Comparison of 7.2% hypertonic saline - 6% hydroxyethyl starch solution and 6% hydroxyethyl starch solution after the induction of anesthesia in patients undergoing elective neurosurgical procedures

Abstract

OBJECTIVE:The ideal solution for fluid management during neurosurgical procedures remains controversial. The aim of this study was to compare the effects of a 7.2% hypertonic saline - 6% hydroxyethyl starch (HS-HES) solution and a 6% hydroxyethyl starch (HES) solution on clinical, hemodynamic and laboratory variables during elective neurosurgical procedures.METHODS:Forty patients scheduled for elective neurosurgical procedures were randomly assigned to the HS-HES group or the HES group. After the induction of anesthesia, patients in the HS-HES group received 250 mL of HS-HES (500 mL/h), whereas the patients in the HES group received 1,000 mL of HES (1000 mL/h). The monitored variables included clinical, hemodynamic and laboratory parameters. Chictr.org: ChiCTR-TRC-12002357RESULTS:The patients who received the HS-HES solution had a significant decrease in the intraoperative total fluid input (p<0.01), the volume of Ringer's solution required (p<0.05), the fluid balance (p<0.01) and their dural tension scores (p<0.05). The total urine output, blood loss, bleeding severity scores, operation duration and hemodynamic variables were similar in both groups (p>0.05). Moreover, compared with the HES group, the HS-HES group had significantly higher plasma concentrations of sodium and chloride, increasing the osmolality (p<0.01).CONCLUSION:Our results suggest that HS-HES reduced the volume of intraoperative fluid required to maintain the patients undergoing surgery and led to a decrease in the intraoperative fluid balance. Moreover, HS-HES improved the dural tension scores and provided satisfactory brain relaxation. Our results indicate that HS-HES may represent a new avenue for volume therapy during elective neurosurgical procedures.

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

“…In contrast, mannitol caused a transient acute dilutional hyponatremia [20,22,26], with a concomitant stepwise increase of potassium over time [22]. However, sodium levels tend to normalize over time, as a result of the diuretic effects of mannitol [28,34,35,41].…”

“…By contrast, mannitol infusion could induce hypovolaemia through an increase in diuresis [13,[20][21][22][23][24][25]28]. …”

“…Half of these studies identified a relative superiority of HTS over mannitol, in terms of cerebral haemodynamics, with a peak effect being recorded at 60 min after the end of HTS infusion [19,24,26]. Two RCTs, reported equivalent brain relaxation scores between both osmotic agents [20,22], as this was assessed by neurosurgeons using the four-point brain relaxation scale [27], while another RCT, using a three-point dural tension score for brain relaxation assessment [28], identified a considerable superiority of HTS over to mannitol for brain relaxation attainment [21].…”

Hypertonic salt solution for peri-operative fluid management

“…The included trials were performed in a wide variety of surgical situations: aortic surgery (four trials) (Bruegger 2005;Shackford 1983;Shackford 1987;Younes 1988); lower limb surgery (three trials) (Ishikawa 1996;Jarvela 2000;Veroli 1992 ); transurethral prostate resection (three trials) (Baraka 1994;Kato 1996;Kimura 1994); coronary artery bypass grafting (three trials) Leverve 2008); hysterectomy (one trial) (Kølsen-Petersen 2004); hernia repair (one trial) (Wang 1997); general surgery (one trial) (Durasnel 1999); pancreaticoduodenectomy (one trial) ( Lavu 2014); and neurological surgery (one trial) (Shao 2013). Anaesthetic techniques included: general anaesthesia (ten trials) (Bruegger 2005;Kato 1996;Kølsen-Petersen 2004;Lavu 2014;Shackford 1983;Shackford 1987;Shao 2013;Younes 1988) and spinal anaesthesia (seven trials) (Baraka 1994;Durasnel 1999;Ishikawa 1996;Jarvela 2000;Kimura 1994;Veroli 1992;Wang 1997).…”

“…Dr. Lavu kindly provided mean and standard deviation values that were not available in the publication (Lavu 2014), and Dr. Jarvela provided additional methodological details regarding random sequence generation and allocation concealment for two studies ( Jarvela 2000;). Dr. Shao was contacted regarding methodology but did not respond (Shao 2013).…”