Download PDF
CC BY-NC-ND 4.0 · J Neuroanaesth Crit Care 2015; 02(01): 023-027
DOI: 10.4103/2348-0548.148382
Original Article
Thieme Medical and Scientific Publishers Private Ltd.

Mannitol versus hypertonic saline for intra-operative brain relaxation during aneurysm surgery

Shalini Sharma
Department of Anaesthesia, DRPGMC, Tanda, Kangra, Himachal Pradesh
,
Vinod K. Grover
1   Department of Anaesthesia, PGIMER, Chandigarh, India
,
Preethy J. Mathew
1   Department of Anaesthesia, PGIMER, Chandigarh, India
› Author Affiliations
Further Information

Publication History

Publication Date:
08 May 2018 (online)

   Permissions and Reprints

Abstract

Background: The study was designed to compare the effects of equiosmolar and equivolemic 3% hypertonic saline (HTS) and 20% mannitol (M) on brain relaxation during aneurysm surgery. Materials and Methods: A prospective, randomised, double-blind study was undertaken in patients scheduled for surgical clipping of intracranial aneurysms presenting with Fisher grade I, II or III. The patients received either 300 mL of 3% hypertonic saline (HTS group) or 300 mL of 20% mannitol infusion (M group) during a period of 15 minutes at the start of scalp incision. The PaCO2 was maintained at 3.4-4.7 kilo Pascal, arterial blood pressure was maintained within ± 20% of baseline and central venous pressure was maintained at 5-10 cm of water. The haemodynamics, arterial blood gases and serum sodium concentration were compared. Surgeons assessed the condition of the brain as bulging, firm, satisfactorily relaxed and perfectly relaxed. An anaesthesiologist also assessed intra-operative brain relaxation. Results: The brain relaxation achieved with hypertonic saline was as good as that with mannitol. Urine output with mannitol was higher than with hypertonic saline (P < 0.04). Hypertonic saline caused an increase in serum sodium over one hour (P < 0.001) but resolved in 24 hours. Conclusions: The brain relaxation was equal in both the groups as assessed by the anaesthesiologist as well as the surgeon while the transient rise in serum sodium in hypertonic saline group returned to normal within 24 hours.

Keywords

Aneurysm surgery - hypertonic saline - mannitol
 

  • REFERENCES

  • 1 Drummond JC, Patel PM. Neurosurgical anaesthesia. In: Miller RD, Eriksson LI, Fleisher LA, Kronish JP, Young WL. editors. Miller's Anaesthesia. 7th ed.. Vol. 2. London: Churchill Livingstone Elsevier; 2009. p. 2066
    Google Scholar
  • 2 Vialet R, Albanese J, Thomachot L, Antonini F, Bourgouin A, Alliez B. et al. Isovolume hypertonic solutes (sodium chloride or mannitol) in the treatment of refractory posttraumatic intracranial hypertension: 2 mL/kg 7.5% saline is more effective than 2 mL/kg 20%mannitol. Crit Care Med 2003; 31: 1683-7
    CrossrefPubMedGoogle Scholar
  • 3 Battison C, Andrews PJ, Graham C, Petty T. Randomized, controlled trial on the effect of a 20% mannitol solution and a 7.5% saline/6% dextran solution on increased intracranial pressure after brain injury. Crit Care Med 2005; 33: 196-202
    CrossrefPubMedGoogle Scholar
  • 4 Harutjunyan L, Holz C, Rieger A, Menzel M, Grond S, Soukup J. Efficiency of 7.2% hypertonic saline hydroxyethyl starch 200/0.5 versus mannitol 15% in the treatment of increased intracranial pressure in neurosurgical patients-A randomized clinical trial. Crit Care 2005; 9: R530-40
    CrossrefPubMedGoogle Scholar
  • 5 Adelson PD, Bratton SL, Carney NA, Chesnut RM, du Coudray HE, Goldstein B. et al. American Association for Surgery of Trauma, Child Neurology Society, International Society for Pediatric Neurosurgery, International Trauma Anesthesia and Critical Care Society, Society of Critical Care Medicine, World Federation of Pediatric Intensive and Critical Care Societies. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Pediatr Crit Care Med 2003; 4: S25-7
    CrossrefPubMedGoogle Scholar
  • 6 Simma B, Burger R, Falk M, Sacher P, Fanconi S. A prospective, randomized, and controlled study of fluid management in children with severe head injury: Lactated Ringer's solution versus hypertonic saline. Crit Care Med 1998; 26: 1265-70
    CrossrefPubMedGoogle Scholar
  • 7 Gemma M, Cozzi S, Tommasino C, Mungo M, Calvi MR, Cipriani A. et al. 7.5% hypertonic saline versus 20% mannitol during elective neurosurgical supratentorial procedures. J Neurosurg Anesthesiol 1997; 9: 329-34
    CrossrefPubMedGoogle Scholar
  • 8 De Vivo P, Del Gaudio A, Ciritella P, Puopolo M, Chiarotti F, Mastronardi E. Hypertonic saline solution: A safe alternative to mannitol 18% in neurosurgery. Minerva Anestesiol 2001; 67: 603-11
    PubMedGoogle Scholar
  • 9 Wu CT, Chen LC, Kuo CP, Ju DT, Cecil OB, Chemg CH. et al. A comparison of 3% hypertonic saline and mannitol for brain relaxation during elective supratentorial brain tumour surgery. Anesth Analg 2010; 110: 903-7
    CrossrefPubMedGoogle Scholar
  • 10 Rozet I, Tontisirin N, Muangman S, Vavilala MS, Souter MJ, Lee LA. et al. Effect of equiosmolar solutions of mannitol versus hypertonic saline on intraoperative brain relaxation and electrolyte balance. Anesthesiology 2007; 107: 697-704
    CrossrefPubMedGoogle Scholar
  • 11 Fisher CM, Kistler JP, Davis JM. Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 1980; 6: 1-9
    CrossrefPubMedGoogle Scholar
  • 12 Todd MM, Warner DS, Sokoll MD, Maktabi MA, Hindman BJ, Scamman FL. et al. Prospective, comparative trial of three anesthetics for elective supratentorial craniotomy: Propofol/fentanyl, isoflurane/nitrous oxide, and fentanyl/nitrous oxide. Anesthesiology 1993; 78: 1005-20
    CrossrefPubMedGoogle Scholar
  • 13 Qureshi AI, Suarez JI. Use of hypertonic saline solutions in treatment of cerebral edema and intracranial hypertension. Crit Care Med 2000; 28: 3301-13
    CrossrefPubMedGoogle Scholar
  • 14 Bhardwaj A, Ulatowski JA. Hypertonic saline in brain injury. Curr Opin Crit Care 2004; 10: 126-31
    CrossrefPubMedGoogle Scholar
  • 15 Mortazavi MM, Andrew KR, Aman D, Christoph JG, Mohammadali MS, Shane T. et al. Hypertonic saline for treating raised intracranial pressure. Literature review with meta-analysis. J Neurosurg 2012; 116: 210-21
    CrossrefPubMedGoogle Scholar
  • 16 Suarez JL. Hypertonic saline for cerebral edema and elevated intracranial pressure. Cleve Clin J Med 2004; 71: S9-13
    CrossrefPubMedGoogle Scholar
  • 17 Mortimer DS, Jancik J. Administering hypertonic saline to patients with severe traumatic brain injury. J Neurosci Nurs 2006; 38: 142-6
    CrossrefPubMedGoogle Scholar
  • 18 White H, Cook D, Venkatesh B. The use of hypertonic saline for treating intracranial hypertension after traumatic brain injury. Anesth Analg 2006; 102: 1836-46
    CrossrefPubMedGoogle Scholar
  • 19 Ogden AT, Mayer SA, Connolly Jr. ES. Hyperosmolar agents in neurosurgical practice: The evolving role of hypertonic saline. Neurosurgery 2005; 57: 207-15
    CrossrefPubMedGoogle Scholar
  • 20 Ware ML, Nemani VM, Meeker M, Lee C, Morabito DJ, Manley GT. Effects of 23.4% sodium chloride solution in reducing intracranial pressure in patients with traumatic brain injury: A preliminary study. Neurosurgery 2005; 57: 727-36
    CrossrefPubMedGoogle Scholar
  • 21 Moss GS, Gould SA. Plasma expanders. An update. Am J Surg 1988; 155: 425-34
    CrossrefPubMedGoogle Scholar
  • 22 Shackford SR, Bourguignon PR, Wald SL, Rogers FB, Osler TM, Clark DE. Hypertonic saline resuscitation of patients with head injury: A prospective, randomized clinical trial. J Trauma 1998; 44: 50-8
    CrossrefPubMedGoogle Scholar
  • 23 Hirota K, Hara T, Hosoi S, Sasaki Y, Hara Y, Adachi T. Two cases of hyperkalemia after administration of hypertonic mannitol during craniotomy. J Anesth 2005; 19: 75-7
    CrossrefPubMedGoogle Scholar
  • 24 Makoff DL, da Silva JA, Rosenbaum BJ, Levy SE, Maxwell MH. Hypertonic expansion: Acid-base and electrolyte changes. Am J Physiol 1970; 218: 1201-7
    PubMedGoogle Scholar