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. 2024 Jul 13;16(7):e64448.
doi: 10.7759/cureus.64448. eCollection 2024 Jul.

Serial Assessment of Hemodynamic and Cerebrovascular Changes After Administration of Mannitol in Postoperative Neurosurgical Patients in the Intensive Care Unit: A Combined Transthoracic and Transcranial Color Doppler Study

Soumya Madhusudan  1 , Smita Vimala  2 , Manikandan S  2 , Ayesha Goyal  3 , Yatiraj Singi  4
Affiliations

Serial Assessment of Hemodynamic and Cerebrovascular Changes After Administration of Mannitol in Postoperative Neurosurgical Patients in the Intensive Care Unit: A Combined Transthoracic and Transcranial Color Doppler Study

Soumya Madhusudan et al. Cureus. .

Abstract

Introduction: Mannitol is widely used in neurosurgical units to mitigate raised intracranial pressure and cerebral edema, crucial in postoperative management. Its hyperosmolar properties reduce brain extracellular fluid, thereby altering cerebral perfusion and cardiac dynamics. However, the temporal and combined effects of mannitol on cardiovascular and cerebrovascular parameters remain inadequately explored in postoperative settings.

Methods: This prospective observational study enrolled 20 adult patients who underwent elective craniotomies for tumor excision. Mannitol was administered to the patients at a dose of 0.5 mg/kg/dose as a bolus dose over 20 to 30 minutes. The time interval was eight hours between the doses (scheduled dosing). Patients received their first dose of mannitol in the ICU after eight hours of intraoperative dose. The patients were given mannitol for two postoperative days and followed up for two days in the postoperative period. Transthoracic echocardiography and transcranial color Doppler were used to assess cardiovascular and cerebrovascular parameters at multiple intervals post-mannitol administration.

Results: Significant increases in mean flow velocities were observed bilaterally immediately post-mannitol administration on the first postoperative day, indicative of improved cerebral blood flow. However, these changes were transient, with no significant variations noted on the second postoperative day. Cerebrovascular resistance, as measured by the pulsatility index, showed non-significant changes bilaterally across both days. Cardiovascular parameters, including stroke volume and cardiac output, remained stable throughout the study period.

Conclusion: Mannitol administration at 0.5 g/kg in postoperative neurosurgical patients transiently improves cerebral perfusion without causing significant hemodynamic instability. This study underscores the importance of monitoring both cerebrovascular and cardiovascular parameters post-mannitol administration to optimize patient management and outcomes.

Keywords: cerebral perfusion; hemodynamics; intracranial pressure; mannitol; transcranial doppler; transthoracic echocardiography.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Institutional Ethical Committee of Sree Chitra Tirunal Institute for Medical sciences and Technology issued approval SCT/IEC/843/December-2015. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. PI on both OP and NOP sides on D1 and D2
PI: pulsatility index, OP: operated, NOP: non-operated, D1: postoperative day 1, D2: postoperative day 2
Figure 2
Figure 2. ICP on both OP and NOP sides on D1 and D2
ICP: intracranial pressure, PI: pulsatility index, OP: operated, NOP: non-operated, D1: postoperative day 1, D2: postoperative day 2
Figure 3
Figure 3. Stroke volume on D1 and D2
A repeated measure ANOVA did not show a statistically significant difference between D1 (F=0.856, p=0.514) and D2 (F=0.150, p=0.980). ANOVA: analysis of variance, D1: postoperative day 1, D2: postoperative day 2
Figure 4
Figure 4. Ejection fraction on D1 and D2
A repeated measure ANOVA did not show a statistically significant difference between D1 (F=1.608, p=0.165) and D2 (F=0.114, p=0.989). ANOVA: analysis of variance, D1: postoperative day 1, D2: postoperative day 2
Figure 5
Figure 5. Cardiac output on D1 and D2
Repeated measure ANOVA did not show a statistically significant difference between D1 (F=1.253, p=0.291) and D2 (F=1.143, p=0.982). ANOVA: analysis of variance, D1: postoperative day 1, D2: postoperative day 2
Figure 6
Figure 6. Heart rate on D1 and D2
Repeated measure ANOVA did not show a statistically significant difference between D1 (F=1.044, p=0.396) and D2 (F=0.566, p=0.726). ANOVA: analysis of variance, D1: postoperative day 1, D2: postoperative day 2
Figure 7
Figure 7. Mean arterial pressure on D1 and D2
Repeated measure ANOVA noticed no significant difference between D1 (F=2.26, p=0.508) and D2 (F=0.583, p=0.713). ANOVA: analysis of variance, D1: postoperative day 1, D2: postoperative day 2
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