7.5% hypertonic saline versus 20% mannitol during elective neurosurgical supratentorial procedures

Area of Science:

• Neurosurgery
• Anesthesiology
• Pharmacology

Background:

• Cerebral edema and increased intracranial pressure are significant concerns during neurosurgical procedures.
• Hyperosmolar agents like mannitol and hypertonic saline are commonly used to reduce brain bulk and intracranial pressure.

Purpose of the Study:

• To compare the efficacy of 7.5% hypertonic saline (HS) versus 20% mannitol (M) in reducing brain bulk and cerebrospinal fluid pressure (CSFP).
• To evaluate the effects of these agents on hemodynamic and biochemical parameters during elective neurosurgery.

Main Methods:

• Prospective randomized clinical study involving 50 American Society of Anesthesiologists physical Status I patients.
• Patients were randomly assigned to receive either HS (n=25) or M (n=25) in equal volumes.
• Monitored variables included mean arterial blood pressure (MAP), heart rate (HR), central venous pressure (CVP), CSFP, arterial blood gases, serum electrolytes, and osmolality.

Main Results:

• Both HS and M groups showed a significant decrease in CSFP over time.
• No significant difference in CSFP reduction or brain bulk was observed between the HS and M groups.
• Hypertonic saline led to a higher increase in serum osmolality compared to mannitol.

Conclusions:

• Hypertonic saline (7.5%) is as effective as mannitol (20%) in reducing brain bulk and CSFP during elective neurosurgical procedures.
• Both agents provide comparable reductions in intracranial pressure under general anesthesia.
• Hypertonic saline may offer an alternative to mannitol for managing brain bulk and CSFP in neurosurgery.