a b s t r a c tProblems 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. ScienceDirect journal homepage: www.elsevier.com/locate/ijnt t h e i n d i a n j o u r n a l o f n e u r o t r a u m a 1 1 ( 2 0 1 4 ) 1 0 9 e1 1 2 http://dx.
Background Improper prone positioning of obese patients for spine surgery can increase the intra-abdominal pressure (IAP), resulting in increased bleeding from epidural venous plexus. The choice of prone positioning frame can be an important determinant of the IAP.
Materials and Methods This prospective, randomized study was performed on obese patients (body mass index ≥ 30) scheduled for lumbar laminectomy. After administration of general anesthesia, patients were positioned prone either on Wilson’s frame (group W), or on horizontal bolsters (group H). IAP was recorded at three intervals: (1) in supine position, (2) 10 minutes after prone positioning, and (3) in prone position at the end of surgery. Intraoperative blood loss was measured quantitatively and assessed subjectively by the surgeon.
Results A total of 60 patients were enrolled with 30 patients in each group. IAP in supine position was similar in both groups. However, IAP 10 minutes after prone positioning was significantly higher at 11.44 ± 1.61 mm Hg in group W as compared to 9.56 ± 1.92 mm Hg in group H (p = 0.001). Similarly, IAP of 12.24 ± 1.45 mm Hg in group W, measured on completion of surgery was significantly higher than 9.96 ± 2.35 mm Hg in group H (p = 0.001). Mean total blood loss of 440.40 ± 176.98 mL in group W was significantly higher than 317.20 ± 91.04 mL in group H (p = 0.003).
Conclusion Obese patients positioned prone on Wilson’s frame had significantly higher IAP and blood loss compared to patients positioned on horizontal bolsters.
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