Ocular Hypotensive Effect of Intravenously Administered Mannitol

Effect of Retrobulbar Anesthesia Upon Intraocular Pressure

“…No significant effect upon the ocular tension was noted with either method of regional anesthesia except in a very few instances of, (a) incomplete paralysis of the lid muscles in a patient who tended to squeeze the lids shut, or (6) excessive infiltration of the lid tissues due to failure to inject the anesthetic deep in the orbicularis oculi and close to the orbital margins. The technique of regional anesthesia varied : in most cases a modi¬ fied Atkinson and Van Lint approach was used; in the remaining cases an O'Brien block was given with no lid injection.…”

Mannitol-Induced Acute Renal Failure

“…It was initially intro duced in the 1940's as a means of measurement for glom erular filtration rate (GFR) [I], though since then its diuretic effect has prompted its use in a number of dis ease states characterized by extracellularfluid volume excess [2][3][4], Additionally, mannitol has been utilized to accomplish a shift of fluid from RBC's and other intracel lular compartments to the extracellular space. This os motic principle has been used to good effect in the ma nagement of such diverse disease entities as cerebral edema [5], dialysis disequilibrium [6], and glaucoma [7], In the instance of glaucoma, mannitol profoundly lowers intraocular pressure when given intravenously, which has led to its widespread use in opthalmologic clinical practice [7,8], Mannitol, though largely pharmacologically inert, does rely primarily on renal excretion for its elimination from the body [9], Although the dangers of mannitol toxicity in the setting of préexistant renal failure are carefully chronicled [10,11] it was only recently that the potential nephrotoxic properties of mannitol have been observed [12,13]. The mechanism of mannitol induced renal failure is unresolved being variably attributed to tubular-cell swelling consequent to osmotic nephrosis [12] or to intense tubuloglomerular feedback as an after math to afferent stimuli at the macula densa [13].…”