Role of preemptive use of mannitol in reducing airway edema following maxillofacial and radical neck surgeries

Introduction Major head and neck surgeries especially in difficult airway patients have a great hazard for post-operative laryngo-pharyngeal oedema and airway obstruction. In this prospective study, mannitol was administrated intra-operatively in an attempt to reduce airway oedema and hence post-extubation airway collapse and obstruction. Materials and methods Two hundred patients undergoing maxillofacial and radical neck surgeries were randomly allocated into the following two equal groups: (1) Group M: in which 0.25 gm /kg mannitol was given after intubation and 30 minutes before the end of surgery. (2) Group C: in which similar volume of the infused mannitol but lactated Ringer was given in the same time points. Cuff-air leak test, flexible fiberoptic laryngoscopic assessment of the upper airway before extubation, post-extubation clinical evaluation of upper airway obstruction and incidence of post-extubation stridor have been conducted to evaluate airway oedema. Results The total mean cuff-leak volume was significantly higher in Group M than in the Group C. The incidence of moderate upper airway lesion was statistically significant lower in mannitol group than in control group. The incidence of post-extubation stridor (after failed cuff-leak test was 4/17 (24%) in the mannitol group and 6/26 (23%) in the control group after passed cuff-leak test it was 2/83 (0.02%) in the mannitol group and 4/74 (.05%) in the control group). Conclusion Pre-emptive use of mannitol in maxillo-facial and radical neck surgeries is effective and nearly side effect free to reduce airway oedema and post-extubation airway obstruction.