Evaluation of equiosmolar 20% mannitol, 3% hypertonic saline and 8.4% sodium bicarbonate on intraoperative brain relaxation and hemodynamic parameters in patients undergoing craniotomy for supratentorial tumors: a prospective randomized study

Barik, Amiya Kumar; Agrawal, Sanjay; Gupta, Priyanka; Kumari, Ranjeeta

doi:10.23736/s0375-9393.21.15448-3

Cited by 6 publications

(9 citation statements)

References 31 publications

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“…All studies included had an overall moderate risk of bias. Of the 10 studies included, 6 studies defined random sequence generation using computer-generated randomization or computerized random number generation and were deemed a low risk of bias [2,5,11,13,18,19]. 4 of the studies did not define the sequence generation and were deemed the unclear risk of bias Johansyah et al Egypt J Neurol Psychiatry Neurosurg (2022) 58:142 [12,[20][21][22].…”

Section: Risk Of Bias Assessment and Quality Of Evidencementioning

confidence: 99%

“…All 10 studies reported this outcome with a total sample size of 735 patients. [2,5,[11][12][13][18][19][20][21][22]. We used a fixedeffects model for this outcome.…”

Section: Brain Relaxationmentioning

confidence: 99%

“…Data on sodium level were observed in 7 studies with different modes of measurements. 4 of the studies measure serum sodium level [11][12][13]18]. 2 of the studies measure arterial sodium level [11,20].…”

Section: Sodium Levelmentioning

confidence: 99%

“…There were two meta-analyses initiated in 2015 and 2017 favouring hypertonic saline as the superior agent to reduce ICP and relax the brain. Since then, there have been 4 new RCTs conducted [5,[11][12][13]. We aimed to update the comparison of these solutions on their safety and efficacy in producing brain relaxation, along with their effect on fluid status, sodium content, and hemodynamic parameters.…”

Section: Introductionmentioning

confidence: 99%

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Equiosmolar doses of hypertonic saline versus mannitol for brain relaxation in patients undergoing elective craniotomies: an updated systematic review and meta-analysis

Johansyah

Jonathan

Yusari

et al. 2022

Egypt J Neurol Psychiatry Neurosurg

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Background Hypertonic saline and mannitol are hyperosmolar agents frequently used to lower ICP and relax the brain during surgeries. Several methods have been used to achieve a good and relaxed brain, such as hyperventilation, cerebrospinal fluid drainage, head position correction, and administration of hyperosmolar agents. Comparing equiosmolar doses between hypertonic saline and mannitol in patients undergoing elective craniotomies is important to further notice the differences in several outcomes. This study aims to compare the outcome of hypertonic saline versus mannitol on brain relaxation in patients undergoing elective craniotomy. Results 10 articles from 2007 to 2021 were included. Hypertonic saline is associated with better brain relaxation (OR = 1.84, 95% CI 1.31–2.59; P = 0.001) but significantly increase blood natrium level, both serum and arterial (MD = 3.03, 95% CI 1.70–4.36; P = < 0.001 and MD = 7.14, 95% CI 0.04–14.24; P = < 0.001, respectively). Mannitol was associated with increased fluid input and urine output (SMD = − 0.56, 95% CI − 0.98 to − 0.15; P = < 0.001 and SMD = − 0.96, 95% CI − 1.42 to − 0.50; P = < 0.001, respectively). Serum osmolality and hemodynamic parameters difference was insignificant. Conclusions Hypertonic saline is associated with significantly better brain relaxation score and increased blood sodium level without increase in urine. This may prove to be clinically significant in patients with electrolyte imbalance.

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Section: Risk Of Bias Assessment and Quality Of Evidencementioning

confidence: 99%

“…All 10 studies reported this outcome with a total sample size of 735 patients. [2,5,[11][12][13][18][19][20][21][22]. We used a fixedeffects model for this outcome.…”

Section: Brain Relaxationmentioning

confidence: 99%

Section: Sodium Levelmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Equiosmolar doses of hypertonic saline versus mannitol for brain relaxation in patients undergoing elective craniotomies: an updated systematic review and meta-analysis

Johansyah

Jonathan

Yusari

et al. 2022

Egypt J Neurol Psychiatry Neurosurg

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“…A recent prospective randomized study published in 2021 by Barik et al . [15] evaluated hemodynamic stability and effectiveness of 20% mannitol, 3% hypertonic saline and 8.4% sodium bicarbonate on intraoperative brain relaxation in patients undergoing craniotomy for supratentorial tumors. Previous findings regarding better hemodynamic stability in HTS group were confirmed but, curiously, the study showed superior brain relaxation when 8.4% sodium bicarbonate was administered compared with 20% mannitol and 3% HTS.…”

Section: Recent Findingsmentioning

confidence: 99%

Salted or sweet? Hypertonic saline or mannitol for treatment of intracranial hypertension

Lamperti¹,

Lobo²,

Tufegdzic³

2022

Current Opinion in Anaesthesiology

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Purpose of reviewThe aim of this review article is to present current recommendations regarding the use of hypertonic saline and mannitol for the treatment of intracranial hypertension. Recent findingsIn recent years, a significant number of studies have been published comparing hypertonic saline with mannitol in patients with acute increased intracranial pressure, mostly caused by traumatic brain injury. Albeit several randomized controlled trials, systematic reviews and meta-analysis support hypertonic saline as more effective than mannitol in reducing intracranial pressure, no clear benefit in regards to the longterm neurologic outcome of these patients has been reported.

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Hypertonic saline achieves superior brain relaxation in tumor craniotomy: An updated systematic-network meta-analysis

Tarimah,

Bramawangsa,

Suhardi

et al. 2024

Journal of Taibah University Medical Sciences

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Evaluation of equiosmolar 20% mannitol, 3% hypertonic saline and 8.4% sodium bicarbonate on intraoperative brain relaxation and hemodynamic parameters in patients undergoing craniotomy for supratentorial tumors: a prospective randomized study

Cited by 6 publications

References 31 publications

Equiosmolar doses of hypertonic saline versus mannitol for brain relaxation in patients undergoing elective craniotomies: an updated systematic review and meta-analysis

Equiosmolar doses of hypertonic saline versus mannitol for brain relaxation in patients undergoing elective craniotomies: an updated systematic review and meta-analysis

Salted or sweet? Hypertonic saline or mannitol for treatment of intracranial hypertension

Hypertonic saline achieves superior brain relaxation in tumor craniotomy: An updated systematic-network meta-analysis

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