The Hypotensive Response to Rapid Intravenous Administration of Hypertonic Solutions in Man and in the Rabbit

Hypertonic fluid resuscitation from subarachnoid hemorrhage in rats: A comparison between small volume resuscitation and mannitol

“…The improved MABP and the resulting elevated CPP due to volume expanding effects of SVR could also contribute to the improved LCBF in group II. The observed transient short-time MABP decrease in both HS-groups has also been observed in humans and is caused by vasodilatation of the muscular resistance vessels by HS solutions [58,59], without influencing the volume substituting effect adversely. Concerning mannitol, Jafar and Johns [60] observed a CBF increase in patients with SAH, treated with a continuous mannitol infusion in contrast to the mannitol bolus application in our study, where we did not observe such an effect.…”

Effects of Hypertonic Saline Hydroxyethyl Starch Solution and Mannitol in Patients With Increased Intracranial Pressure After Stroke

“…This finding is in agreement with the results of several clinical and animal studies in which the SABP remained unaffected or even decreased after mannitol, probably due to a reactive decrease in the peripheral resistance. 6,7,27,31,41 Similarly, in contrast to patients with hemorrhagic shock, HS-HES does not increase SABP in euvolemic patients. 22,42,43 Mechanisms of HS-HES are complex, because HS-HES consists of 2 components: sodium chloride, which is mainly responsible for the osmotic gradient, and HES, which is added to maintain the short-lived volume effect of hypertonic saline.…”

Hypertonic saline: First-line therapy for cerebral edema?

“…The rheologic effects are most effective with rapid bolus administration rather than continuous infusion [20,21]. Other properties of mannitol include reduction in systemic vascular resistance (and hence afterload), combined with transiently increased preload and a mild positive ionotropic effect resulting in improved cardiac output and oxygen delivery [22,23], and scavenging of toxic oxygen free radicals with potential cytoprotection [24]. However, intravascular volume is often reduced following its diuretic effect and fluid replacement is an important component of mannitol therapy to avoid both hypovolemia resulting in secondary ischemic injury or elevation of ICP due to reflex vasodilation of cerebral arterioles [20].…”