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Hypertonic saline solution: a safe alternative to mannitol 18% in neurosurgery
P De Vivo1, A Del Gaudio, P Ciritella
1II Department of Anesthesiology and Intensive Care, H Casa Sollievo della Sofferenza, Istituto di Ricovero e Cura a Carattere Scientifico, S. Giovanni Rotondo (Foggia), Italy.
Minerva Anestesiologica
|December 4, 2001
Summary
Hypertonic saline solutions (HTS) can be a safe alternative to mannitol for reducing intracranial pressure (ICP) in neurosurgery patients. This study found HTS effective in lowering ICP without adverse effects on CVP, osmolality, or sodium levels.
Area of Science:
- Neurosurgery
- Critical Care Medicine
- Pharmacology
Background:
- Mannitol is a standard osmotic agent for reducing intracranial pressure (ICP).
- Exploring alternatives to mannitol is crucial for optimizing neurosurgical patient care.
Purpose of the Study:
- To evaluate the efficacy and safety of hypertonic saline solutions (HTS) as an alternative to mannitol in reducing ICP.
- To compare the effects of HTS and mannitol on various physiological parameters during and after intracranial surgery.
Main Methods:
- Thirty patients undergoing craniotomy for supratentorial tumors were randomized into three groups: mannitol (M), mannitol plus HTS (HM), and HTS (H).
- Treatment protocols varied in the dosage and timing of mannitol and HTS administration.
- Continuous monitoring of respiratory rate, mean arterial pressure, ICP, central venous pressure (CVP), and diuresis was performed for 72 hours.
Main Results:
- Hypertonic saline solutions (HTS) effectively reduced ICP without significantly altering CVP, serum osmolality, or serum sodium levels.
- Diuresis was higher in the mannitol and mannitol-HTS groups compared to the HTS-only group, though not statistically significant.
- Serum sodium levels decreased postoperatively in the mannitol and mannitol-HTS groups, remaining stable in the HTS group.
Conclusions:
- Hypertonic saline solutions (HTS) demonstrate a favorable safety profile for ICP reduction in neurosurgical patients.
- HTS can be utilized as a viable alternative to mannitol, particularly for patients requiring multiple doses.
- The findings support the use of HTS in managing intracranial pressure during and after intracranial surgery.