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. 2015 May 8:6:73.
doi: 10.4103/2152-7806.156771. eCollection 2015.

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

A Raghava  1 , Prasanna Udupi Bidkar  1 , M V S Satya Prakash  1 , B Hemavathy  1
Affiliations

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

A Raghava et al. Surg Neurol Int. .

Abstract

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.

Keywords: Brain relaxation; hypertonic saline; mannitol.

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Figures

Figure 1
Figure 1
Comparison of heart rate in two groups, P > 0.05 – Not significant
Figure 2
Figure 2
Comparison of mean blood pressure in two groups, P > 0.05 – Not significant
Figure 3
Figure 3
Comparison of CVP in two groups, *P< 0.05 – significant
Figure 4
Figure 4
Comparison of urine output in two groups
See this image and copyright information in PMC

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