Effect of Equiosmolar Solutions of Mannitol <i>versus</i>  Hypertonic Saline on Intraoperative Brain Relaxation and Electrolyte Balance

Rozet, Irene; Tontisirin, Nuj; Muangman, Saipin; Vavilala, Monica S.; Souter, Michael J.; Lee, Lorri A.; Kincaid, M. Sean; Britz, Gavin W.; Lam, Arthur M.

doi:10.1097/01.anes.0000286980.92759.94

Cited by 123 publications

(105 citation statements)

References 32 publications

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“…In line with previous reports [9,35,39,40], our SR confirmed that the administration of HTS heightened the levels of serum sodium, which was sustained for 6 h, and promoted a temporary reduction of potassium [20-22, 24, 26]. In contrast, mannitol caused a transient acute dilutional hyponatremia [20,22,26], with a concomitant stepwise increase of potassium over time [22].…”

Section: Discussionsupporting

confidence: 92%

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

Tsaousi

Stazi

Cinicola

et al. 2018

Brit J Clinical Pharma

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AIMOsmotherapy constitutes a first-line intervention for intracranial hypertension management. However, hyperosmolar solutes exert various systematic effects, among which their impact on systemic haemodynamics is poorly clarified. This review aims to appraise the clinical evidence of the effect of mannitol and hypertonic saline (HTS) on cardiac performance in neurosurgical and neurocritical care patients. METHODA database search was conducted to identify randomized clinical trials and observational studies reporting HTS or mannitol use in acute brain injury setting. The primary end-points were alterations of cardiac output (CO) and other haemodynamic variables, while the impact of osmotic agents on intracranial pressure, brain relaxation, plasma osmolality, electrolyte levels and urinary output constituted secondary outcomes. RESULTSEight studies, enrolling 182 patients in total, were included. HTS exerted a more profound cardiac output augmentation than mannitol, but no distinct difference between groups occurred. Central venous pressure, stroke volume and stroke volume variation were favourably affected by both osmotic agents, whilst the reported changes in blood pressure were inconclusive. HTS infusion yielded a larger intracranial pressure reduction than mannitol but had an equivalent effect on brain relaxation. Mannitol presented a more potent diuretic effect than HTS. Effect on serum osmolality was alike in both osmotic agents, but contrary to HTS-promoted hypernatraemia, mannitol use induced transient hyponatraemia. CONCLUSIONSMannitol or HTS administration seems to induce an enhancement of cardiac performance; being more prominent after HTS infusion. This effect combined with mannitol-induced enhancement of diuresis and HTS-promoted increase of plasma sodium concentration could partially explain the effects of osmotherapy on cerebral haemodynamics. British Journal of Clinical Pharmacology WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• Osmotherapy with either mannitol or hypertonic saline (HTS) is the recommended first-line medical intervention for optimizing cerebral perfusion through brain relaxation.• Mannitol has long been used as osmotic agent for ensuring brain relaxation in neurosurgical patients undergoing craniotomy, but the clinical benefit of mannitol infusion in acute brain injury setting, has not yet been proven according to evidence-based medicine.• Recent guidelines suggest the use of HTS as a second-line therapy in case mannitol fails to reduce intracranial pressure, in patients sustaining traumatic brain injury. WHAT THIS STUDY ADDS• Both mannitol and HTS induce an increase in cardiac output, which is more pronounced after HTS than mannitol administration.• Mannitol and HTS infusion are associated with a trend towards to mean arterial pressure and heart rate reduction.• Both osmotic agents induced an intracranial pressure reduction and brain relaxation, an effect that seems to be more prominent in HTS-treated patients.

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Section: Discussionsupporting

confidence: 92%

“…While all hyperosmolar agents promote diuresis, HTS exerts a weaker diuretic effect than mannitol, possibly because it stimulates the release of antidiuretic hormones [9,39,40]. By contrast, mannitol infusion could induce hypovolaemia through an increase in diuresis [13,[20][21][22][23][24][25]28].…”

Section: Discussionmentioning

confidence: 99%

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

Tsaousi

Stazi

Cinicola

et al. 2018

Brit J Clinical Pharma

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“…Using a cerebral relaxation scale similar to the one we used, Gemma et al 9 reported satisfactory cerebral relaxation in all cases when different osmolar loads but similar volume of HS (7.5%) or mannitol (20%) were administered. On the other hand, Rozet et al 10 observed a similar effect on cerebral relaxation when equiosmolar solutions of mannitol and HS were used. The main mechanism of action of hyperosmolar solutions is the generation of an osmolar gradient across the blood brain barrier (BBB), due to its impermeability to solutes (sodium and mannitol) 10 , leading to contraction of cerebral tissue (were the BBB is intact) and therefore reducing the ICP.…”

Section: Discussionmentioning

confidence: 86%

Equilíbrio Hidroeletrolítico e relaxamento cerebral com salina isoncótica hipertônica versus manitol (20%) durante neuroanestesia eletiva

Boas¹,

Marques

Alves

2011

Rev. Bras. Anestesiol.

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Background and objectives:Cerebral relaxation during intracranial surgery is necessary, and hiperosmolar therapy is one of the measures used to this end. Frequently, neurosurgical patients have sodium imbalances. The objective of the present study was to quantify and determine cerebral relaxation and duration of hydroelectrolytic changes secondary to the use of mannitol versus hypertonic isoncotic solution (HIS) during neurosurgery.

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“…During craniotomy, mannitol is frequently used to facilitate brain relaxation primarily via the reduction of brain tissue water (29, 30). However, mannitol is also an osmotic diuretic, its use leads to a large urine output and intravascular volume depletion as a consequence (31). Whether the depleted volume should be replaced is debated.…”

Section: Optimizing Intravascular Volume and Monitoring Cardiac Outpumentioning

confidence: 99%

Practice Trends and Research Priorities of Neurosurgical Anesthesia

Meng¹,

Li²,

Gelb³

2015

J Anesth Perioper Med

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Aim of review:One of the goals of neurosurgical anesthesia is to facilitate the execution of neurosurgical procedures including intraoperative neurological monitoring. However, it should also and always aim at benefiting the patients by improving the patient's long-term and disease-specific outcomes. Method: In this review, we highlighted some perspectives of today's practice trends and research priorities of neurosurgical anesthesia for the purpose of exploring the best care based on evidence, and speculation where relevant evidence is lacking. Recent findings: The advancement in general anesthesia and better understanding of neurological diseases have promoted the evolution of the sub-specialty of neurosurgical anesthesia. Facilitating modern neurosurgical procedures including intraoperative neurological monitoring is a priority of neurosurgical anesthesia. However, a focus on the patient outcomes can never be over-emphasized. The effect of any component of anesthesia care, such as drugs choice and dose, ventilation management, and intravascular volume and cardiac output care, on patient's outcome should be appraised by quality research. Summary: It is important to recognize that different patient populations have different and disease/surgery-specific outcomes that should also be taken into account during the customization of anesthesia techniques. ABSTRACT

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Effect of Equiosmolar Solutions of Mannitol versus Hypertonic Saline on Intraoperative Brain Relaxation and Electrolyte Balance

Abstract: Mannitol and HS cause an increase in cerebrospinal fluid osmolality, and are associated with similar brain relaxation scores and arteriovenous oxygen and lactate difference during craniotomy.

Cited by 123 publications

References 32 publications

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

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

Equilíbrio Hidroeletrolítico e relaxamento cerebral com salina isoncótica hipertônica versus manitol (20%) durante neuroanestesia eletiva

Practice Trends and Research Priorities of Neurosurgical Anesthesia

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