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Indian Journal of Neurotrauma 2014; 11(02): 109-112
DOI: 10.1016/j.ijnt.2014.12.001
Original Article
Thieme Medical and Scientific Publishers Private Ltd.

Evaluation of changes in serum phenytoin level after craniotomy and its relation to intra operative blood loss

Bansal Hanish
a   Assistant Professor, Department of Neurosurgery, DMC&H, Ludhiana Punjab, India
,
Gupta Gulzar
b   Associate Professor, Department of Neurosurgery, DMC&H, Ludhiana Punjab, India
,
Kaushal Rakesh
c   Professor & Head, Department of Neurosurgery, DMC&H, Ludhiana, Punjab, India
,
Chaudhary K. Ashwani
d   Professor, Department of Neurosurgery, DMC&H, Ludhiana, Punjab, India
,
Kundra Sandeep
e   Associate Professor, Department of Anesthesia, DMC&H, Ludhiana, Punjab, India
,
Vishnu Gupta
f   Consultant, Department of Neurosurgery, Fortis Hospital, Ludhiana, Punjab, India
› Author Affiliations
Subject Editor:
Further Information

Publication History

20 September 2014

02 December 2014

Publication Date:
06 April 2017 (online)

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Abstract

Problems considered

Phenytoin is the drug of choice for post operative seizures while some studies have shown lack of efficacy of phenytoin in reducing seizure frequency after craniotomy, which in turn may be due to fall in plasma phenytoin levels after craniotomy.

Aims

The aim of the study is to describe changes, if any, in plasma phenytoin levels after craniotomy and its relation to intra operative blood loss.

Methods

This was a prospective study in which total of 50 consecutive patients were enrolled after taking written informed consent, who were either on oral phenytoin for at least 7 days or had received intravenous loading dose prior to craniotomy. All patients had serum phenytoin levels monitored 24 h pre operatively, immediately pre craniotomy before skin incision and post craniotomy after skin closure, and 24 h after craniotomy. All patients had intra operative blood loss calculated with help of modification of Gross formula.

Results

There was a mean fall of 23.6% in serum phenytoin level immediately following craniotomy which was statistically significant. Furthermore, analysis indicated that greater the operative duration and blood loss, greater was the fall in serum phenytoin level.

Conclusions

The study concludes that routine measurement of perioperative serum phenytoin levels in high risk patients may be of benefit in preventing post craniotomy seizures and an additional bolus dose should be given towards the end of surgery to patients with significant intra operative blood loss.

Keywords

Phenytoin - Craniotomy - Seizure
 

  • References

  • 1 Shaw M.D., Foy P.M.. Epilepsy after craniotomy and the place of prophylactic anticonvulsant drugs: discussion paper. J R Soc Med 1991; 84: 221-223
    PubMedSearch in Google Scholar
  • 2 Santis A.D., Villani R., Sinisi M., Stocchetti N., Perucca E.. Add-on phenytoin fails to prevent early seizures for supratentorial brain tumors: a randomized controlled study. Epilepsia 2002; Feb 43 (02) 175-182
    CrossrefPubMedSearch in Google Scholar
  • 3 Temkin N.R.. Prophylactic anticonvulsants after neurosurgery. Epilepsy Curr 2002; July 02 (04) 105-107
    CrossrefPubMedSearch in Google Scholar
  • 4 Tsolaki M., Yannacou-Peftoulidou M., Grammaticos P., Sofianos E., Foroglou G.. Phenytoin plasma levels after intraoperative administration, for the prevention of post-craniotomy seizures. Acta Neurochir (Wien) 1987; 84: 36-38
    CrossrefPubMedSearch in Google Scholar
  • 5 Franceschetti S., Binelli S., Casazza M.. et al Influence of surgery and anti epileptic drugs on seizures symptomatic of brain tumours. Acta Neurochir 1990; 103: 47-51
    CrossrefPubMedSearch in Google Scholar
  • 6 North J.B., Penha II R., Haneih A., Frewin D.B., Taylor W.B.. Phenytoin and postoperative epilepsy: a randomized double—blind trial. J Neurosurg 1982; 58: 272-278
    PubMedSearch in Google Scholar
  • 7 Deutschman C.S., Haines S.J.. Anticonvulsant prophylaxis in neurological surgery. Neurosurgery 1985; 17: 510-517
    CrossrefPubMedSearch in Google Scholar
  • 8 Freeman W.. Hazards of lobotomy: study of two thousand operations. J Am Med Assoc 1953; 152: 487-491
    CrossrefPubMedSearch in Google Scholar
  • 9 Mathew E., Sherwin A.L., WeIner S.A., Odusote K., Stratford J.G.. Seizures following intracranial surgery: incidence in the first post—operative week. Can J Neurol Sci 1980; 07: 285-290
    CrossrefPubMedSearch in Google Scholar
  • 10 Yeh J.S., Dhir J.S., Green A.L., Bodiwala D., Brydon H.L.. Changes in plasma phenytoin level following craniotomy. Br J Neurosurg Dec 2006; 20 (06) 403-406
    CrossrefPubMedSearch in Google Scholar
  • 11 Kuijlen J.M., Teernnstra O.P., Kessels A.G., Herpers M.J., Beuls E.A.. Effectiveness of antiepileptic prophylaxis used with supratentorial craniotomies: a meta analysis. Seizure 1996; 05: 291-298
    CrossrefPubMedSearch in Google Scholar
  • 12 Radhakrishnan M., Devaraj N.D., Umamaheswara Rao G.S., Subhash M.N.. Additional phenytoin is frequently needed in patients undergoing craniotomy for supratentorial tumor. Eur J Anaesthesiol Aug 2008; 25 (07) 601-603
    CrossrefPubMedSearch in Google Scholar
  • 13 Phunsawat A., Tuchinda L., Somboonviboon W.. Plasma phenytoin levels and incidence of seizure in patients undergoing craniotomy for supratentorial brain tumors. J Anesth Clin Res 2012; 03: 10 http://dx.doi.org/10.4172/2155-6148.1000255
    CrossrefPubMedSearch in Google Scholar
  • 14 Yang S.H., Lee K.S., Lee T.K., Jeun S.S., Park C.K., Hong Y.K.. Seizures in patients with brain tumors. J Korean Neurosurg Soc 2007; 41: 387-390
    PubMedSearch in Google Scholar