Preoperative mannitol infusion improves perioperative cerebral oxygen saturation and enhances postoperative recovery after laparoscopic cholecystectomy

Abstract

Objectives:To test the effect of preoperative mannitol infusion on perioperative decreased cerebral oxygen saturation (rSO2) during laparoscopic cholecystectomy.Methods:Forty patients scheduled for laparoscopic cholecystectomy were enrolled in this study conducted at Dammam Hospital of the University, Dammam, Kingdom of Saudi Arabia from December 2013 to June 2014. Patients received either 0.5 g/kg of 20% intravenous mannitol infusion over 10 minutes before induction of anesthesia (group M), or an equal volume of normal saline instead (group C). Primary outcome variable was rSO2. Other variables included extubation time, clinical assessment of consciousness recovery using the Modified Observer’s Assessment of Alertness/Sedation Scale (OAA/S), and the mini-mental state examination (MMSE) for cognitive evaluation.Results:Anesthesia induction increased rSO2 in both groups. Pneumoperitoneum decreased rSO2 in group C, but not in group M. This drop in rSO2 in the group C reached its maximum 30 minutes after extubation, and was significantly less than the preinduction value. Time to extubation in group M was significantly shorter compared to group C (p=0.007). The OAAS in group M at 10 min after extubation was significantly higher compared to group C. No differences were found between the 2 groups in cognitive function as measured by MMSE score.Conclusion:Preoperative mannitol infusion maintains perioperative rSO2 during laparoscopic cholecystectomy and shortens extubation time with earlier resurgence of OAAS.

Systematic Review: Enhanced Recovery After Cholecystectomy Surgery

“…Higher alertness/sedation scale scores at 10 minutes post-extubation were found in the mannitol group, with a median score of 4, compared to 2 (p = .007). There was no difference found in MMSE scores (Mousa et al, 2015).…”

“…The third study by Moro et al (2017) found that Ketamine given just before incision had no effect on the parameters studied, and therefore did not decrease recovery time or length of stay. Finally, Mousa et al (2015) found that Mannitol led to shorter extubation time as well as a decreased recovery time overall. Length of stay was not measured, but a shorter recovery time would lead to a shorter length of stay.…”

“…Finally, Mousa, Mowafi, Al-Metwalli, Al-Ghamdi, and Al-Gameel (2015), conducted a double-blind, randomized controlled study to determine if mannitol infusions before the induction of anesthesia would enhance recovery after surgery in patients undergoing laparoscopic cholecystectomies. Forty patients were computer-randomized into two groups, group mannitol and group control.…”

Low-Dose Mannitol Pretreatment Reduces Postoperative Nausea And Vomiting In Patients Undergoing Gynaecological Laparoscopic Surgery: A Randomized, Double-Blind, Placebo-Controlled Trial 

“…Mousa and colleagues [23] reported that administration of 0.5 g/kg mannitol during the pre-induction period was found to improve regional cerebral oxygen saturation in patients undergoing laparoscopic surgery. CBFV is an important non-invasive index used to re ect the cerebral oxygen metabolic condition [24].…”

Cerebral Oximetry for Detecting High-mortality Risk Patients with Cryptococcal Meningitis

“…The lack of an association between ICP and rSO 2 was surprising, especially considering the survival benefits of therapeutic lumbar punctures [ 6 ]. In studies of traumatic brain injury, elevated ICP has been associated with reduced rSO 2 [ 13 , 19 , 20 ]. Our findings suggest that additional mechanisms beyond ICP likely influence cerebral oxygenation (and mortality) in addition to previously identified prognostic markers in cryptococcosis.…”