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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

Authors

  • 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

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