Incidence and risk factors of hypotension after intravenous fosphenytoin administration

Kim, H. K.; Hwang, Ilseon; Koh, Im-Seok; Kim, D. W.

doi:10.1111/jcpt.12537

Cited by 8 publications

(3 citation statements)

References 15 publications

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“…Intravenous administration of fosphenytoin has shown to be associated with hypotension in 39% and also atrioventricular block in a retrospective case–control study. 19 Studies comparing adverse effects of phenytoin and fosphenytoin in the emergency department did not find a difference between the two. 20 The current study failed to show a significant difference in the incidence of hypotension, but the incidence was higher when phenytoin and fosphenytoin were coadministered with propofol than sevoflurane.…”

Section: Discussionmentioning

confidence: 98%

Hemodynamic Effects and QTc Changes with Intravenous Phenytoin and Fosphenytoin during Propofol and Sevoflurane Anesthesia

Maremanda,

Geetha,

Reddy

et al. 2023

J Neuroanaesth Crit Care

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Background Phenytoin is a commonly used antiepileptic drug (AED) for postoperative seizure prophylaxis; it is associated with adverse cardiovascular effects. Fosphenytoin is considered a safer alternative but can produce prolongation of QT interval. This hypothesis generating pilot study evaluated the changes in hemodynamics and the heart rate corrected QT interval (QTc) with phenytoin and fosphenytoin during propofol and sevoflurane anesthesia. Methods Eighty American Society of Anesthesiologists I and II patients aged 20 to 60 years undergoing elective supratentorial craniotomy requiring a loading dose of the intraoperative AED for seizure prophylaxis were randomized into four groups: group PP, receiving propofol (0.2 mg/kg/min) for maintenance and phenytoin (15 mg/kg) for seizure prophylaxis; group SP, receiving sevoflurane (1 minimal alveolar concentration) for maintenance and phenytoin(15mg/kg) for seizure prophylaxis; group PF, receiving propofol for maintenance and fosphenytoin (22.5 mg/kg) for seizure prophylaxis; and group SF, receiving sevoflurane for maintenance and fosphenytoin for seizure prophylaxis. The heart rate, systolic, diastolic, mean arterial pressure, and QTc were measured at baseline before anesthesia, during maintenance of anesthesia, and during various phases of AED infusion and up to 1 hour after completion of AED administration. Appropriate statistical analysis was done and a two-tailed p-value of less than 0.05 was considered significant. Results The incidence of changes in the heart rate and hypotension was not significant among the groups. Administration of fosphenytoin significantly prolonged QTc, which was more remarkable when coadministered with sevoflurane than with phenytoin. Conclusion Fosphenytoin did not confer hemodynamic benefits over phenytoin. Fosphenytoin produces prolongation of QTc, and when coadministered with sevoflurane, the prolongation is more significant, suggesting a possible additive effect.

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Section: Discussionmentioning

confidence: 98%

Hemodynamic Effects and QTc Changes with Intravenous Phenytoin and Fosphenytoin during Propofol and Sevoflurane Anesthesia

Maremanda,

Geetha,

Reddy

et al. 2023

J Neuroanaesth Crit Care

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“…Any event of hypotension was recorded. Hypotension was defined as: a) !20 mm Hg decrease in systolic blood pressure or a !10 mm Hg decrease in diastolic blood pressure (9), or b) a systolic blood pressure less than 90 mm Hg (10). Other side effects such as nausea, dizziness, nystagmus, loss of coordination and confusion were also recorded systematically.…”

Section: Study Proceduresmentioning

confidence: 99%

Intravenous fosphenytoin as treatment for acute exacerbation of trigeminal neuralgia: A prospective systematic study of 15 patients

et al. 2022

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Introduction Intravenous fosphenytoin is widely used for acute exacerbation of trigeminal neuralgia, however, few studies have investigated this treatment. We aimed to examine the efficacy and side effects of initial intravenous fosphenytoin plus oral tapering of phenytoin for exacerbation of trigeminal neuralgia. Methods Consecutive patients with primary trigeminal neuralgia were included in this prospective observational 90-days follow-up study. Data were collected using standardized interviews before, at 24 hours, day 7, 30 and 90 post loading dose. The primary outcome was the proportion of responders defined as a 50% reduction in pain intensity 24 hours post loading dose. Results We included 15 patients. Nine patients (60%) were responders. Pain intensity 24 hours post loading dose was reduced by 5.00 points on the numerical rating scale (p < 0.001), and at day 7 by 5.5 points (p < 0.001). The most common side effects were hypotension and dizziness. Conclusion Intravenous fosphenytoin relieves trigeminal neuralgia pain in most patients and provides a window for titrating prophylactic trigeminal neuralgia medications or planning neurosurgery. The decision to administer intravenous fosphenytoin should be taken with support from trigeminal neuralgia experts and involves considerations of co-morbidities and other treatment options for acute exacerbation of trigeminal neuralgia. Clinical Trial: Preregistered (ClinicalTrials.gov Identifier: NCT03712254

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“…Fosphenytoin, the prodrug of phenytoin is associated with hypotension and arrhythmias (e.g., atrioventricular blocks), with older age, infection, and infusion rates predisposing to these side effects [48,49].…”

Section: Na Channel Blockersmentioning

confidence: 99%

Cardiovascular complications of epileptic seizures

Oduah

Iwanowski

2020

Epilepsy & Behavior

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Seizure disorders are associated with multisystem complications. Cardiovascular complications account for a significant proportion of morbidity and mortality in these patients. As such, particular attention must be paid to the incidence of cardiovascular complications especially in populations at increased risk. The background for cardiac dysfunction lies in the interplay of genetic/molecular, autonomic, and iatrogenic factors that contribute to its onset. The purpose of this review was to summarize the state of literature in the last decade with regard to cardiac complications of epileptic seizures in order to increase awareness of short-and long-term debilitating cardiac complications as well as facilitate informed clinical decision-making. Taken together, the evidence provided in this review suggests that cardiac dysfunction following seizures should not be viewed as a separate entity but as an important complication of epileptic seizures. Appropriate cardiac therapy should be instituted in the postictal medical management of epileptic seizures. In acute states, postictal cardiac troponinemia (elevated cTn) should be worked up. Longer-term, monitoring for the development of cardiac structural and functional abnormalities is prudent.

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Incidence and risk factors of hypotension after intravenous fosphenytoin administration

Cited by 8 publications

References 15 publications

Hemodynamic Effects and QTc Changes with Intravenous Phenytoin and Fosphenytoin during Propofol and Sevoflurane Anesthesia

Hemodynamic Effects and QTc Changes with Intravenous Phenytoin and Fosphenytoin during Propofol and Sevoflurane Anesthesia

Intravenous fosphenytoin as treatment for acute exacerbation of trigeminal neuralgia: A prospective systematic study of 15 patients

Cardiovascular complications of epileptic seizures

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