Advertisement!
Author Information Pack
Editorial Board
Submit article
Special Issue
Editor's selection process
Join as Reviewer/Editor
List of Reviewer
Indexing Information
Most popular articles
Purchase Single Articles
Archive
Free Online Access
Current Issue
Recommend this journal to your library
Advertiser
Accepted Articles
Search Articles
Email Alerts
FAQ
Contact Us
Indian Journal of Anesthesia and Analgesia

Volume  5, Issue 10, Oct 2018, Pages 1673-1678
 

Original Article

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

Neelesh Bhatnagar1, Manmohan Jindal2

1Associate Professor 2Assistant Professor, Department of Anesthesiology, Geetanjali Medical College and Hospital, Udaipur, Rajasthan 313002, India.

Choose an option to locate / access this Article:
90 days Access
Check if you have access through your login credentials.        PDF      |
|

Open Access: View PDF

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

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.


Keywords : Hyperosmolar Solutions; Brain Relaxation; Hypertonic Saline; Mannitol Traumatic Brain Injury.
Corresponding Author : Manmohan Jindal, Assistant Professor, Department of Anesthesiology, Geetanjali Medical College and Hospital, Udaipur, Rajasthan 313001, India