Mannitol versus hypertonic saline solution in neuroanaesthesia
Keywords:
Osmotherapy, Intracranial hypertension, Cerebral oedema, Mannitol, Hypertonic saline solution, Severe TBI, Osmotic load
Abstract
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.
References
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2. Diringer MN, Zazulia AR. Osmotic therapy: fact and fiction. Neurocrit Care. 2004;1:219-33.
3. Hays AN, Lazaridis C, Neyens R. Osmotherapy: use among neurointensivists. Neurocrit Care. 2011;14:222-8.
4. Schwartz ML, Tator CH, Rowed DW, Reid SR, Meguro K, Andrews DF. The University of Toronto TBI treatment study: a prospective, randomized comparison of pentobarbital and mannitol. Can J Neurol Sci. 1984;11:434-40.
5. Silver S. The treatment of tromboangiitis obliterans by intravenous injection of hypertonic salt solution. JAMA. 1926;86:1759-61.
6. Ziai WC, Toung TJ, Bhardwaj A. Hypertonic saline: first-line therapy for cerebral edema? J Neurol Sci. 2007;261(1-2): 157-66.
7. Weed LH, McKibben PS. Experimental alteration of brain bulk. Am J Physiol. 1919;48:531-55.
8. Fremont-Smith F, Forbes HS. Intraocular and intracranial pressure: an experimental study. Arch Neurol Psychiatr. 1927;18:550-64.
9. Wise BL, Chater N. The value of hypertonic mannitol solution in decreasing brain mass and lowering cerebro-spinal-fluid pressure. J Neurosurg. 1962;19:1038-43.
10. Zornow MH. Hypertonic saline as a safe and efficacious treatment of intracranial hypertension. J Neurosurg Anesthesiol. 1996;8:175-7.
11. Todd MM, Tommasino C, Moore S. Cerebral effects of isovolemic hemodilution with hypertonic saline solution. J Neurosurg. 1985;63:944-8.
12. Anderson P, Boreus L, Gordon E, Lagerkranser M, Rudejill A, Lindquist C, et al. Use of mannitol during neurosurgery: interpatient variability in the plasma and CSF levels. Eur J Clin Pharmacol. 1988;35:643-9.
13. Rudehill A, Gordon E, Ohman G, Lindgvist C, Andersson P. Pharmacokinetics and effects of mannitol on hemodynamics, blood and cerebrospinal fluid electrolytes and osmolality during intracranial surgery. J Neurosurg Anesthesiol. 1993;5:4-12.
14. Muizelaar JP, Wei EP, Kontos HA, Becker DB. Mannitol causes compensatory cerebral vasoconstriction and vasodilation in response to blood viscosity changes. J Neurosurg. 1983;59:822-8.
15. Burke AM, Quest DO, Chien S, Cerri C. The effects of mannitol on blood viscosity. J Neurosurg. 1981;55:550-3.
16. Smith QR, Rapoport SI. Cerebrovascular permeability coefficients to sodium, potassium and chloride. J Neurochem. 1986;46:1732-42.
17. Mendelow AD, Teasdale GM, Russell T, Flood J, Patterson J, Murray GD. Effect of mannitol on cerebral blood flow and cerebral perfusion pressure in human TBI. J Neurosurg. 1985;63:43-8.
18. Torre-Healy A, Marko N, Weil R. Hyperosmolar therapy for intracranial hypertension. Neurocrit Care. 2012;117: 117-30.
19. Bratton SL, Chestnut RM, Ghajar J, McConnell Hammond FF, Harris OA, Hartl R, et al. Brain Trauma Foundation; American Association of Neurological Surgeons; Congress of Neurological Surgeons; Joint Section on Neurotrauma and Critical Care, AANS/CNS. Guidelines for the management of severe traumatic brain injury. II. Hyperosmolar therapy. J Neurotrauma. 2007;24 Suppl. 1:S14-20.
20. Wakai A, Roberts I, Schierhout G. Mannitol for acute traumatic brain injury. Cochrane Database Syst Rev. 2007;24:CD001049.
21. James HE. Methodology for the control of intracranial pressure with hypertonic mannitol. Acta Neurochir (Wien). 1980;51:161-72.
22. Sorani MD, Manley GT. Dose-response relationship of mannitol and intracranial pressure: a meta analysis. J Neurosurg. 2008;108:80-7.
23. Rosner MJ, Coley I. Cerebral perfusion pressure: a hemodynamic mechanism of mannitol and the post-mannitol hemogram. Neurosurgery. 1987;21:147-56.
24. Sorani MD, Morabito D, Rosenthal G, Giacomini KM, Manley GT. Characterizing the dose-response relationship between mannitol and intracranial pressure in traumatic brain injury patients using a high-frequency physiological data collection system. J Neurotrauma. 2008;25:291-8.
25. Gondim FdeA, Aiyagari V, Shackleford A, Diringer MN. Osmolality not predictive of mannitol-induced acute renal insufficiency. J Neurosurg. 2005;103:444-7.
26. Garcia-Morales EF, Cariappa R, Parvin CA, Scott MG, Diringer MN. Osmole gap in neurologic-neurosurgical intensive care unit: its normal value, calculation, and relationship with mannitol serum concentrations. Crit Care Med. 2004;32:986-91.
27. Gadallah MF, Lynn M, Work J. Case report: mannitol nephrotoxicity syndrome: role of hemodialysis and postulate of mechanisms. Am J Med Sci. 1995;309:219-22.
28. Visweswaran P, Massin EK, Dubose TD Jr. Mannitol-induced renal failure. J Am Soc Nephrol. 1997;8:1028-33.
29. Dorman HR, Sondheimer JH, Cadnapaphornchai P. Mannitol induced acute renal failure. Medicine (Baltimore). 1990;69:153-9.
30. Manninen PH, Lam AM, Gelb AW, Brown SC. The effect of high-dose mannitol on serum and urine electrolytes and osmolality in neurosurgical patients. Can J Anaesth. 1987;34:442-6.
31. Berger S, Schrer L, Hartl R, Messmer K, Baethmann A. Reduction of post-traumatic intracranial hypertension by hypertonic/hyperoncotic saline/dextran and hypertonic mannitol. Neurosurgery. 1995;37:98-107.
32. Van Hengel P, Nikken JJ, de Jong GM, Hesp WL, van Bommel EF. Mannitol-induced acute renal failure. Neth J Med. 1997;50:21-4.
33. McManus ML, Soriano SG. Rebound swelling of astroglial cells exposed to hypertonic mannitol. Anesthesiology. 1998;88:1586-91.
34. Zeng HK, Wang QS, Deng YY, Jiang WQ, Fang M, Chen CB, et al. A comparative study on the efficacy of 10% hypertonic saline and equal volume of 20% mannitol in the treatment of experimentally induced cerebral edema in adult rats. BMC Neurosci. 2010;11:153.
35. Kaufmann AM, Cardoso ER. Aggravation of vasogenic cerebral edema by multiple-dose mannitol. J Neurosurg. 1992;77:584-9.
36. Stuart FP, Torres E, Fletcher R, Crocker D, Moore FD. Effects of single, repeated and massive mannitol infusion in the dog: structural and function changes in the kidney and brain. Ann Surg. 1970;172:190-204.
37. Donato T, Shapira Y, Artru A, Powers K. Effect of mannitol on cerebrospinal fluid dynamics and brain tissue edema. Anesth Analg. 1994;78:58-66.
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Llorente G, Niño de Mejia MC. Mannitol versus hypertonic saline solution in neuroanaesthesia. Colomb. J. Anesthesiol. [Internet]. 2015 Jul. 1 [cited 2024 Apr. 25];43(Supplement):29-3. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/721
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How to Cite
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Llorente G, Niño de Mejia MC. Mannitol versus hypertonic saline solution in neuroanaesthesia. Colomb. J. Anesthesiol. [Internet]. 2015 Jul. 1 [cited 2024 Apr. 25];43(Supplement):29-3. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/721
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