Hyperosmolar Therapy for the Intracranial Hypertension in Neurosurgical Practice: Mannitol Versus Hypertonic Saline

2018 ◽

Vol 4 (2) ◽

pp. 54-56

Author(s):

Gentle Sunder Shrestha

Keyword(s):

Intracranial Pressure ◽

Intracranial Hypertension ◽

Hypertonic Saline ◽

Significant Heterogeneity ◽

Raised Intracranial Pressure ◽

Threshold Method ◽

Treatment Threshold ◽

Hyperosmolar Therapy ◽

Surgical Options ◽

Selection Of

Intracranial hypertension is a major cause of morbidity and mortality in patients with brain injury. If not appropriately treated, it can precipitate brain ischemia, brain herniation and death. Hyperosmolar therapy remains the main armamentarium for management of raised intracranial pressure, especially in patients with diffuse lesions and where surgical options are not applicable. Substantial amount of studies have tried to explore the superiority of hypertonic saline or mannitol over the other. Due to significant heterogeneity in the pathophysiology of patients, variation in treatment threshold, method of drug administration and drug concentration, substantial evidence is lacking to support one agent over other. Hypertonic saline may be more effective than mannitol for lowering raised intracranial pressure. Well designed novel trials need to try to find the answer. Clinical, pathophysiological and biochemical data should be incorporated at bedside while individualizing selection of hyperosmolar therapy, with the aim to improve outcome and minimize harm.Journal of Society of Anesthesiologists of NepalVol. 4, No. 2, 2017, Page: 54-56

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The Use of Hypertonic Saline for Treating Intracranial Hypertension After Traumatic Brain Injury

Anesthesia & Analgesia ◽

10.1213/01.ane.0000217208.51017.56 ◽

2006 ◽

Vol 102 (6) ◽

pp. 1836-1846 ◽

Cited By ~ 106

Author(s):

Hayden White ◽

David Cook ◽

Bala Venkatesh

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Intracranial Hypertension ◽

Hypertonic Saline

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Faculty Opinions recommendation of Assessing the impact of 3% hypertonic saline hyperosmolar therapy on intubated children with isolated traumatic brain injury by cerebral oximetry in a pediatric emergency setting.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.737479813.793583750 ◽

2021 ◽

Author(s):

Saskia de Wildt ◽

Gerald Jaspers

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Hypertonic Saline ◽

Pediatric Emergency ◽

Cerebral Oximetry ◽

Emergency Setting ◽

Hyperosmolar Therapy ◽

The Impact

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Hypertonic saline infusion for treating intracranial hypertension after severe traumatic brain injury

Critical Care ◽

10.1186/s13054-018-1963-7 ◽

2018 ◽

Vol 22 (1) ◽

Cited By ~ 8

Author(s):

Halinder S. Mangat

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Intracranial Hypertension ◽

Hypertonic Saline ◽

Severe Traumatic Brain Injury ◽

Saline Infusion ◽

Hypertonic Saline Infusion

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Effect of osmotherapy with mannitol or hypertonic saline on cerebral oxygenation and metabolism in patients with intracranial hypertension after severe brain injury

Critical Care ◽

10.1186/cc14527 ◽

2015 ◽

Vol 19 (Suppl 1) ◽

pp. P447 ◽

Cited By ~ 1

Author(s):

T Suys ◽

H Quintard ◽

C Patet ◽

M Oddo

Keyword(s):

Brain Injury ◽

Intracranial Hypertension ◽

Hypertonic Saline ◽

Cerebral Oxygenation ◽

Severe Brain Injury

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\"Balanced hyperosmolar therapy\" using 3% hypertonic saline - 20% mannitol versus an equiosmolar volume of either 3% hypertonic saline or mannitol 20% in supratentorial tumor resection: A new approach to achieve hemodynamic stability

Indian Journal of Clinical Anaesthesia ◽

10.18231/j.ijca.2021.044 ◽

2021 ◽

Vol 8 (2) ◽

pp. 221-229

Author(s):

Samir A Elkafrawy ◽

Mahmoud K Khames ◽

Islam M Kandeel

Keyword(s):

Hypertonic Saline ◽

Urine Output ◽

Fluid Intake ◽

Tumor Resection ◽

Double Blind Study ◽

Hemodynamic Stability ◽

Hyperosmolar Therapy ◽

Significant Difference ◽

Brain Relaxation ◽

The Brain

Both 3% hypertonic saline (3% HTS) and 20% mannitol were proven to be effective in relaxing the brain during supratentorial surgeries. This work aimed to study the effect of consecutive use of both drugs on the brain relaxation score and hemodynamic status during such surgeries.Ninety patients scheduled for supratentorial brain surgeries included in this prospective, randomized and double-blind study. Patients were allocated in three groups; HTS group (n=30) received 3 ml/kg 3% NaCl infusion over 30 minutes, HTS/M group (n=30) received mannitol 20% (1.4 ml/kg) as an infusion over 15 minute followed by 1.5 ml/kg 3% NaCl infused over 15 minutes and M group (n=30) received 3.2 ml/kg mannitol 20% infusion over 30 minutes. Brain relaxation was estimated. MAP and serum Na level were recorded at baseline and then at 30, 90 and 150 min. Total fluid intake, total urine output and operative time were recorded. Fluid intake and urine output were the highest with 20% mannitol (p ˂ 0.001). HTS/M and HTS groups showed no significance when satisfactory and fairly brain relaxation scores were added (p=0.862). MAP and CVP were near to baseline in HTS/M group at 30 and 90 min, while at 150 min no significant difference between groups. Serum hyperosmolarity was noticed in all groups at all check points but maximally with HTS group at 30 min (321.1 mOsm/L). Balanced hyperosmolar therapy using 3% HTS and 20% mannitol consecutively resulted in a satisfactory brain relaxation and allowed more hemodynamic stability.

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