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CC-BY-NC-ND 4.0 · J Neuroanaesth Crit Care 2014; 01(01): 056-059
DOI: 10.4103/2348-0548.124851
Original Article
Thieme Medical and Scientific Publishers Private Ltd.

Coagulation effects of mannitol in combination with 0.9% normal saline or hydroxyethyl starch in patients undergoing supratentorial craniotomy: A preliminary report

Hemanshu Prabhakar
Department of Neuroanaesthesiology, All India Institute of Medical Sciences, New Delhi, India
,
Gyaninder Pal Singh
Department of Neuroanaesthesiology, All India Institute of Medical Sciences, New Delhi, India
,
Parmod Kumar Bithal
Department of Neuroanaesthesiology, All India Institute of Medical Sciences, New Delhi, India
,
Mani Kalaivani
1   Department of Biostatistics, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
› Author Affiliations
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Publication History

Publication Date:
27 April 2018 (online)

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Abstract

Background: Neurosurgical patients often require administration of both, mannitol and hydroxyethyl starch (HES). A recent in vitro study demonstrated that HES in combination with mannitol could disturb coagulation parameters and should be avoided in neurosurgical practice. The aim of our study was to evaluate coagulation abnormalities due to mannitol when administered alone and in combination with HES in patients undergoing craniotomy for various intracranial brain tumours. Materials and Methods: We enrolled 30 adult patients undergoing craniotomy. Patients were randomised into two groups using a computer generated randomisation chart. Interventions: Group A: Patients received 10 ml/kg 0.9% normal saline and 1 g/kg mannitol and Group B: Patients received 10 ml/kg, HES 130/0.4, and 1 gm/kg mannitol; immediately after induction of general anaesthesia. Rotational thromboelastography was done immediately after induction of general anaesthesia and 5 min after administration of mannitol. Measured parameters of blood coagulation were clotting time (CT) and clot formation time (CFT) with EXTEM and maximum clot firmness (MCF) with EXTEM and (FIBTEM). Results: Fourteen patients in each group completed the study. Insignificant change was noted in CT; CFT altered significantly from the baseline in both the groups (P < 0.05). MCF with FIBTEM did not change significantly from baseline (P > 0.05), but significantly differed between groups (P = 0.001). However, all values were in normal range. Conclusion: Mannitol 1 g/kg and HES 10 ml/kg can be safely administered in patients undergoing craniotomy for supratentorial tumours, without clinically significant changes in coagulation parameters.

Keywords

Coagulation - colloid - mannitol - neuroanaesthesia - thromboelastography
 

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