\"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

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.

scholarly journals Mannitol versus hypertonic saline for intra-operative brain relaxation during aneurysm surgery

2015 ◽  
Vol 02 (01) ◽  
pp. 023-027
Author(s):  
Shalini Sharma ◽  
Vinod Grover ◽  
Preethy Mathew
Keyword(s):  
Hypertonic Saline ◽  
Serum Sodium ◽  
Venous Pressure ◽  
Double Blind Study ◽  
Aneurysm Surgery ◽  
Double Blind ◽  
Arterial Blood ◽  
Fisher Grade ◽  
Brain Relaxation ◽  
The Brain

Abstract Background: The study was designed to compare the effects of equiosmolar and equivolemic 3% hypertonic saline (HTS) and 20% mannitol (M) on brain relaxation during aneurysm surgery. Materials and Methods: A prospective, randomised, double-blind study was undertaken in patients scheduled for surgical clipping of intracranial aneurysms presenting with Fisher grade I, II or III. The patients received either 300 mL of 3% hypertonic saline (HTS group) or 300 mL of 20% mannitol infusion (M group) during a period of 15 minutes at the start of scalp incision. The PaCO2 was maintained at 3.4-4.7 kilo Pascal, arterial blood pressure was maintained within ± 20% of baseline and central venous pressure was maintained at 5-10 cm of water. The haemodynamics, arterial blood gases and serum sodium concentration were compared. Surgeons assessed the condition of the brain as bulging, firm, satisfactorily relaxed and perfectly relaxed. An anaesthesiologist also assessed intra-operative brain relaxation. Results: The brain relaxation achieved with hypertonic saline was as good as that with mannitol. Urine output with mannitol was higher than with hypertonic saline (P < 0.04). Hypertonic saline caused an increase in serum sodium over one hour (P < 0.001) but resolved in 24 hours. Conclusions: The brain relaxation was equal in both the groups as assessed by the anaesthesiologist as well as the surgeon while the transient rise in serum sodium in hypertonic saline group returned to normal within 24 hours.

scholarly journals Effect of Equiosmolar Solutions of Mannitol versus  Hypertonic Saline on Intraoperative Brain Relaxation and Electrolyte Balance

2007 ◽  
Vol 107 (5) ◽  
pp. 697-704 ◽  
Author(s):  
Irene Rozet ◽  
Nuj Tontisirin ◽  
Saipin Muangman ◽  
Monica S. Vavilala ◽  
Michael J. Souter ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Hypertonic Saline ◽  
Statistical Tests ◽  
Venous Pressure ◽  
Electrolyte Balance ◽  
Double Blind Study ◽  
Double Blind ◽  
Arterial Blood ◽  
Brain Relaxation ◽  
Over Time

Background The purpose of the study was to compare the effect of equiosmolar solutions of mannitol and hypertonic saline (HS) on brain relaxation and electrolyte balance. Methods After institutional review board approval and informed consent, patients with American Society of Anesthesiologists physical status II-IV, scheduled to undergo craniotomy for various brain pathologies, were enrolled into this prospective, randomized, double-blind study. Patients received 5 ml/kg 20% mannitol (n = 20) or 3% HS (n = 20). Partial pressure of carbon dioxide in arterial blood was maintained at 35-40 mmHg, and central venous pressure was maintained at 5 mmHg or greater. Hemodynamic variables, fluid balance, blood gases, electrolytes, lactate, and osmolality (blood, cerebrospinal fluid, urine) were measured at 0, 15, 30, and 60 min and 6 h after infusion; arteriovenous difference of oxygen, glucose, and lactate were calculated. The surgeon assessed brain relaxation on a four-point scale (1 = relaxed, 2 = satisfactory, 3 = firm, 4 = bulging). Appropriate statistical tests were used for comparison; P &lt; 0.05 was considered significant. Results There was no difference in brain relaxation (mannitol = 2, HS = 2 points; P = 0.8) or cerebral arteriovenous oxygen and lactate difference between HS and mannitol groups. Urine output with mannitol was higher than with HS (P &lt; 0.03) and was associated with higher blood lactate over time (P &lt; 0.001, compared with HS). Cerebrospinal fluid osmolality increased at 6 h in both groups (P &lt; 0.05, compared with baseline). HS caused an increase in sodium in cerebrospinal fluid over time (P &lt; 0.001, compared with mannitol). Conclusion Mannitol and HS cause an increase in cerebrospinal fluid osmolality, and are associated with similar brain relaxation scores and arteriovenous oxygen and lactate difference during craniotomy.

23.4% Sodium Chloride Versus Mannitol for the Reduction of Intracranial Pressure in Patients With Traumatic Brain Injury: A Single-Center Retrospective Cohort Study

2020 ◽  
pp. 106002802098237
Author(s):  
Hayley A. Tatro ◽  
James C. McMillen ◽  
Leslie A. Hamilton ◽  
A. Shaun Rowe
Keyword(s):  
Cohort Study ◽  
Sodium Chloride ◽  
Intracranial Pressure ◽  
Hypertonic Saline ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Single Center ◽  
Hyperosmolar Therapy ◽  
Absolute Reduction ◽  
Significant Difference

Background Intermittent doses of mannitol or hypertonic saline are recommended to treat elevated intracranial pressure (ICP). However, it is unclear if one agent is more effective than the other. Previous studies have compared mannitol and hypertonic saline in reduction of ICP, with conflicting results. However, no study thus far has compared 23.4% sodium chloride with mannitol. Objective The objective of this study was to determine the difference in absolute reduction of ICP 60 minutes after infusion of 23.4% sodium chloride versus mannitol. Methods This was a single-center retrospective cohort study that included patients at least 16 years old admitted to the trauma/surgical intensive care unit between August 8, 2016, and August 30, 2018, who received either 23.4% sodium chloride 30 mL and/or mannitol 0.5 g/kg and had an ICP monitor or external ventricular drain in place. The primary outcome was absolute reduction in ICP 60 minutes after infusion of hyperosmolar therapy. Results In all, 31 patients and 162 doses of hyperosmolar therapy were included in the analysis. There was no statistically significant difference in the primary end point of absolute reduction of ICP 60 minutes after infusion of hyperosmolar therapy comparing 23.4% sodium chloride 30 mL with 0.5 g/kg mannitol ( P = 0.2929). There was no statistically significant difference found for any secondary end points. Conclusion and Relevance No difference was found for absolute reduction of ICP at 30, 60, and 120 minutes, respectively, after infusion of hyperosmolar agent or time to next elevated ICP. Patient-specific parameters should be used to guide the choice of hyperosmolar agent to be administered.

Associations between clinical outcome and tractography based on navigated transcranial magnetic stimulation in patients with language-eloquent brain lesions

2020 ◽  
Vol 132 (4) ◽  
pp. 1033-1042 ◽  
Author(s):  
Nico Sollmann ◽  
Alessia Fratini ◽  
Haosu Zhang ◽  
Claus Zimmer ◽  
Bernhard Meyer ◽  
...  
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Brain Tumors ◽  
Risk Stratification ◽  
Magnetic Stimulation ◽  
Diffusion Tensor ◽  
Tumor Resection ◽  
Navigated Transcranial Magnetic Stimulation ◽  
Language Mapping ◽  
Significant Difference ◽  
Related Pathway

OBJECTIVENavigated transcranial magnetic stimulation (nTMS) in combination with diffusion tensor imaging fiber tracking (DTI FT) is increasingly used to locate subcortical language-related pathways. The aim of this study was to establish nTMS-based DTI FT for preoperative risk stratification by evaluating associations between lesion-to-tract distances (LTDs) and aphasia and by determining a cut-off LTD value to prevent surgery-related permanent aphasia.METHODSFifty patients with left-hemispheric, language-eloquent brain tumors underwent preoperative nTMS language mapping and nTMS-based DTI FT, followed by tumor resection. nTMS-based DTI FT was performed with a predefined fractional anisotropy (FA) of 0.10, 0.15, 50% of the individual FA threshold (FAT), and 75% FAT (minimum fiber length [FL]: 100 mm). The arcuate fascicle (AF), superior longitudinal fascicle (SLF), inferior longitudinal fascicle (ILF), uncinate fascicle (UC), and frontooccipital fascicle (FoF) were identified in nTMS-based tractography, and minimum LTDs were measured between the lesion and the AF and between the lesion and the closest other subcortical language-related pathway (SLF, ILF, UC, or FoF). LTDs were then associated with the level of aphasia (no/transient or permanent surgery-related aphasia, according to follow-up examinations).RESULTSA significant difference in LTDs was observed between patients with no or only surgery-related transient impairment and those who developed surgery-related permanent aphasia with regard to the AF (FA = 0.10, p = 0.0321; FA = 0.15, p = 0.0143; FA = 50% FAT, p = 0.0106) as well as the closest other subcortical language-related pathway (FA = 0.10, p = 0.0182; FA = 0.15, p = 0.0200; FA = 50% FAT, p = 0.0077). Patients with surgery-related permanent aphasia showed the lowest LTDs in relation to these tracts. Thus, LTDs of ≥ 8 mm (AF) and ≥ 11 mm (SLF, ILF, UC, or FoF) were determined as cut-off values for surgery-related permanent aphasia.CONCLUSIONSnTMS-based DTI FT of subcortical language-related pathways seems suitable for risk stratification and prediction in patients suffering from language-eloquent brain tumors. Thus, the current role of nTMS-based DTI FT might be expanded, going beyond the level of being a mere tool for surgical planning and resection guidance.

scholarly journals RONC-26. A CASE OF RADIATION NECROSIS OF THE CEREBELLUM 16 YEARS AFTER CHEMORADIOTHERAPY FOR MEDULLOBLASTOMA

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii460-iii460
Author(s):  
Mayuko Miyata ◽  
Masahiro Nonaka ◽  
Akio Asai
Keyword(s):  
Radiation Necrosis ◽  
Tumor Resection ◽  
Pathological Examination ◽  
Secondary Cancer ◽  
Brain Necrosis ◽  
Cerebellar Medulloblastoma ◽  
Cerebellar Peduncle ◽  
The Right ◽  
The Brain

Abstract BACKGROUND If new lesions are observed during follow-up of the malignant tumor after treatment, it is difficult to distinguish whether the tumor is a recurrent lesion, secondary cancer, or radiation necrosis of the brain. We have encountered a patient with symptomatic radiation necrosis of the cerebellum 16 years after treatment of medulloblastoma. CASE PRESENTATION: A 24-year-old man who had received a tumor resection and chemoradiotherapy for cerebellar medulloblastoma at the age of 8 presented with dizziness. For the past 16 years, there was no recurrence of the tumor. He subsequently underwent MRI scan, and T1-Gd image showed enhanced lesion in the right cerebellar peduncle. Cerebrospinal fluid cytology analysis was negative for tumor. We suspected tumor reccurence or secondary cancer, and performed lesion biopsy. The result of the pathological examination was radiation necrosis of the cerebellum. DISCUSSION: The interval of radiation necrosis of the brain and radiotherapy can vary from months to more than 10 years. So, whenever a new lesion is identified, radiation brain necrosis must be envisioned. According to guidelines in Japan, there is no absolute examination for discriminating tumor recurrence from radiation brain necrosis and diagnosis by biopsy may be required. CONCLUSION We experienced a case of symptomatic radiation necrosis of the cerebellum 16 years after treatment. In patients showing new lesion after long periods of time, the possibility of radiation necrosis to be considered.

In vivo exploration of brain phosphorus 31 metabolism in patients with senile dementia of Alzheimer type

1994 ◽  
Vol 9 (2) ◽  
pp. 105-109
Author(s):  
G Mecheri ◽  
Y Bissuel ◽  
J Dalery ◽  
JL Terra ◽  
G Balvay ◽  
...  
Keyword(s):  
Statistical Analysis ◽  
Senile Dementia ◽  
Phospholipid Metabolism ◽  
Alzheimer Type ◽  
Dementia Of Alzheimer Type ◽  
Non Invasive ◽  
Significant Difference ◽  
The Brain

SummaryIn vivo NMR 31p spectroscopy is a non invasive, non ionizing method of exploration of energy and phospholipid metabolism in the brain. This study consisted of comparing 31p spectra in five patients with Senile Dementia of Alzheimer Type (SDAT) with those of four controls of similar ages. Abnormal phosphonionocsters (PME) concentrations, either high or low, were found in the patients, but statistical analysis did not elicit any significant difference relative to controls.

Apparent Higher Brain Weight in Suicide Victims: Possible Reasons

2002 ◽  
Vol 90 (1) ◽  
pp. 236-238 ◽  
Author(s):  
Jože Balažic ◽  
Andrej Marušič
Keyword(s):  
Postmortem Examination ◽  
Brain Weight ◽  
The Other ◽  
Emotional Information ◽  
Partial Explanation ◽  
Suicide Methods ◽  
Surrounding Environment ◽  
Significant Difference ◽  
Self Harm ◽  
The Brain

In 2000 we tested previously reported findings by Salib and Tadros that brain weight of fatal self-harm victims is higher than of those who died of natural causes. Our results were based on data from 15 suicides and 15 deaths of other causes. Data included matching variables of age, sex, time between death and postmortem examination, and temperature of the surrounding environment. The exploratory variables were brain weight and method of death. No significant difference was found between the brain weights of suicides and others. On the other hand, some differences were obtained for different suicide methods, which also differed in the temperature of the environment, this being lower for the group of suicides that occurred outdoors (around or below 0°C). Once we excluded all the outdoor cases and controls, a significantly higher brain weight was obtained for suicide cases. These and previous results are intriguing and require explanation. Respirator brain syndrome as described by Moseley, Molinari, and Walker in 1976 may provide only a partial explanation. Another possible suggestion is that higher brain weight in suicide victims may be related to previously demonstrated increased amygdala blood flow and subsequent amygdala enlargement due to the increased processing of emotional information.

scholarly journals Divergent mechanism regulating fluid intake and metabolism by the brain renin-angiotensin system

2012 ◽  
Vol 302 (3) ◽  
pp. R313-R320 ◽  
Author(s):  
Curt D. Sigmund
Keyword(s):  
Blood Pressure ◽  
Fluid Intake ◽  
Renin Angiotensin System ◽  
Metabolic Effects ◽  
Angiotensin System ◽  
Renin Angiotensin ◽  
Intracellular Form ◽  
Efferent Pathways ◽  
The Brain ◽  
Pituitary Adrenal Axis

The purpose of this review is two-fold. First, I will highlight recent advances in our understanding of the mechanisms regulating angiotensin II (ANG II) synthesis in the brain, focusing on evidence that renin is expressed in the brain and is expressed in two forms: a secreted form, which may catalyze extracellular ANG I generation from glial or neuronal angiotensinogen (AGT), and an intracellular form, which may generate intracellular ANG in neurons that may act as a neurotransmitter. Second, I will discuss recent studies that advance the concept that the renin-angiotensin system (RAS) in the brain not only is a potent regulator of blood pressure and fluid intake but may also regulate metabolism. The efferent pathways regulating the blood pressure/dipsogenic effects and the metabolic effects of elevated central RAS activity appear different, with the former being dependent upon the hypothalamic-pituitary-adrenal axis, and the latter being dependent upon an interaction between the brain and the systemic (or adipose) RAS.

Sign in / Sign up

Export Citation Format

Share Document