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Changes in CSF pressure after mannitol in patients with and without elevated CSF pressure.
P Ravussin1, M Abou-Madi, D Archer
1Department of Anaesthesia, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland.
Journal of Neurosurgery
|December 1, 1988
Summary
Mannitol infusion can initially increase intracranial pressure in patients with normal cerebrospinal fluid pressure (CSFP), but decreases it in those with elevated CSFP. This difference is not explained by changes in cerebral blood volume.
Area of Science:
- Neurosurgery
- Anesthesiology
- Critical Care Medicine
Background:
- Mannitol is commonly used to reduce intracranial pressure.
- Concerns exist regarding its potential to initially worsen intracranial hypertension.
Purpose of the Study:
- To investigate the effects of rapid mannitol infusion on lumbar cerebrospinal fluid pressure (CSFP).
- To compare the CSFP response in patients with normal versus elevated baseline CSFP.
Main Methods:
- 49 patients undergoing craniotomy were divided into normal (Group I) and elevated (Group II) CSFP groups.
- CSFP, mean arterial blood pressure (MABP), and central venous pressure (CVP) were monitored during and after mannitol infusion.
- Cerebral blood volume (CBV) was measured in dogs in a parallel study.
Main Results:
- Mannitol caused a fall in MABP and increase in CVP in both groups.
- CSFP decreased immediately in Group II (elevated CSFP) but transiently increased in Group I (normal CSFP).
- CBV increased similarly in normal and hypertensive dogs, suggesting it doesn't explain the differing CSFP responses.
Conclusions:
- The response of CSFP to mannitol differs based on baseline intracranial pressure.
- Increased CVP may contribute to the transient CSFP rise in patients with normal baseline CSFP.
- Intracranial hypertension may alter the cerebrovascular response to mannitol infusion.