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Mannitol versus hypertonic saline for brain relaxation in patients undergoing craniotomy
Hemanshu Prabhakar1, Gyaninder Pal Singh, Vidhu Anand
1Department of Neuroanaesthesiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India, 110029.
The Cochrane Database of Systematic Reviews
|July 15, 2014
Summary
Hypertonic saline may reduce the risk of tense brain during craniotomy compared to mannitol. Further research is needed on long-term outcomes and adverse events for both brain relaxation agents.
Area of Science:
- Neurosurgery
- Anesthesiology
- Pharmacology
Background:
- Patients with brain tumors often experience increased intracranial pressure due to brain swelling, complicating surgical removal.
- Brain relaxation techniques are crucial for easing tumor resection, with intravenous fluids like mannitol and hypertonic saline commonly used.
- This review compares the efficacy of mannitol versus hypertonic saline for achieving intraoperative brain relaxation.
Purpose of the Study:
- To compare the effects of mannitol and hypertonic saline on intraoperative brain relaxation in patients undergoing craniotomy.
- To evaluate the impact of these agents on primary outcomes such as mortality and adverse events, and secondary outcomes including hospital and ICU stay.
- To synthesize evidence from randomized controlled trials (RCTs) regarding brain relaxation efficacy.
Main Methods:
- Systematic review of randomized controlled trials (RCTs) identified through comprehensive database searches (CENTRAL, MEDLINE, EMBASE) and clinical trial registries.
- Inclusion criteria focused on RCTs comparing hypertonic saline with mannitol for brain relaxation, or comparing either agent against other relaxation methods.
- Data extraction and analysis followed Cochrane Handbook guidelines, employing fixed-effect or random-effects models based on heterogeneity.
Main Results:
- Six RCTs involving 527 participants were included, with most studies having a high risk of bias.
- Hypertonic saline demonstrated a significantly reduced risk of brain bulge or tense brain (Risk Ratio 0.60, 95% CI 0.44 to 0.83) compared to mannitol (low-quality evidence).
- Intensive care unit (ICU) and hospital stays were comparable between the two groups, with no significant differences reported.
Conclusions:
- Hypertonic saline appears to be more effective in reducing the risk of tense brain during craniotomy compared to mannitol, based on limited available data.
- Current evidence suggests comparable ICU and hospital lengths of stay for both agents.
- Further research is essential to investigate long-term mortality, patient outcomes, adverse events, and quality of life associated with mannitol and hypertonic saline use.
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