title: A comparison of equivolume, equiosmolar solutions of hypertonic saline and mannitol for brain relaxation in patients undergoing elective intracranial tumor surgery: a randomized clinical trial.
abstract: BACKGROUND
  Hyperosmolar solutions have been used in neurosurgery to modify brain bulk and prevent neurological deterioration. The purpose of the study was to compare the effects of equivolume, equiosmolar solutions of mannitol and hypertonic saline (HTS) on brain relaxation and postoperative complications in patients undergoing elective intracranial tumor surgery.
  
  
  METHODS
  In this prospective, randomized study, patients with American Society of Anesthesiologists physical status I to III scheduled to undergo a craniotomy for intracranial tumors were enrolled. Patients received a 3.75 mL/kg intravenous infusion of either 3.2% HTS (group HTS, n=36) or 20% mannitol (group M, n=38). The surgeon assessed the condition of the brain using a 4-point scale after opening the dura. Recorded measures included duration of surgery, blood loss, urine output, volume and type of infused fluids, hemodynamic variables, electrolytes, glucose, creatinine, predefined postoperative complications, and length of intensive care unit and hospital stays.
  
  
  RESULTS
  Brain relaxation conditions in group HTS (score 1/2/3/4, n=10/17/2/7) were better than those in group M (score 1/2/3/4, n=3/18/3/14, P=0.0281). Patients in group M had higher urine output, received more crystalloids during surgery, and displayed lower central venous pressure and lower natremia at the end of surgery than did patients in group HTS. No significant differences in postoperative complications or lengths of intensive care unit and hospital stays were observed between the groups.
  
  
  CONCLUSIONS
  Our results suggest that HTS provides better brain relaxation than mannitol during elective intracranial tumor surgery.
authors.affiliation: Departments of *Anesthesia and Intensive Care ‡Neurosurgery, Faculty of Medicine Hradec Kralove, Charles University in Prague, University Hospital Hradec Kralove, Hradec Kralove †Department of Anesthesia and Intensive Care, 1st Faculty of Medicine Prague, Charles University in Prague, Military University Hospital, Prague, Czech Republic.
authors.forename: Pavel
authors.initials: P
authors.lastname: Dostal
authors.forename: Vlasta
authors.initials: V
authors.lastname: Dostalova
authors.forename: Jitka
authors.initials: J
authors.lastname: Schreiberova
authors.forename: Tomas
authors.initials: T
authors.lastname: Tyll
authors.forename: Jirina
authors.initials: J
authors.lastname: Habalova
authors.forename: Vladimir
authors.initials: V
authors.lastname: Cerny
authors.forename: Svatopluk
authors.initials: S
authors.lastname: Rehak
authors.forename: Tomas
authors.initials: T
authors.lastname: Cesak
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D001810:Blood Volume / Q000187:drug effects; D001921:Brain / Q000187:drug effects*; D001932:Brain Neoplasms / Q000601:surgery*; D003399:Craniotomy / Q000379:methods; D003422:Critical Care; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007902:Length of Stay; D008297:Male; D008353:Mannitol / Q000627:therapeutic use*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D011300:Preoperative Care; D011446:Prospective Studies; D012462:Saline Solution, Hypertonic / Q000627:therapeutic use*; D014563:Urodynamics / Q000187:drug effects; D055815:Young Adult
chemical_list: D012462:Saline Solution, Hypertonic; D008353:Mannitol