What is it about?
Mannitol + Hypertonic Saline Combination for Brain Relaxation during Craniotomy
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Why is it important?
Background: Hyperosmolar solutions are most commonly used to relax brain and facilitate intracranial surgery. This study was planned to compare the effects of three equiosmolar, equivolemic solutions (mannitol, 3% hypertonic saline, and mannitol+3% hypertonic saline) on intraoperative brain relaxation. Material and Methods: This prospective randomized study was conducted in 90 patients of age group 1865 years with traumatic brain injury undergoing craniotomy only after approval from the institutional ethics committee. Patients were randomly allocated into three groups; Group M ( received mannitol 300 ml), GROUP S (Group received 3% Hypertonic Saline 300 ml), and GROUP M+S (received mannitol 150 ml and 3% Hypertonic Saline 150 ml). Brain relaxation score was assessed by neurosurgeon on a four point scale as perfectly relaxed1, satisfactorily relaxed2, firm brain3, bulging brain4. All the patients were assessed for Glasgow coma score at 24 hrs postoperatively and at the time of discharge from the intensive care unit. Results: Grade 1 and Grade 2 brain relaxation scores were 4/14, 4/16 and 8/12 in Group M, Group S and Group M+S respectively. (p>0.05) Total urine out was 1453.33±376.68 ml in group M, 823.33±238.43 ml in group S and 1313.33±156.96 ml in group M+S respectively. (p<0.001) There was nonsignificant rise and fall of electrolyte (Na+ and K+) level amongst the groups. Additional rescue dose of mannitol was required in all three groups in 12, 8 and 10 patients respectively. Conclusion: All three hyperosmolar solutions are equally effective in providing adequate intraoperative brain relaxation during decompressive craniotomy in traumatic brain injury.
Perspectives
Background: Hyperosmolar solutions are most commonly used to relax brain and facilitate intracranial surgery. This study was planned to compare the effects of three equiosmolar, equivolemic solutions (mannitol, 3% hypertonic saline, and mannitol+3% hypertonic saline) on intraoperative brain relaxation. Material and Methods: This prospective randomized study was conducted in 90 patients of age group 1865 years with traumatic brain injury undergoing craniotomy only after approval from the institutional ethics committee. Patients were randomly allocated into three groups; Group M ( received mannitol 300 ml), GROUP S (Group received 3% Hypertonic Saline 300 ml), and GROUP M+S (received mannitol 150 ml and 3% Hypertonic Saline 150 ml). Brain relaxation score was assessed by neurosurgeon on a four point scale as perfectly relaxed1, satisfactorily relaxed2, firm brain3, bulging brain4. All the patients were assessed for Glasgow coma score at 24 hrs postoperatively and at the time of discharge from the intensive care unit. Results: Grade 1 and Grade 2 brain relaxation scores were 4/14, 4/16 and 8/12 in Group M, Group S and Group M+S respectively. (p>0.05) Total urine out was 1453.33±376.68 ml in group M, 823.33±238.43 ml in group S and 1313.33±156.96 ml in group M+S respectively. (p<0.001) There was nonsignificant rise and fall of electrolyte (Na+ and K+) level amongst the groups. Additional rescue dose of mannitol was required in all three groups in 12, 8 and 10 patients respectively. Conclusion: All three hyperosmolar solutions are equally effective in providing adequate intraoperative brain relaxation during decompressive craniotomy in traumatic brain injury.
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This page is a summary of: Comparison of Mannitol, Hypertonic Saline and Mannitol + Hypertonic Saline Combination for Brain Relaxation during Craniotomy, Indian Journal of Anaesthesia and Analgesia, January 2018, Red Flower Publication Private, Ltd.,
DOI: 10.21088/ijaa.2349.8471.51018.14.
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