Plasma Phenytoin Levels and Incidence of Seizure in Patients Undergoing Craniotomy for Supratentorial Brain Tumors
Aitsaraporn Phunsawat*, Lawan Tuchinda and Wanna Somboonviboon
Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Chulalongkorn Hospital, Thailand
- *Corresponding Author:
- Phunsawat A
Department of Anesthesiology
Faculty of Medicine, Naresaun University
Phitsanulok 65000, Thailand
E-mail: [email protected]
Received date: July 17, 2012; Accepted date: October 17, 2012; Published date: October 27, 2012
Citation: Phunsawat A, Tuchinda L, Somboonviboon W (2012) Plasma Phenytoin Levels and Incidence of Seizure in Patients Undergoing Craniotomy for Supratentorial Brain Tumors. J Anesth Clin Res 3:255 doi: 10.4172/2155-6148.1000255
Copyright: © 2012 Phunsawat A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Phenytoin is often used to prevent seizures especially postoperative seizures after craniotomy for supratentorial brain tumors but the effectiveness is controversy. To investigate perioperative changes in plasma phenytoin levels and incidence of immediate postoperative seizure in patients undergoing craniotomy for supratentorial brain tumors. The study is prospective observational descriptive study. Twenty patients who received phenytoin and undergoing craniotomy for supratentorial brain tumors were enrolled in this study. The measurement of plasma phenytoin levels were done at preoperative, intraoperatively and postoperative period after the second dose of phenytoin. Demographic data of the patients were recorded include age, sex, weight, preoperative seizure, pathology, size and location of brain tumors, operative duration, amount of fluid replacement and blood loss. If postoperative seizure occurred, plasma phenytoin level was measured again. Intraoperative plasma phenytoin level was decreased from preoperative period by 29.6% in fourteen patients. Intraoperative plasma phenytoin level was increased from preoperative period by 52% in six patients. Three from 20 patients had immediate postoperative seizure and plasma phenytoin levels were 8.18, 16.43, 18.7 mcg/ml. In these three patients, bleeding at operative site was found in two patients while one more patient had cerebral edema with acute hydrocephalus. Intraoperative plasma phenytoin levels can be either increase or decrease from preoperative period. This study suggested that the routine measurement of perioperative plasma phenytoin levels in the high risk patients may be benefit for adding intraoperative dose of phenytoin to achieve the postoperative therapeutic level. However, seizures can occur from others complications after craniotomy such as bleeding, cerebral edema and acute hydrocephalus even in patients who had therapeutic range of phenytoin level.