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Mannitol increases cerebral arteriovenous oxygen difference in patients undergoing craniotomy
1Department of Anesthesiology, Veterans General Hospital-Taipei, Taiwan, R.O.C.
Acta Anaesthesiologica Sinica
|June 1, 1995
Summary
Mannitol may decrease jugular venous oxygen saturation (SjVO2) and increase cerebral arteriovenous oxygen difference (AVDO2) during hyperventilation in craniotomy patients. Caution is advised when administering mannitol in neurosurgical patients under hyperventilation.
Area of Science:
- Neurosurgery
- Anesthesiology
- Cerebral monitoring
Background:
- Jugular venous oxygen saturation (SjVO2) and cerebral arteriovenous oxygen difference (AVDO2) are key indicators for detecting cerebral ischemia.
- Monitoring these parameters is crucial in patients undergoing craniotomy.
Purpose of the Study:
- To investigate the impact of mannitol on SjVO2 and AVDO2 in patients undergoing craniotomy.
- To assess the combined effects of hyperventilation and mannitol on cerebral oxygenation.
Main Methods:
- A study involving 25 ASA class II-III patients undergoing craniotomy.
- Anesthesia maintained with thiopental, fentanyl, isoflurane, and vecuronium.
- Measurements of SjVO2 and AVDO2 taken during normocapnia, hypocapnia, and after mannitol administration.
Main Results:
- Hyperventilation significantly decreased SjVO2 and increased AVDO2 in most patients.
- Subsequent mannitol administration further reduced SjVO2 and increased AVDO2 in a majority of patients.
- These changes suggest a reduction in cerebral blood flow (CBF) during hyperventilation and mannitol treatment.
Conclusions:
- Mannitol can potentially lower SjVO2 and raise AVDO2, indicating reduced cerebral blood flow during hyperventilation.
- Mannitol should be administered with caution in neurosurgical patients who are hyperventilating.
- This finding has implications for managing cerebral oxygenation in high-risk surgical patients.