Mannitol versus hypertonic saline solution in neuroanaesthesia

Abstract

Intracranial hypertension Cerebral oedema Mannitol Hypertonic saline solution Severe TBI Osmotic load a b s t r a c t Background: Hyperosmolar therapy with mannitol or hypertonic saline solution is the main medical strategy for the clinical management of intracranial hypertension (IH) and cerebral oedema. IH and cerebral oedema are usually the result of acute and chronic brain injuries such as severe head trauma, ischaemic stroke, intracerebral haemorrhage, aneurismal subarachnoid haemorrhage, tumours and cerebral infections.Objective: We conducted this research in order to assess the benefits and side effects of osmotherapy and to identify the current trends in the management of IH and cerebral oedema. These two conditions worsen neurological outcomes and are the major cause of mortality in neurological patients.In this article we show the current evidence supporting the use of HTS and mannitol, and examine the question of which of the two agents is considered the best option for the medical treatment of IH. We review the efficacy data for HTS compared with mannitol in terms of clinical considerations. Conclusion: Data availability is limited because of small sample sizes, inconsistent methods and few prospective randomized comparative studies, although both agents are effective and have a reasonable risk profile for the treatment of cerebral oedema and IH. Currently, several trials show that HTS could be more effective in reducing ICP, with longer lasting effects. HTS maintains systemic and cerebral haemodynamics.r e v c o l o m b a n e s t e s i o l . 2 0 1 5;4 3(S 1):29-39 Manitol versus solución salina hipertónica en neuroanestesia Palabras clave: Osmoterapia Hipertensión intracraneal Edema cerebral Manitol Solución salina hipertónica Trauma craneoencefalico severo Carga osmótica r e s u m e n Antecedentes: La terapia hiperosmolar con manitol o solución salina hipertónica (SSH)es la principal estrategia médica para el manejo clínico de la hipertensión intracraneal (HIC) y del edema cerebral. La HIC y el edema cerebral suelen ser las consecuencias de lesiones cerebrales agudas y crónicas tales como el trauma craneoencefálico severo, el accidente cerebrovascular isquémico, la hemorragia intracerebral, la hemorragia subaracnoidea aneurismática, y los tumores e infecciones cerebrales. Ambas entidades, contribuyen a peores resultados neurológicos y producen mayor mortalidad en los pacientes neurocríticos.Objetivo: Realizamos esta investigación con el objetivo de valorar lo efectos beneficiosos y secundarios de la osmoterapia y cuáles son las tendencias actuales para el manejo de la HIC y del edema cerebral. En el presente artículo mostramos la evidencia actual que soporta a la SSH y al manitol y cuál se considera la mejor opción como terapia médica en el tratamiento de la HIC. Revisamos la eficacia de los datos para SSH frente a manitol hablando sobre sus consideraciones clínicas.Conclusión: La disponibilidad de los datos es imitada por las muestras pequeñas, métodos inconsistentes y pocos estudios aleatorizados ...

Comparative Evaluation of Efficacy of Mannitol and Hypertonic Saline (3%) for Treatment of Moderate to Severe Traumatic Brain Injury (TBI)

“…Glasgow coma score Grade of traumatic brain injury [13][14][15] Mild (Concussion) 9-12 Moderate Less than 8 Severe…”

“…However, the most common outcomes of Traumatic Brain Injury remain Intracranial Hypertension and cerebral oedema. These injuries, whether acute or chronic, which may result in these complications, may be caused due to trauma, stroke, infections, aneurysms, haemorrhage, tumours, etc [8].…”

Comparison of preoperative hypertonic saline versus mannitol for intraoperative brain relaxation and early postoperative outcome among patients with cerebral low-grade glioma: A prospective study

“…[ 1 2 ] Mannitol is a well-known osmotic agent for the reduction of ICP through plasma expansion and decreasing extravascular volume. [ 3 ]…”

“…[1,2] Mannitol is a well-known osmotic agent for the reduction of ICP through plasma expansion and decreasing extravascular volume. [3] Nevertheless, the administration of mannitol has certain side effects such as rebound increase in ICP, electrolyte imbalance, and intravascular volume depletion. Many studies have searched for alternative hypertonic solutions with different concentrations for brain relaxation in neurosurgery, of which the hypertonic saline (HS) is the most popular one.…”

“…[4,5] The administration of HS initially decreases hematocrit and blood viscosity and increases cerebral perfusion, and eventually, it results in the reduction of ICP and brain's blood volume and finally leads to brain relaxation. [3] In addition to the mentioned properties of HS, it appears to have anti-inflammatory and neuroprotective effects, which has been studied in several studies in recent years. [6][7][8][9] In recent years, researchers tend to measure specific neural biomarkers to estimate the intensity of brain injury in patients suffering…”