title: Is phenytoin administration safe in a hypothermic child?
abstract: A male neonate with a Chiari malformation and a leaking myelomeningocoele underwent ventriculoperitoneal shunt insertion followed by repair of myelomeningocoele. During anaesthesia and surgery, he inadvertently became moderately hypothermic. Intravenous phenytoin was administered during the later part of the surgery for seizure prophylaxis. Following phenytoin administration, the patient developed acute severe bradycardia, refractory to atropine and adrenaline. The cardiac depressant actions of phenytoin and hypothermia can be additive. Administration of phenytoin in the presence of hypothermia may lead to an adverse cardiac event in children. As phenytoin is a commonly used drug, clinicians need to be aware of this interaction.
authors.affiliation: Department of Neuroanaesthesiology, Neurosciences Centre, Room No. 709-A, C.N. Centre, All India Institute of Medical Sciences, New Delhi 110029, India. drhemantbhagat@rediffmail.com
authors.forename: Hemant
authors.initials: H
authors.lastname: Bhagat
authors.forename: Parmod K
authors.initials: PK
authors.lastname: Bithal
authors.forename: Rajendra S
authors.initials: RS
authors.lastname: Chouhan
authors.forename: Rajni
authors.initials: R
authors.lastname: Arora
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D000927:Anticonvulsants / Q000009:adverse effects; D001283:Atrioventricular Node / Q000187:drug effects* / Q000503:physiopathology; D001285:Atropine / Q000627:therapeutic use; D001831:Body Temperature / Q000187:drug effects / Q000502:physiology; D001919:Bradycardia / Q000139:chemically induced* / Q000503:physiopathology; D004305:Dose-Response Relationship, Drug; D062787:Drug Overdose / Q000503:physiopathology / Q000517:prevention & control; D004351:Drug Resistance / Q000502:physiology; D004837:Epinephrine / Q000627:therapeutic use; D006801:Humans; D007035:Hypothermia / Q000150:complications* / Q000503:physiopathology; D007231:Infant, Newborn; D007431:Intraoperative Complications / Q000139:chemically induced* / Q000503:physiopathology / Q000517:prevention & control; D008297:Male; D008591:Meningomyelocele / Q000601:surgery; D019635:Neurosurgical Procedures / Q000009:adverse effects; D010672:Phenytoin / Q000009:adverse effects*; D013566:Sympathomimetics / Q000627:therapeutic use; D017287:Ventriculoperitoneal Shunt
chemical_list: D000889:Anti-Arrhythmia Agents; D000927:Anticonvulsants; D013566:Sympathomimetics; D010672:Phenytoin; D001285:Atropine; D004837:Epinephrine