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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 2001 September;67(9):603-11

language: English

Hypertonic saline solution: a safe alternative to mannitol 18% in neurosurgery

De Vivo P., Del Gaudio A., Ciritella P., Puopolo M. *, Chiarotti F. *, Mastronardi E. **

From the II Depart­ment of Anes­the­sio­lo­gy and Inten­sive ­Care H «­Casa Sol­lie­vo del­la Sof­fe­ren­za» Isti­tu­to di Ric­o­ve­ro e ­Cura a Carat­tere Scien­tif­i­co, S. Gio­van­ni
Roton­do (Fog­gia)
*Isti­tu­to Super­iore di ­Sanità, Depart­ment of ­Organ and ­System Pathoph­y­sio­lo­gy, ­Rome
**Insti­tute of Anes­the­sio­lo­gy and Inten­sive ­Care, Uni­ver­sity of ­Naples “Feder­i­co II”, ­Naples


Back­ground. To eval­u­ate the use­ful­ness of hyper­ton­ic ­saline solu­tions (HTS) as an alter­na­tive to man­ni­tol in neu­ro­sur­gery.
Meth­ods. Thir­ty ­patients sub­ject­ed to cran­i­ot­o­my for supra­ten­to­ri­al cere­bral ­tumors ­were ran­dom­ly divid­ed in to ­three ­Groups: M: had man­ni­tol 0.5 g·kg-1 as ­bolus at the ­start of ­skin inci­sion, and post­op­er­a­tive­ly 0.5 g·kg-1 dai­ly ­three ­times a day for 3 ­days (72 hrs); HM: had man­ni­tol 0.25 g·kg-1 as ­bolus at the ­start of ­skin inci­sion ­plus 3% HTS, 20 ml·h-1 intra­op­er­a­tive­ly and man­ni­tol 0.25 g·kg-1 dai­ly ­three ­times a day for 3 ­days ­plus HTS in the con­cen­tra­tion of 3% in the ­first day and 2% and 1% the sec­ond and the ­third day ­after sur­gery; H: had 3% HTS 3.5 ml kg-1 as ­bolus at the ­start of ­skin inci­sion ­plus 3% HTS, 20 ml hr-1 intra­op­er­a­tive­ly and 3% HTS, 20 ml h-1 on the ­first day and 2% and 1% the sec­ond and the ­third day ­after sur­gery. FR, MAP, ICP, CVP and diu­re­sis ­were con­tin­u­ous­ly mon­i­tored intra­op­er­a­tive­ly and post­op­er­a­tive­ly for 72 hrs. ICP was mon­i­tored intra­op­er­a­tive­ly ­until ­dural open­ing and in the post­op­er­a­tive peri­od for 72 hrs at ­least.
­Results. Diu­re­sis was ­increased in the ­first and sec­ond ­Group (M and HM) ­more ­than in the H ­Group espe­cial­ly in the post­op­er­a­tive peri­od, but ­this ­change was not a sig­nif­i­ca­tive one (35.31 ml·kg-1·h-1±4.57 and 36.56±3.92 vs 3.23 ml·kg-1·h-1). ­Mean ser­um Na+ val­ues ­declined in the post­op­er­a­tive peri­od, in ­Groups M and MH and ­remained ­stable in the post­op­er­a­tive peri­od in the ­Group H (137.6±7 mEq·l-1 and 136.5±6.5 mEq·l-1 vs 139.2±5 mEq·l-1). Ser­um osmo­lal­ity ­increased sig­nif­i­cant­ly in the post­op­er­a­tive peri­od in ­group H and ­remained ­unchanged in the ­same peri­od in ­Group M and MH. Potas­sium val­ues ­declined sig­nif­i­cant­ly dur­ing the ­whole peri­od in all ­groups but ­remained in a nor­mal clin­i­cal ­range. CVP val­ues ­decreased in ­Groups M and MH in the post­op­er­a­tive peri­od, and ­increased ­although not sig­nif­i­cant­ly in the post­op­er­a­tive peri­od in the ­Group H ­patients. Ht val­ues ­declined sig­nif­i­cant­ly in all ­groups with­out dif­fer­enc­es ­among the ­groups ­although the reduc­tion was great­er in ­group H.
Con­clu­sions. HTS can safe­ly be ­used in ­hu-mans; ­they ­obtain a reduc­tion of ICP with­out reduc­ing CVP, ser­um osmo­lal­ity and Na+ ser­um val­ues. Our ­data under­line the pos­sibil­ity of ­their use as an alter­na­tive to man­ni­tol in the treat­ment of ­patients sched­uled for intra­cra­ni­al sur­gery, espe­cial­ly ­when mul­ti­ple dos­es are need­ed.

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