Original Article   

Journal of Neurosurgical Sciences 2022 Apr 05

DOI: 10.23736/S0390-5616.22.05678-8

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

Effect of mannitol on platelet function during elective craniotomy in adult patients with brain tumor

Kilian ARLT ¹, Paul FRANK ¹, Markus FLENTJE ¹, Hendrik EISMANN ¹, Elvis J. HERMANN ², Joachim K. KRAUSS ², Shadi AL-AFIF ², Thomas PALMAERS ¹ ✉

¹ Department of Anaesthesiology and Intensive Care, Hanover Medical School, Hannover, Germany; ² Department of Neurosurgery, Hanover Medical School, Hannover, Germany

BACKGROUND: Mannitol is used in the treatment of raised intracranial pressure (ICP). The aim of this study was to investigate whether mannitol (MAN) leads to a relevant deterioration in platelet function in routine neurosurgical procedures.
METHODS: Thirty-eight patients undergoing elective craniotomy due to a brain tumor with elevated ICP were included. After induction of anaesthesia a blood sample was taken (T1). The patients then received 1 g-kg-1 MAN within 30 minutes. The second blood sample (T2) was obtained 60 minutes after T1. Blood samples were examined by means of aggregometry (Multiplate®) and PFA-100® tests.
RESULTS: No patient had clinical signs of increased bleeding. We could not find any deterioration in the aggregometry using Multiplate®, neither in the adenosinediphosphate (ADP), the arachidonic acid (ASPI), or the thrombin receptor activating protein (TRAP) test. PFA-100® closing times (cT) showed a significant prolongation between T1 and T2: collagen/adenosindiphosphate (COL/ADP) test 79s [70/99] and 91s [81/109]; p=0.002); collagen/epinephrine (COL/EPI) test 109s [92/129] and 122s [94/159]; p=0.0004). A subgroup analysis showed that the patients who received isotonic balanced infusions only, had no prolongation of cT, whereas the patients who received additionally gelatine solution had a significant prolongation. COL/ADP: 78s [70/98] and 91s [82/133]; p=0.0004). COL/EPI: test 111s [92/128] and 127s [103/146]; p=0.0026). Except for individual outliers, the measured values were in the normal range.
CONCLUSIONS: In this study, we found no clinically relevant deterioration of platelet function in neurosurgical patients with increased ICP after administration of MAN. Changes that occurred were all within normal ranges.

KEY WORDS: Mannitol; Multiplate; Platelet function; Platelet aggregometry; PFA-100; Neurosurgery; Craniotomy