The relationship of developing metabolic acidosis with antiepleptic drugs in craniotomy operations

Metabolic acidosis is a life-threatening complication in the perioperative, intraoperative and postoperative period. It can cause decreased cardiac output, electrolyte imbalance, surgical bleeding and neurological complications, even coma and death in surgical patients.

Topiramate and zonisamide are sulfonamide derivative compounds used in the treatment of epilepsy. It has been shown in studies that both drugs have a strong inhibition of carbonic anhydrase enzyme. Recent case reports suggest that both drugs may cause metabolic acidosis by lowering serum bicarbonate levels in some patients.

Aim in this study is to determine the relationship between preoperative, intraoperative and postoperative metabolic acidosis and to emphasize the importance of anesthesia management in patients who have undergone craniotomy and use antiepileptic drugs.

Inclusion Criteria:

• Patients undergoing intracranial surgery with craniotomy and using antiepileptic drugs
• ASA I-III
• Patients undergoing elective surgery

Exclusion Criteria:

• Patients with a surgical procedure time of more than 5 hours
• Patients who received more than 2 units of blood transfusion during the operation
• Patients taking other drugs that can cause metabolic acidosis
• Patients with diabetes mellitus, diabetes insipidus, hepatic or renal disease

Patients who underwent craniotomy and intracranial surgery at Trakya University Medical Faculty Hospital and used antiepileptic drugs were included in the study as a retrospective file review. The files of 35 patients who met the study criteria were reviewed retrospectively.