication. Analysis of the patient's genotype revealed a CYP2D6 gene duplication resulting in ultra-rapid metabolism of tramadol to its active metabolite (+)O-desmethyltramadol. Concomitant renal impairment resulting in decreased metabolite clearance enhanced opioid toxicity. This genetic CYP2D6 variant is particularly common in specific ethnic populations and should be a future diagnostic target whenever administration of tramadol or codeine is anticipated, as both drugs are subject to a comparable CYP2D6-dependent metabolism.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2008 by the International Anesthesia Research Society.