Cargando…

Comparison of equiosmolar concentrations of hypertonic saline and mannitol for intraoperative lax brain in patients undergoing craniotomy

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 boar...

Descripción completa

Detalles Bibliográficos
Autores principales: Raghava, A., Bidkar, Prasanna Udupi, Prakash, M. V. S. Satya, Hemavathy, B.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4429334/
https://www.ncbi.nlm.nih.gov/pubmed/25984387
http://dx.doi.org/10.4103/2152-7806.156771
_version_ 1782371015084474368
author Raghava, A.
Bidkar, Prasanna Udupi
Prakash, M. V. S. Satya
Hemavathy, B.
author_facet Raghava, A.
Bidkar, Prasanna Udupi
Prakash, M. V. S. Satya
Hemavathy, B.
author_sort Raghava, A.
collection PubMed
description 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.
format Online
Article
Text
id pubmed-4429334
institution National Center for Biotechnology Information
language English
publishDate 2015
publisher Medknow Publications & Media Pvt Ltd
record_format MEDLINE/PubMed
spelling pubmed-44293342015-05-15 Comparison of equiosmolar concentrations of hypertonic saline and mannitol for intraoperative lax brain in patients undergoing craniotomy Raghava, A. Bidkar, Prasanna Udupi Prakash, M. V. S. Satya Hemavathy, B. Surg Neurol Int Original Article 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. Medknow Publications & Media Pvt Ltd 2015-05-08 /pmc/articles/PMC4429334/ /pubmed/25984387 http://dx.doi.org/10.4103/2152-7806.156771 Text en Copyright: © 2015 Raghava A. http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Original Article
Raghava, A.
Bidkar, Prasanna Udupi
Prakash, M. V. S. Satya
Hemavathy, B.
Comparison of equiosmolar concentrations of hypertonic saline and mannitol for intraoperative lax brain in patients undergoing craniotomy
title Comparison of equiosmolar concentrations of hypertonic saline and mannitol for intraoperative lax brain in patients undergoing craniotomy
title_full Comparison of equiosmolar concentrations of hypertonic saline and mannitol for intraoperative lax brain in patients undergoing craniotomy
title_fullStr Comparison of equiosmolar concentrations of hypertonic saline and mannitol for intraoperative lax brain in patients undergoing craniotomy
title_full_unstemmed Comparison of equiosmolar concentrations of hypertonic saline and mannitol for intraoperative lax brain in patients undergoing craniotomy
title_short Comparison of equiosmolar concentrations of hypertonic saline and mannitol for intraoperative lax brain in patients undergoing craniotomy
title_sort comparison of equiosmolar concentrations of hypertonic saline and mannitol for intraoperative lax brain in patients undergoing craniotomy
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4429334/
https://www.ncbi.nlm.nih.gov/pubmed/25984387
http://dx.doi.org/10.4103/2152-7806.156771
work_keys_str_mv AT raghavaa comparisonofequiosmolarconcentrationsofhypertonicsalineandmannitolforintraoperativelaxbraininpatientsundergoingcraniotomy
AT bidkarprasannaudupi comparisonofequiosmolarconcentrationsofhypertonicsalineandmannitolforintraoperativelaxbraininpatientsundergoingcraniotomy
AT prakashmvssatya comparisonofequiosmolarconcentrationsofhypertonicsalineandmannitolforintraoperativelaxbraininpatientsundergoingcraniotomy
AT hemavathyb comparisonofequiosmolarconcentrationsofhypertonicsalineandmannitolforintraoperativelaxbraininpatientsundergoingcraniotomy