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168 Journal of Neuroanaesthesiology and Critical Care | Vol. 3 • Issue 2 • May-Aug 2016 | Background and Objectives: Additional dose of anticonvulsants are administered during supratentorial craniotomy. It has impact on recovery time, haemodynamics and depth of anaesthesia. Our study compared the recovery time in patients who received additional anticonvulsant with those who received the regular dose during craniotomy. Patient and Methods: After the Institutional Review Board approval, the study was carried out in 36 patients who underwent supratentorial craniotomy. Patients were divided into two groups; Group 1: Regular dose, Group 2: Additional dose. Patients were anaesthetised using standard anaesthesia protocol. Anticonvulsant was administered during craniotomy, and the haemodynamics and changes in bispectral index were noted during and 1 h after administration of the anticonvulsant. Plasma anticonvulsant levels were measured before and after craniotomy. Extubation time, time to open eyes, obeys commands and orientations were noted. Patients were followed up for 48 h to note the occurrence of seizures. Results: Of 36 patients, 19 patients received regular dose; 17 received an additional dose. Age, sex, weight, tumour location and tumour pathology, dose of propofol, fentanyl administered were comparable between the two groups. There was no significant difference in recovery time between the two groups as they were analysed as additional versus regular dose. However, the subgroup analysis showed significant delay in recovery especially, time to obey commands (>15 min) and time to get orientation (>1 h) in patients who received additional dose of phenytoin. Although these differences looked clinically very significant, it was not statistically significant because of smaller sample size. Plasma anticonvulsant levels had significantly dropped in patients who received regular dose (P 0.004). There was a positive correlation between intravenous fluid administered and drop in plasma anticonvulsant level. Five patients had post-operative seizures, of which four had preoperative seizure. There was no correlation with postoperative plasma anticonvulsant levels and occurrence of post-operative seizures. Conclusion: Administration of additional dose of phenytoin causes delays the recovery and causes haemodynamic fluctuations. Administration of additional dose of sodium valproate did not affect either the recovery time or the haemodynamics. The presence of pre‐operative seizures is one of the significant risk factors for developing post-operative seizure. Due to the small sample size, it is very difficult to comment on the occurrence of post-operative seizures and the plasma anticonvulsant level. This warrants larger randomised control trials to see the correlation statistically.

journal of neuroanaesthesiology and critical care

Quantitative analysis of changes in cerebral oxygenation during induction of anaesthesia and in different positions in spine surgery using near-infrared spectroscopy