"Tramadol is a centrally acting analgesic used to treat moderate-to-severe pain. Side effects of this medication include dizziness, confusion, drowsiness, seizures, and respiratory depression. Any of these side effects could negatively affect a pilot's performance and become a factor in an aviation accident. Due to the severity of aviation accidents, blood samples are often not available, and frequently, only tissue specimens are available for analysis. Therefore, understanding the distribution of a drug throughout all fluids and tissues of the body is important when trying to interpret drug impairment and/or intoxication. Our laboratory has determined the distribution of tramadol and its main active metabolite, O-desmethyltramadol, in various postmortem tissues and fluids obtained from 11 fatal aviation accident cases. Whole blood tramadol concentrations obtained from these 11 cases ranged from 81-2720 ng/mL. When available, 10 specimen types were analyzed for each case, including blood, urine, vitreous humor, liver, lung, kidney, spleen, muscle, heart, and brain. Distribution, expressed as specimen/blood ratio, for tramadol was 69 ± 74 in urine, 2.58 ± 3.26 in vitreous humor, 4.90 ± 3.32 in liver, 3.43 ± 2.31 in lung, 3.05 ± 1.49 in kidney, 5.15 ± 2.66 in spleen, 1.18 ± 0.85 in muscle, 2.33 ± 1.21 in brain, and 1.89 ± 1.01 in heart. Distribution coefficients obtained had coefficient of variations (CV) ranging from 49-126%. With such large CV's, the distribution coefficients have little use in predicting blood concentrations from the analysis of a tissue specimen. This study indicates that tramadol concentrations undergo significant postmortem changes."--Report documentation page.
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