Abstract
BackgroundHyperosmolar solutions have been used in neurosurgery to modify brain bulk and prevent neurological deterioration. The aim of this animal study was to compare the short-term effects of equivolemic, equiosmolar solutions of mannitol and hypertonic saline (HTS) on cerebral cortical microcirculation in a rabbit craniotomy model.MethodsRabbits (weight, 2.0–3.0 kg) were anesthetized, ventilated mechanically, and subjected to a craniotomy. The animals were allocated randomly to receive a 3.75 ml/kg intravenous infusion of either 3.2 % HTS (group HTS, n = 8) or 20 % mannitol (group MTL, n = 8). Microcirculation in the cerebral cortex was evaluated using sidestream dark-field (SDF) imaging before and 20 min after the end of the 15-min HTS infusion. Global hemodynamic data were recorded, and blood samples for laboratory analysis were obtained at the time of SDF image recording.ResultsNo differences in the microcirculatory parameters were observed between the groups before the use of osmotherapy. After osmotherapy, lower proportions of perfused small vessel density (P = 0.0474), perfused vessel density (P = 0.0457), and microvascular flow index (P = 0.0207) were observed in the MTL group compared with those in the HTS group.ConclusionsOur findings suggest that an equivolemic, equiosmolar HTS solution better preserves perfusion of cortical brain microcirculation compared to MTL in a rabbit craniotomy model.
Highlights
Hyperosmolar solutions have been used in neurosurgery to modify brain bulk and prevent neurological deterioration
Lower values of proportion of perfused vessels (PPV) (P = 0.0379), Perfused small vessel density (PSVD) (P = 0.0474), perfused vessel density (PVD) (P = 0.0457), and MFI (P = 0.0207) were observed in the MTL group compared with the hypertonic saline (HTS) group
We demonstrated improved preservation of cerebral cortex microcirculation with HTS compared with MTL in an animal craniotomy model; the observed differences were caused mainly by a higher proportion of perfused vessels in the HTS group
Summary
Hyperosmolar solutions have been used in neurosurgery to modify brain bulk and prevent neurological deterioration. The aim of this animal study was to compare the short-term effects of equivolemic, equiosmolar solutions of mannitol and hypertonic saline (HTS) on cerebral cortical microcirculation in a rabbit craniotomy model. Hyperosmolar solutions have been used during neurosurgical procedures to improve operating conditions and prevent transdural herniation and neurological deterioration [1,2,3]. Mannitol (MTL) and hypertonic saline (HTS) have been evaluated in patients without intracranial hypertension [1, 2, 4, 5] with equivocal results. A recent meta-analysis comparing the intraoperative effects of HTS and MTL during neurosurgical procedures [6] demonstrated significantly increased odds of satisfactory.
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