title: A comparison of 3% hypertonic saline and mannitol for brain relaxation during elective supratentorial brain tumor surgery.
abstract: BACKGROUND
  In this study, we compared the effects of 3% hypertonic saline (HTS) and 20% mannitol on brain relaxation during supratentorial brain tumor surgery, intensive care unit (ICU) stays, and hospital days.
  
  
  METHODS
  This prospective, randomized, and double-blind study included patients who were selected for elective craniotomy for supratentorial brain tumors. Patients received either 160 mL of 3% HTS (HTS group, n = 122) or 150 mL of 20% mannitol infusion (M group, n = 116) for 5 minutes at the start of scalp incision. The PCO(2) in arterial blood was maintained within 35 to 40 mm Hg, arterial blood pressure was controlled within baseline values +/-20%, and positive fluid balance was maintained intraoperatively at a rate of 2 mL/kg/h. Outcome measures included fluid input, urine output, arterial blood gases, serum sodium concentration, ICU stays, and hospital days. Surgeons assessed the condition of the brain as "tight," "adequate," or "soft" immediately after opening the dura.
  
  
  RESULTS
  Brain relaxation conditions in the HTS group (soft/adequate/tight, n = 58/43/21) were better than those observed in the M group (soft/adequate/tight, n = 39/42/35; P = 0.02). The levels of serum sodium were higher in the HTS group compared with the M group over time (P < 0.001). The average urine output in the M group (707 mL) was higher than it was in the HTS group (596 mL) (P < 0.001). There were no significant differences in fluid input, ICU stays, and hospital days between the 2 groups.
  
  
  CONCLUSIONS
  Our results suggest that HTS provided better brain relaxation than did mannitol during elective supratentorial brain tumor surgery, whereas it did not affect ICU stays or hospital days.
authors.affiliation: Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, # 325 Section 2, Chenggung Rd., Neihu 114, Taipei, Taiwan. wuchingtang@msn.co
authors.forename: Ching-Tang
authors.initials: CT
authors.lastname: Wu
authors.forename: Liang-Chih
authors.initials: LC
authors.lastname: Chen
authors.forename: Chang-Po
authors.initials: CP
authors.lastname: Kuo
authors.forename: Da-Tong
authors.initials: DT
authors.lastname: Ju
authors.forename: Cecil O
authors.initials: CO
authors.lastname: Borel
authors.forename: Chen-Hwan
authors.initials: CH
authors.lastname: Cherng
authors.forename: Chih-Shung
authors.initials: CS
authors.lastname: Wong
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003399:Craniotomy; D003422:Critical Care; D004231:Diuresis / Q000187:drug effects; D004311:Double-Blind Method; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007427:Intracranial Pressure / Q000187:drug effects*; D008136:Longevity; D008297:Male; D008353:Mannitol / Q000008:administration & dosage*; D008875:Middle Aged; D011446:Prospective Studies; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage*; D012964:Sodium / Q000097:blood; D012996:Solutions; D015173:Supratentorial Neoplasms / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D012462:Saline Solution, Hypertonic; D012996:Solutions; D008353:Mannitol; D012964:Sodium