English

Abstract

BACKGROUND: Twenty percent mannitol is widely used to reduce brain bulk and facilitate the surgical approach in intracranial surgery. However, a dose-response relationship has not yet been established. In this study, we compared the effects of 0.5, 1.0 and 1.5 gkg_1 mannitol on brain relaxation during elective supratentorial brain tumor craniotomy MATERIALS AND METHODS: In this prospective, randomized, single-blind study, we enrolled 48 patients undergoing supratentorial craniotomy for tumor resection. Patients were assigned to receive 0.5 gkg_1 (Group A), 1.0 gkg_1 (Group B) or 1.5 gkg_1 (Group C) of 20% mannitol at surgical incision. Brain relaxation was assessed immediately after opening of the dura on a scale (rozet quentin scale) ranging from 1 to 4 (Scale 1: perfectly relaxed (shrunken dura with prominent veins) (Scale 2: satisfactorily relaxed (only prominent veins) Scale 3: firm brain, Scale 4: bulging brain). Secondary outcome measures like mean arterial blood pressure, arterial blood electrolytes, blood PH, urine output and temperature also measured. RESULTS: There was no significant difference between the three groups regarding age, sex, body mass index, and brain tumor localization or size. We then used a proportional odds model to adjust for this unbalanced distribution and to assess the group effect (low-dose verses high-dose mannitol) on brain relaxation scores. Serum electrolytes, blood gases, urine output and hemodynamic stability are better maintained in group C. CONCLUSION: In this study, from the data and statistical analysis, shows that 1.5 gkg_1 OF 20% mannitol results in better brain relaxation scores than 0.5 and 1.0 gkg_1 in patients undergoing craniotomy for supratentorial brain tumor. In this study, it is concluded that 1.5 gkg_1 OF 20% mannitol gives better brain relaxation scores with blood electrolytes, blood PH, urine output and hemodynamic stability are better maintained.