Evaluation the effects of intraarterial tramadol to the vessel wall in rats

Aim of the study:Accidental intra-arterial (IA) drug application in the practice of anesthesia and intensive care is a rare iatrogenic complication but may result in serious morbidity and mortality. Most IA applications are performed by medical care givers or drug addicts by accidentally assuming the arterial catheterization as venous access. IA application of many opioid agents have known effects, whereas the impact of IA tramadol on arteries are still unidentified. . In this experimental study , examination of histological effects of IA tramadol application on arterial wall on normal and electrone microscopy is aimedMethods:This randomized, controlled, experimental study is carried out on 33 Wistar albino adult male rats after the approval of the ethic committee . In all groups anesthesia is provided with intraperitoneal (ip) 50 mg/kg ketamin and 10 mg/kg xylazine hydrochlorid. After laparotomy, dissecting the radix mezentery is disected reaching aorta abdominalisand then injections are performed under arteria renalis furcation. The middle section of the abdominal aorta in the distal of the injected region is discarded and resected. In the conrol group (n=5), after the laparotomy, abdominal aorta is resected without injection. In other four groups, after laparotomy, radix mezentery is disected, abdominal aorta is reached and injections are performed at 0.1 mL/sn under the furcation point of arteria renalis. After every injection, 0.1 mL saline is applied. Saline equivalent of 10 mg/kg tramadol is given, and in Sham 5 group (n=7) in the 5th minute, in Sham 30 group (n=7) in the 30th minute of the injection abdominal aorta is resected. With the injection of 10 mg/kg tramadol, In Tramadol 5 Group (n=7) in the 5th minute, in Tramadol 30 group, in the 30th minute abdominal aorta is resected. Samples are examined histopathologically on normal and electrone microscope. The integrity of the endothelial, the damage and cell morphology, subendothelial tissue condition, tunica media and tunica adventitia tissue integrity is evaluated. Damage level is scored on a range between 0 to 4. Damage scores are uploaded to SPSS 15.0 programme and analysed via Pearson Chi-Square, Kruskal Wallis, Mann Whitney U tests. p<0.05 is accepted as statistically valid .Results:There was no damage in the arteries of the Control group. In Sham 30 group a mild endothelial damage is observed. In Tramadol 5 Group, medium-serious damage is detected (p<0.05) while in Tramadol 30 group, serious damage in arteries, including damage in the adventitia layer is observed (p<0.05).Conclusion:Accidental application of tramadol in arteries, causes serious damage in all arterial layers. Clinicians, who use tramadol for analgesia, should pay attention to the accidental IA tramadol injection and operationalize precaution protocoles. Furher studies are needed to understand damage mechanisms of IA Tramadol and to form treatment protocoles.