title: Sudden asystole during craniotomy: unrecognized phenytoin toxicity.
abstract: The authors report a case of intraoperative sinus arrest in an otherwise healthy patient undergoing craniotomy for aneurysm clipping after mild subarachnoid hemorrhage. The sinus arrest was precipitated by a rapid infusion of 1500 mg phenytoin and was successfully treated with standard resuscitative measures. The differential diagnosis of intraoperative cardiac arrest and the mechanisms of action of phenytoin are discussed. The authors emphasize the role of phenytoin in cerebral protection.
authors.affiliation: Department of Anesthesiology, University of Texas-Houston Health Science Center, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Berry
authors.forename: A
authors.initials: A
authors.lastname: Kowalski
authors.forename: S A
authors.initials: SA
authors.lastname: Fletcher
mesh_terms: D000927:Anticonvulsants / Q000008:administration & dosage / Q000009:adverse effects* / Q000494:pharmacology; D003399:Craniotomy; D003937:Diagnosis, Differential; D005260:Female; D006323:Heart Arrest / Q000139:chemically induced*; D006801:Humans; D007262:Infusions, Intravenous; D002532:Intracranial Aneurysm / Q000601:surgery; D007431:Intraoperative Complications / Q000139:chemically induced*; D008875:Middle Aged; D018696:Neuroprotective Agents / Q000494:pharmacology; D010672:Phenytoin / Q000008:administration & dosage / Q000009:adverse effects* / Q000494:pharmacology; D012151:Resuscitation; D013345:Subarachnoid Hemorrhage / Q000601:surgery
chemical_list: D000927:Anticonvulsants; D018696:Neuroprotective Agents; D010672:Phenytoin