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Comparison of Mannitol, Hypertonic Saline and Mannitol + Hypertonic Saline Combination for Brain Relaxation during Craniotomy

Manmohan Jindal, Assistant Professor, Department of Anesthesiology, Geetanjali Medical College and Hospital, Udaipur, Rajasthan 313001, India , Neelesh Bhatnagar1 , Manmohan Jindal2

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Indian Journal of Anesthesia and Analgesia 5(10):p 1673-1678, Oct 2018. | DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.51018.14

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Abstract

  Background: Hyperosmolar solutions are most commonly used to relax brain and facilitate intracranial surgery. This study was planned to compare the effects of three equiosmolar, equivolemic solutions (mannitol, 3% hypertonic saline, and mannitol+3% hypertonic saline) on intraoperative brain relaxation. Material and Methods: This prospective randomized study was conducted in 90 patients of age group 18­65 years with traumatic brain injury undergoing craniotomy only after approval from the institutional ethics committee. Patients were randomly allocated into three groups; Group M ( received mannitol 300 ml), GROUP S (Group received 3% Hypertonic Saline 300 ml), and GROUP M+S (received mannitol 150 ml and 3% Hypertonic Saline 150 ml). Brain relaxation score was assessed by neurosurgeon on a four point scale as perfectly relaxed­1, satisfactorily relaxed­2, firm brain­3, bulging brain­4. All the patients were assessed for Glasgow coma score at 24 hrs postoperatively and at the time of discharge from the intensive care unit. Results: Grade 1 and Grade 2 brain relaxation scores were 4/14, 4/16 and 8/12 in Group M, Group S and Group M+S respectively. (p>0.05) Total urine out was 1453.33±376.68 ml in group M, 823.33±238.43 ml in group S and 1313.33±156.96 ml in group M+S respectively. (p<0.001) There was non­significant rise and fall of electrolyte (Na+ and K+) level amongst the groups. Additional rescue dose of mannitol was required in all three groups in 12, 8 and 10 patients respectively. Conclusion: All three hyperosmolar solutions are equally effective in providing adequate intraoperative brain relaxation during decompressive craniotomy in traumatic brain injury.

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DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.51018.14

Keywords

Hyperosmolar Solutions; Brain Relaxation; Hypertonic Saline; Mannitol Traumatic Brain Injury.

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