A comparison of equivolume, equiosmolar solutions of hypertonic saline and mannitol for brain relaxation during elective supratentorial craniotomy

Abstract

Single doses of 3 ml/kg of 20% mannitol and 3% HS are safe and effective for intraoperative brain debulking during elective supratentorial craniotomy, but less effective in patients with pre-existing mass effect and midline shift.

Cardiac output changes after osmotic therapy in neurosurgical and neurocritical care patients: a systematic review of the clinical literature

“…The full-text evaluation identified 18 studies as not appropriate, no full-text publication and non-observational or RCT studies, and were finally excluded. The selected eight articles consisted of four RCTs [19][20][21][22] and three prospective [23][24][25] and 1 retrospective [26] observational studies, that enrolled a total of 182 adult patients. All these studies met the criteria to be included in the final qualitative appraisal, Table 1 Physiological and clinical effects of mannitol vs. hypertonic saline …”

“…Five studies were conducted in elective craniotomy setting [20][21][22][23]26], while the remaining three enrolled NCC patients treated either for subarachnoid haemorrhage [9] or traumatic brain injury [24,25]. Three studies included the administration of either mannitol [23,25] or HTS [24] as a sole osmotherapy; four trials (two observational and two RCTs) compared mannitol with HTS [combined or not to hydroxyethyl starch (HES)] [20][21][22]24], and in one RCT, the haemodynamic effects of mixed HTS-HES solution were tested against placebo [19].…”

“…Three studies included the administration of either mannitol [23,25] or HTS [24] as a sole osmotherapy; four trials (two observational and two RCTs) compared mannitol with HTS [combined or not to hydroxyethyl starch (HES)] [20][21][22]24], and in one RCT, the haemodynamic effects of mixed HTS-HES solution were tested against placebo [19]. Haemodynamic effects of mannitol were recorded as primary outcome end-point in two of the included studies [23,24].…”

“…A considerable variability was recorded in the timing of osmotic agents administration. As for the subgroup of patients subjected to craniotomy surgery, this was defined as 15 min before dura opening [23,25], 30 min before skull opening [21], during scalp incision [20] or shortly afterwards the drilling for the first burr hole of craniotomy was performed [22].…”

“…Outcomes were assessed at different time points after termination of osmotic agent administration (ranging from 1 min to 6 h), while in one RCT systemic haemodynamic parameters were recorded at two different phases during the infusion of the tested drugs [20]. The cut-off ICP values defined as a criterion for osmotherapy application in NCC patients ranged from 15 mmHg [23] to 20 mmHg [26], whereas ethical issues in a placebo-controlled RCT dictated the administration of an osmotic agent for ICP values <20 mmHg [19].…”