Effective and safe mannitol administration in patients undergoing supratentorial tumor surgery: A prospective, randomized and double blind study

Akçıl, Eren Fatma; Dilmen, Özlem Korkmaz; Karabulut, Esra Sultan; Koksal, Serdar Selcuk; Altındaş, Fatiş; Tunalı, Yusuf

doi:10.1016/j.clineuro.2017.05.018

Cited by 7 publications

(3 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[18,19] Elevated serum lactate levels have also been attributed to administration of furosemide with mannitol which is common in neurosurgery. [20] Additionally, in both our current and previous study, no patient had evidence of postoperative end-organ dysfunction such as MI, renal failure or death within 30 days of surgery. In the current study, given the small number of patients enrolled and that catastrophic outcomes such as mortality and end organ dysfunction were relatively rare, this particular result is expected.…”

Section: Discussionmentioning

confidence: 54%

Clinical impact of intraoperative hyperlactatemia during craniotomy

et al. 2019

View full text Add to dashboard Cite

ObjectPatients often develop markedly elevated serum lactate levels during craniotomy although the reason for this is not entirely understood. Elevated lactate levels have been associated with poor outcomes in critically ill septic shock patients, as well as patients undergoing abdominal and cardiac surgeries. We investigated whether elevated lactate in craniotomy patients is associated with neurologic complications (new neurological deficits) as well as systemic complications.MethodsWe performed a cohort study of elective craniotomy patients. Demographic and intraoperative data were collected, as well as three timed intraoperative arterial lactate values. Additional lactate, creatinine and troponin values were collected immediately postoperatively as well as 12 and 24 hours postoperatively. Assessment for neurologic deficit was performed at 6 hours and 2 weeks postoperatively. Hospital length-of-stay and 30-day mortality were collected.ResultsInterim analysis of 81 patients showed that no patient had postoperative myocardial infarction, renal failure, or mortality within 30 days of surgery. There was no difference in the incidence of new neurologic deficit in patients with or without elevated lactate (10/26, 38.5% vs. 15/55 27.3%, p = 0.31). Median length of stay was significantly longer in patients with elevated lactate (6.5 vs. 3 days, p = 0.003). Study enrollment was terminated early due to futility (futility index 0.16).ConclusionElevated intraoperative serum lactate was not associated with new postoperative neurologic deficits, other end organ events, or 30 day mortality. Serum lactate was related to longer hospital stay.

show abstract

Section: Discussionmentioning

confidence: 54%

Clinical impact of intraoperative hyperlactatemia during craniotomy

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Our study has several limitations. The four-point scale used in this work to assess brain relaxation is subjective and observer-dependent, but it has been widely used by other authors [ 2 , 4 , 7 , 8 , 11 , 12 , 15 ] to assess brain relaxation. This scale remains a major method because surgical conditions are evaluated by attending neurosurgeon, and some decisions, such as increasing the dimensions of craniotomy, initiating hyperventilation, opting for a partial resection, and raising the pressure of brain retractors, are typically based on this evaluation.…”

Section: Discussionmentioning

confidence: 99%

“…To analyze the effect of 20% mannitol on BRS, we performed a power calculation to determine the ideal sample size before the initiation of the study. On the basis of previous studies [ 11 , 12 ] and the assumption that a difference of one unit on BRS from 1 to 4 in brain relaxation is clinically relevant, α was set to 0.05 and β to 0.9, and the sample size of 44 patients was calculated. Considering a loss ratio of 15%, this calculation produced a sample size of 52 subjects.…”

Section: Methodsmentioning

confidence: 99%

Risk Factors Associated With Inadequate Brain Relaxation in Craniotomy for Surgery of Supratentorial Tumors

Arriba¹,

Ramos²,

Fernandez³

et al. 2022

Cureus

View full text Add to dashboard Cite

Introduction: Cerebral swelling often occurs during craniotomy for cerebral tumors. Poor brain relaxation can increase the risk of cerebral ischemia, possibly worsening the outcome. The surgical team should identify any risk factors that could cause perioperative brain swelling and decide which therapies are indicated for improving it. The present investigation aimed to elucidate the risk factors associated with brain swelling during elective craniotomy for supratentorial brain tumors. Methods: This prospective, nonrandomized, observational study included 52 patients scheduled for elective supratentorial tumor surgery. The degree of brain relaxation was classified upon the opening of the dura according to a four-point scale (brain relaxation score: 1, perfectly relaxed; 2, satisfactorily relaxed; 3, firm brain; and 4, bulging brain). Moreover, hemodynamic and respiratory parameters, arterial blood gas, and plasma osmolality were recorded after the removal of the bone flap. Results: This study showed that the use of preoperative dexamethasone was associated with a brain relaxation score of ≤2 (p = 0.005). The median midline shift of 6 (3-0) mm and median hemoglobin level of >13 g/dL were associated with a brain relaxation score of ≥3 (p = 0.02 and p = 0.01, respectively). The dosage of mannitol (0.25 g/kg versus 0.5 g/kg), physical status, intraoperative position, tumor diameter and volume, peritumoral edema and mass effect, World Health Organization (WHO) grading, mean arterial pressure, PaCO 2 , osmolality, and core temperature were not identified as risk factors associated with poor relaxation. Conclusion: The use of preoperative dexamethasone was associated with improved brain relaxation, whereas the presence of a preoperative midline shift and a higher level of hemoglobin were associated with poor brain relaxation.

show abstract

Anesthetic Management of Asleep and Awake Craniotomy for Supratentorial Tumor Resection

Vagnerova

2021

Anesthesiology Clinics

View full text Add to dashboard Cite

Effective and safe mannitol administration in patients undergoing supratentorial tumor surgery: A prospective, randomized and double blind study

Cited by 7 publications

References 13 publications

Clinical impact of intraoperative hyperlactatemia during craniotomy

Clinical impact of intraoperative hyperlactatemia during craniotomy

Risk Factors Associated With Inadequate Brain Relaxation in Craniotomy for Surgery of Supratentorial Tumors

Anesthetic Management of Asleep and Awake Craniotomy for Supratentorial Tumor Resection

Contact Info

Product

Resources

About