Key result
A balanced hyperosmolar therapy of 3% hypertonic saline and 20% mannitol achieved satisfactory brain relaxation in 53.3% of patients, which was superior to 20% mannitol alone (16.7%, p=0.01) while providing greater hemodynamic stability.
Why the study?
Both 3% hypertonic saline and 20% mannitol effectively relax the brain during supratentorial surgeries, but the effect of consecutive use of both drugs on brain relaxation and hemodynamic status was unknown.
Does balanced hyperosmolar therapy using 3% hypertonic saline and 20% mannitol improve brain relaxation and hemodynamic stability in patients undergoing supratentorial tumor resection?
RCT (n=90)
Double-blind
1:1 computerized random number generator
No
Does balanced hyperosmolar therapy using 3% hypertonic saline and 20% mannitol improve brain relaxation and hemodynamic stability in patients undergoing supratentorial tumor resection?
Absolute Event Rate: 53.3% vs 16.7%
p-value: p=0.01
A balanced hyperosmolar regimen of 20% mannitol followed by 3% hypertonic saline provides satisfactory brain relaxation comparable to hypertonic saline alone, while maintaining better hemodynamic stability during supratentorial tumor resection.
Consecutive HTS-mannitol use may aid brain relaxation in supratentorial surgery; leaves open optimal sequencing and hemodynamic safety in larger trials.
Both 3% hypertonic saline (3% HTS) and 20% mannitol were proven to be effective in relaxing the brain during supratentorial surgeries. This work aimed to study the effect of consecutive use of both drugs on the brain relaxation score and hemodynamic status during such surgeries. Ninety patients scheduled for supratentorial brain surgeries included in this prospective, randomized and double-blind study. Patients were allocated in three groups; HTS group (n=30) received 3 ml/kg 3% NaCl infusion over 30 minutes, HTS/M group (n=30) received mannitol 20% (1.4 ml/kg) as an infusion over 15 minute followed by 1.5 ml/kg 3% NaCl infused over 15 minutes and M group (n=30) received 3.2 ml/kg mannitol 20% infusion over 30 minutes. Brain relaxation was estimated. MAP and serum Na level were recorded at baseline and then at 30, 90 and 150 min. Total fluid intake, total urine output and operative time were recorded. Fluid intake and urine output were the highest with 20% mannitol (p ˂ 0.001). HTS/M and HTS groups showed no significance when satisfactory and fairly brain relaxation scores were added (p=0.862). MAP and CVP were near to baseline in HTS/M group at 30 and 90 min, while at 150 min no significant difference between groups. Serum hyperosmolarity was noticed in all groups at all check points but maximally with HTS group at 30 min (321.1 mOsm/L). Balanced hyperosmolar therapy using 3% HTS and 20% mannitol consecutively resulted in a satisfactory brain relaxation and allowed more hemodynamic stability.
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Elkafrawy et al. (2021) conducted an RCT in Supratentorial brain tumors (n=90). Balanced hyperosmolar therapy (3% hypertonic saline and 20% mannitol) vs. 3% hypertonic saline (3 ml/kg) or 20% mannitol (3.2 ml/kg) was evaluated on Satisfactory brain relaxation score (score of 1 on a 4-point scale) (p=0.01). A balanced hyperosmolar therapy of 3% hypertonic saline and 20% mannitol achieved satisfactory brain relaxation in 53.3% of patients, which was superior to 20% mannitol alone (16.7%, p=0.01) while providing greater hemodynamic stability.
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