title: Equiosmolar Solutions of Hypertonic Saline and Mannitol Do Not Impair Blood Coagulation During Elective Intracranial Surgery.
abstract: BACKGROUND
  The authors investigated the effect of equiosmolar, equivolemic solutions of 3% hypertonic saline (HS) and 20% mannitol on blood coagulation assessed by rotational thromboelastometry (ROTEM) and standard coagulation tests during elective craniotomy.
  
  
  METHODS
  In a prospective, randomized, double-blind trial, 40 patients undergoing elective craniotomy were randomized to receive 5 mL/kg of either 20% mannitol or 3% HS for intraoperative brain relaxation. Fibrinogen, activated partial thromboplastin time, prothrombin time, hemoglobin, hematocrit, and platelet count were simultaneously measured intraoperatively with ROTEM for EXTEM, INTEM, and FIBTEM analysis. ROTEM parameters were: clotting time (CT), clot formation time (CFT), maximum clot firmness (MCF), and α-angle.
  
  
  RESULTS
  No significant differences between groups were found in ROTEM variables CT, CFT, MCF, α-angle (EXTEM and INTEM), and MCF (FIBTEM) nor standard coagulation tests. ROTEM parameters did not show changes after administration of hyperosmolar solutions relating to basal values, except for an increase of CFT EXTEM (118±28 vs. 128±26 s) and decrease of CT INTEM (160±18 vs. 148±15 s) with values within normal range. Significant decreases from baseline levels were observed for hematocrit (-7%), platelet count (-10%), and fibrinogen (-13%) after HS infusion, and hematocrit (-9%), platelet count (-13%), and fibrinogen (-9%) after mannitol infusion, but remaining normal.
  
  
  CONCLUSIONS
  The use of 5 mL/kg of equiosmolar solutions of 3% HS and 20% mannitol applied to reach a brain relaxation during elective craniotomy does not induce coagulation impairment as evidenced by ROTEM and standard coagulation tests.
authors.affiliation: Departments of *Anesthesia †Neurosurgery, Hospital Clinico Universitario "Virgen de la Arrixaca," Murcia, Spain.
authors.forename: Joaquín
authors.initials: J
authors.lastname: Hernández-Palazón
authors.forename: Diego
authors.initials: D
authors.lastname: Fuentes-García
authors.forename: Paloma
authors.initials: P
authors.lastname: Doménech-Asensi
authors.forename: Claudio
authors.initials: C
authors.lastname: Piqueras-Pérez
authors.forename: Luis
authors.initials: L
authors.lastname: Falcón-Araña
authors.forename: Sebastián
authors.initials: S
authors.lastname: Burguillos-López
mesh_terms: D001777:Blood Coagulation / Q000187:drug effects*; D001780:Blood Coagulation Tests / Q000706:statistics & numerical data; D003399:Craniotomy; D004234:Diuretics, Osmotic / Q000494:pharmacology*; D004311:Double-Blind Method; D017558:Elective Surgical Procedures; D005260:Female; D005340:Fibrinogen / Q000187:drug effects; D006400:Hematocrit / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008353:Mannitol / Q000494:pharmacology*; D008875:Middle Aged; D009994:Osmolar Concentration; D010314:Partial Thromboplastin Time / Q000706:statistics & numerical data; D011446:Prospective Studies; D012462:Saline Solution, Hypertonic / Q000494:pharmacology*; D013916:Thrombelastography / Q000706:statistics & numerical data
chemical_list: D004234:Diuretics, Osmotic; D012462:Saline Solution, Hypertonic; D008353:Mannitol; D005340:Fibrinogen