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Phenytoin plasma levels after intraoperative administration, for the prevention of post-craniotomy seizures

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Summary

Since in a previous study (preliminary report) (18) the iv. administration of 15 mg × kg−1 of phenytoin (PNT) over 30 min in men produced toxic levels (25μg/ml), a smallerr iv. dose of 7 mg×kg−1 was given during anaesthesia to 80 patients under going craniotomy, for the prevention of post-operative seizures.

Plasma PNT concentrations were studied in 22 patients before its iv. infusion 20min, 40min, and 1, 2, 3, 5, 8 and 12 hours later.

Mean serum phenytoin levels were 9.3,31.9,27.8,25.5,19.4,17.2, 15.4 and 19.2* μg/ml respectively.

In this study it appeared that although the initial dose was 50% smaller than before, toxic levels were still encountered one hour after PNT administration (therapeutic range 10–25 μg/ml). Bearing in mind that in both our studies PNT appeared to have approximately the same efficacy in seizure prevention (from 95–97%), we suggest, that 7–10mg × kg−1 would be adequate if administered as an intraoperative iv. infusion over an hour and that whenever possible serial serum levels should be monitored.

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Author notes

  1. G. Foroglou

    Present address: Department of Neurological Surgery, Ahepa Hospital, Surgical Clinic of the University, Thessaloniki, Greece

Authors and Affiliations

  1. Department of Anaesthesiology, Ahepa Hospital, Thessaloniki, Greece

    M. Tsolaki, M. Yannacou-Peftoulidou & E. Sofianos

  2. Department of Nuclear Medicine, Ahepa Hospital, Thessaloniki, Greece

    Ph. Grammaticos

Authors
  1. M. Tsolaki
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  2. M. Yannacou-Peftoulidou
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  3. Ph. Grammaticos
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  4. E. Sofianos
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  5. G. Foroglou
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Tsolaki, M., Yannacou-Peftoulidou, M., Grammaticos, P. et al. Phenytoin plasma levels after intraoperative administration, for the prevention of post-craniotomy seizures. Acta neurochir 84, 36–38 (1987). https://doi.org/10.1007/BF01456348

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