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.

\"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 Role of pre–extubation fentanyl in mastectomy: a randomized, controlled, double–blind study

2021 ◽  
Vol 25 (2) ◽  
Author(s):  
Ahmed Salman ◽  
Norma Osama Zayed ◽  
Ahmed Mansour ◽  
Ramy Howaidi ◽  
Ahmed Gamaleldin Foly ◽  
...  
Keyword(s):  
Short Form ◽  
Cardiovascular Responses ◽  
Blind Study ◽  
Double Blind Study ◽  
Double Blind ◽  
Randomized Controlled ◽  
Arterial Blood ◽  
Extubation Time ◽  
Significant Difference

Background: Both tracheal intubation and extubation are associated with dangerous consequences such as tachycardia, hypertension, myocardial ischemia and arrhythmias. The aim was to evaluate pre–extubation two different doses of fentanyl on hemodynamic stabilization and delayed recovery in mastectomy. Methodology: The randomized controlled double–blind study was conducted on 126 patients aged 16–60 years, with controlled hypertension, receiving chemotherapy before surgery and underwent mastectomy for breast cancer. Patients were randomly allocated into 3 equal groups. Before extubation, patients received 10 ml saline in group (C), 1 µg/kg fentanyl in Group–F1: and 2 µg/kg fentanyl in Group–F2. Mean arterial blood pressure (MAP) and heart rate (HR) were recorded at T1 (after maintenance of anesthesia), T2 (after giving the test drug), T3 (immediately after extubation), T4 (5 min. after extubation) and T5 (15 min after extubation). Results: MAP was significantly lower in fentanyl groups compared to Group–C at T2 and T3 without significant deference between fentanyl groups. HR was significantly lower in fentanyl groups compared to Group–C and in Group–F2 compared to Group–F1 at T3, T4 and T5. Time of extubation was significantly prolonged in Group–F2 compared to Group–F1 and Group–C without a significant difference between Group–F1 and Group–C. Conclusions: Pre–extubation fentanyl 1 µg/kg blunted cardiovascular responses to extubation without respiratory depression or prolonged recovery. Pre–extubation fentanyl 2 µg/kg provide more control in HR but with delay in the extubation time compared to 1 µg/kg of fentanyl. Key words: Pre–Extubation, Fentanyl, Mastectomy, Hemodynamics, Recovery Preregistration: The study was registered in the Ethical Committee of Faculty of Medicine, Cairo University, Cairo, Egypt (approval number: 281) Citation: Salman A, Zayed NO, Mansour A, Howaidi R, Foly AG, ElSharkawy MS, Abdelgalil AS. Role of pre–extubation fentanyl in mastectomy: a randomized, controlled, double–blind study. Anaesth. pain intensive care 2021;25(2):143-149. DOI: 10.35975/apic.v25i2.1462. Abbreviations: CST=Craniosacral therapy; SMT=Sensorimotor training; NCLBP=Nonspecific chronic low back pain; VAS=Visual analogue scale; ODI=Oswestry disability index, BDI-II=Beck depression inventory-II, and SF-36=Short Form-36; CSF=cerebral spinal fluid; CSS=craniosacral system; PRM=primary respiratory movements Received: 27 June 2020, Reviewed: 24 July 2020, Accepted: 27 July 2020

Raised intracranial pressure, cerebral oedema, and hydrocephalus

2011 ◽  
Author(s):  
Ian Whittle
Keyword(s):  
Intracranial Pressure ◽  
Dynamic Equilibrium ◽  
Venous Pressure ◽  
Venous Blood ◽  
Contributory Factor ◽  
Common Disease ◽  
Brain Vessels ◽  
Arterial Blood ◽  
Pressure Dynamics ◽  
The Brain

The brain is protected by the cranial skeleton. Within the intracranial compartment are also cerebrospinal fluid, CSF, and the blood contained within the brain vessels. These intracranial components are in dynamic equilibrium due to the pulsations of the heart and the respiratory regulated return of venous blood from the brain. Normally the mean arterial blood pressure, systemic venous pressure, and brain volume are regulated to maintain physiological values for intracranial pressure, ICP. There are a range of very common disorders such as stroke, and much less common, such as idiopathic intracranial hypertension, that are associated with major disturbances of intracranial pressure dynamics. In some of these the contribution to pathophysiology is relatively minor whereas in others it may be substantial and be a major contributory factor to morbidity or even death.Intracranial pressure can be disordered because of brain oedema, disturbances in CSF flow, mass lesions, and vascular engorgement of the brain. Each of these may have variable causes and there may be interactions between mechanisms. In this chapter the normal regulation of intracranial pressure is outlined and some common disease states in clinical neurological practice that are characterized by either primary or secondary problems in intracranial pressure dynamics described.

Hypertonic saline dextran produces early (8-12 hrs) fluid sparing in burn resuscitation: A 24-hr prospective, double-blind study in sheep

2000 ◽  
Vol 28 (1) ◽  
pp. 163-171 ◽  
Author(s):  
Geir Ivar Elgjo ◽  
Luiz F. Poli de Figueiredo ◽  
Paul J. Schenarts ◽  
Daniel L. Traber ◽  
Lillian D. Traber ◽  
...  
Keyword(s):  
Hypertonic Saline ◽  
Blind Study ◽  
Double Blind Study ◽  
Double Blind ◽  
Burn Resuscitation

Effects of Two Target-controlled Concentrations (1 and 3 ng/ml) of Remifentanil on MACBARof Sevoflurane

2004 ◽  
Vol 100 (2) ◽  
pp. 255-259 ◽  
Author(s):  
Andrea Albertin ◽  
Andrea Casati ◽  
Piercarlo Bergonzi ◽  
Greta Fano ◽  
Giorgio Torri
Keyword(s):  
Nitrous Oxide ◽  
Skin Incision ◽  
Double Blind Study ◽  
Double Blind ◽  
Surgical Incision ◽  
Arterial Blood ◽  
Sequential Allocation ◽  
Sympathetic Responses ◽  
American Society ◽  
End Tidal

Background The aim of this prospective, randomized, double-blind study was to determine the effects of two different target-controlled concentrations of remifentanil (1 and 3 ng/ml) on the sevoflurane requirement for blunting sympathetic responses after surgical incision (MACBAR). Methods Seventy-four patients aged 20-50 yr, with American Society of Anesthesiologists physical status I, were anesthetized with propofol, cisatracurium, and sevoflurane with a mixture of 60% nitrous oxide in oxygen. Then, patients were randomly allocated to receive no remifentanil infusion (n = 27) or a target-controlled plasma concentration of 1 ng/ml (n = 27) or 3 ng/ml remifentanil (n = 20). Sympathetic responses to surgical incision (presence or absence of an increase in either heart rate or mean arterial blood pressure of 15% or more above the mean of the values measured during the 2 min before skin incision) were determined after a 20-min period of stable end-tidal sevoflurane and target-controlled remifentanil concentrations. Predetermined end-tidal sevoflurane concentrations and the MACBAR for each group were determined using an up-and-down sequential-allocation technique. Results The MACBAR of sevoflurane was higher in the group receiving no remifentanil (2.8% [95% confidence interval: 2.5-3.0%]) as compared with patients of the groups receiving 1 ng/ml (1.1% [0.9-1.3%]; P = 0.012) and 3 ng/ml remifentanil (0.2% [0.1-0.3%]; P = 0.006). When considering a minimum anesthetic concentration (MAC) value in this age population and the contribution of 60% nitrous oxide (0.55 MAC), the combined MACBAR values, expressed as multiples of the MAC, were 1.95 MAC, 1.1 MAC, and 0.68 MAC, in the three groups, respectively. Conclusion A target-controlled concentration of 1 ng/ml remifentanil results in a 60% decrease in the MACBAR of sevoflurane combined with 60% nitrous oxide. Increasing the target concentration of remifentanil to 3 ng/ml produces a further 30% decrease in the MACBAR values of sevoflurane.

Osmotic thirst and vasopressin release in humans: a double-blind crossover study

1985 ◽  
Vol 248 (6) ◽  
pp. R645-R650 ◽  
Author(s):  
P. A. Phillips ◽  
B. J. Rolls ◽  
J. G. Ledingham ◽  
M. L. Forsling ◽  
J. J. Morton
Keyword(s):  
Hypertonic Saline ◽  
Water Intake ◽  
Sodium Concentration ◽  
Plasma Sodium ◽  
Double Blind ◽  
Vasopressin Release ◽  
Arterial Blood ◽  
Plasma Vasopressin ◽  
Plasma Sodium Concentration ◽  
Osmotic Thirst

Thirst is a subjective sensation. Therefore to investigate further the nature, intensity, and specificity of osmotic thirst, we studied the effects of double-blind infusions of hypertonic (0.45 M) and isotonic (0.15 M) saline on subjective ratings and sensations of thirst, water intake, plasma vasopressin, and body fluids in seven healthy volunteer young men. Only the hypertonic saline significantly increased plasma sodium concentration, plasma osmolality, plasma vasopressin concentration, and visual analog ratings of thirst sensations. Both infusions expanded blood volume, which was greater with the hypertonic saline infusion. Neither solution significantly altered mean arterial blood pressure nor plasma angiotensin levels. Throughout a 60-min drinking period after the infusions, water intake was always significantly greater after the hypertonic saline than after the isotonic saline. The subjects described the thirst sensations as mainly due to a dry unpleasant tasting mouth, which was promptly relieved by drinking. Visual analog rating changes confirmed the subjective reports. Finally, the effects on thirst and vasopressin secretion were observed at plasma sodium concentration and osmolality changes that are well within the physiological range.

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