title: Current purpose and practice of hypertonic saline in neurosurgery: a review of the literature.
abstract: OBJECTIVE
  To review and summarize controversies and current concepts regarding the use of hypertonic saline during the perioperative period in neurosurgery.
  
  
  METHODS
  Relevant literature was searched on PubMed and Scopus electronic databases to identify all studies that have investigated the use of hypertonic saline in neurosurgery.
  
  
  RESULTS
  Fluid management during the course of neurosurgical practice has been debated at length, especially strategies to control intracranial pressure and small volume resuscitation. The goal of fluid therapy includes minimizing cerebral edema, preserving intravascular volume, and maintaining cerebral perfusion pressure. Mannitol is widely recognized as the gold standard for treating intracranial hypertension but can result in systemic hypotension. Thus, hypertonic saline provides volume expansion and may improve cerebral and systemic hemodynamics. Recently published prospective data, however, regarding the use of osmotic agents fails to establish clear guidelines in neurosurgical patients.
  
  
  CONCLUSIONS
  We suggest that hypertonic saline will emerge as an alternative to mannitol, especially for a long-term use or multiple doses are needed and lead to a great opportunity for collaborative research.
authors: Department of Anesthesiology, Ohio State University Wexner Medical Center and Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio, USA; Department of Anesthesiology, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. Electronic address: jupiters66@gmail.com.
authors: Cattleya
authors: C
authors: Thongrong
authors: Department of Anesthesiology, Ohio State University Wexner Medical Center and Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio, USA.
authors: Nicolas
authors: N
authors: Kong
authors: Department of Anesthesiology, Ohio State University Wexner Medical Center and Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio, USA.
authors: Barani
authors: B
authors: Govindarajan
authors: Department of Anesthesiology, Ohio State University Wexner Medical Center and Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio, USA.
authors: Duane
authors: D
authors: Allen
authors: Department of Neurological Surgery, Ohio State University Wexner Medical Center and Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio, USA.
authors: Ehud
authors: E
authors: Mendel
authors: Department of Anesthesiology, Ohio State University Wexner Medical Center and Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio, USA; Department of Neurological Surgery, Ohio State University Wexner Medical Center and Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio, USA.
authors: Sergio D
authors: SD
authors: Bergese
mesh_terms: D003422:Critical Care; D005440:Fluid Therapy / Q000379:methods* / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D019635:Neurosurgical Procedures / Q000379:methods*; D019990:Perioperative Care; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D012462:Saline Solution, Hypertonic
keywords: Anesthesia; Hyperosmolar agent; Hypertonic saline; Intracranial pressure; Mannitol; Neurosurgery