Abstract
Background:Osmotherapy is the frequently used for the treatment of intracranial pressure. The purpose of the study was to compare the effect of equiosmolar solution of 3% hypertonic saline and 20% mannitol on brain relaxation in supratentorial tumor surgery.Methods:After institutional review board approval and written informed consent, 50 patients aged >18, Glasgow Coma Scale (GCS) >13 with ASA physical status 1, 2, and 3 scheduled to undergo craniotomy for supratentorial tumors were enrolled in this prospective, randomized study. Patients received 5 ml/kg of either 3% hypertonic saline (n = 25) or 20% mannitol (n = 25). Hemodynamic variables (heart rate [HR], SBP, DBP, MBP, and central venous pressure [CVP]), serum electrolytes, serum osmolality, urine output, and fluid balance were measured. The surgeon assessed the brain condition on four point scale (1 = perfectly relaxed, 2 = satisfactorily relaxed, 3 = firm brain, and 4 = bulging brain), who was blinded to study drug.Results:Brain relaxation was comparable in two groups and there was no significant difference (P = 0.633). The number of brain conditions classified as perfectly relaxed, satisfactorily relaxed, firm brain, and bulging brain in the HS group was 8, 13, 3, and 1, respectively, whereas it was 5, 17, 3, and 0, respectively, in the M group. There was no significant difference in hemodynamic variables between the two groups except CVP at 30 min (P = 048). Compared with mannitol, hypertonic saline caused increase in the serum osmolality at 120 min (P = 0.008) and in serum sodium at 120 min (P = 0.001). Urine output was higher with mannitol than hypertonic saline (P = 0.001).Conclusion:3% hypertonic saline and 20% mannitol are equally effective for brain relaxation in elective supratentorial tumor surgery and compared with mannitol, hypertonic saline was associated with less diuretic effect.
Highlights
One of the main goals of anesthesia during any neurosurgical procedure is to provide a relaxed or ‘slack’ brain that will allow retraction of the brain and thereby reduce brain retractor ischemia
Fifty neurosurgical patients admitted at our institution between October 2010 and march 2013 were enrolled in the study after satisfying the inclusion and exclusion criteria, and were randomized into group hypertonic saline (HS) and group M to receive either 3% HS (n = 25) or 20% mannitol (n = 25)
There was no significant difference between the groups in age, sex, weight, severity of illness, and brain pathology [Table 1] and the baseline hemodynamic and laboratory parameters were comparable in two groups [Table 2]
Summary
One of the main goals of anesthesia during any neurosurgical procedure is to provide a relaxed or ‘slack’ brain that will allow retraction of the brain and thereby reduce brain retractor ischemia. Osmotherapy is frequently used to reduce brain tissue volume and intracranial pressure (ICP) during neurosurgical operation. Mannitol (20%) and hypertonic saline (HS) are most commonly used hyperosmolar solutions in the treatment of elevated ICP.[14,23]. Mannitol is recommended as a first‐choice hyperosmotic agent for the treatment of increased ICP.[23] The hyperosmolarity of mannitol reduces ICP by withdrawing water from the brain parenchyma to the intravascular tissue with intact blood–brain barrier (BBB). It reduces blood viscosity and transiently increases cerebral blood flow leading to reflex cerebral vasoconstriction. The purpose of the study was to compare the effect of equiosmolar solution of 3% hypertonic saline and 20% mannitol on brain relaxation in supratentorial tumor surgery
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