Abstract
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.
Highlights
Phenytoin is generally prescribed in patients with supratentorial tumors to decrease the risk of seizures during craniotomy [1,2]
Demographic data of patients and preoperative data included medical history, previous seizures and brain tumors characteristic were shown in table 1
Intraoperative plasma phenytoin level was decreased from preoperative period by 29.6% in 14 patients (14.68 vs 10.34 mcg/ml) and increased from preoperative period by 52% in 6 patients (9.62 vs 20.06 mcg/ml)
Summary
Phenytoin is generally prescribed in patients with supratentorial tumors to decrease the risk of seizures during craniotomy [1,2]. An additional intraoperative of phenytoin is generally used to prevent postoperative seizures but the effectiveness is controversy. Earlier studies showed that plasma phenytoin concentration may not be in the therapeutic range despite continued therapy [3,4]. It has been common practice to administer phenytoin intraoperatively, but the postoperative seizures remain to occur and plasma phenytoin level is not routinely measured. The objective of this research is to study perioperative changes of plasma phenytoin levels in normal practice and incidence of immediate postoperative seizure in patients undergoing craniotomy for supratentorial brain tumors
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