Manitol versus solución salina hipertónica en neuroanestesia It appears that a low dose of mannitol acts as a renal vasodilator while high-dose mannitol is. Randomized, controlled trial on the effect of a 20% mannitol solution and a % saline/6% dextran solution on increased intracranial pressure. Introduction Hyperosmolar therapy with mannitol or hypertonic saline (HTS) is the primary medical management strategy for elevated intracranial pressure (ICP).

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Global brain water increases after experimental focal cerebral ischemia: Use of hypertonic saline solutions in treatment of cerebral edema and intracranial hypertension. Wien Klin Wochenschr,pp. The journal promotes the progress, improvement, and disclosure of anesthesiology, intensive care, treatment of pain, and cardiopulmonary resuscitation.

Metabolic acidosis in the critically ill: Observational studies have shown a relationship between PbtO 2 reduction and poor outcomes 80,81 and suggest that therapy targeted on maintaining PbtO 2 may improve clinical outcomes. Pressure changes in the cerebrospinal fluid following intravenous injection of solutions of various concentrations. As far as manitoll is concerned, ICP reduction and longer lasting responses have been observed soucion a dose between 0.

IH and cerebral oedema are usually the result of acute and chronic brain injuries such as severe head trauma, ischaemic stroke, intracerebral haemorrhage, aneurismal subarachnoid haemorrhage, tumours and cerebral infections. The effect of high-dose mannitol on serum and urine electrolytes and osmolality in neurosurgical patients.

Fluid resuscitation in this population, particularly with HTS alone or combined with dextran, restores intravascular volume with less volumes, 73 increases CPP, lowers ICP, 74 and modulates the inflammatory response. J Neurol Neurosurg Psychiatr. Of these 12 studies, only 6 compared mannitol and HTS.

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Anesthesiol Clin North America, 20pp. The critical importance of ICP in the management of traumatic head injuries and nontraumatic neurologic diseases e. Brain myelinolysis following hypernatremia in rats. Research studies that have influenced practice of neuroanesthesiology in recent years: Mannitol causes compensatory cerebral vasoconstriction and vasodilation in response to blood viscosity changes.

It acts on ICP min after administration, optimizing the rheological properties of blood by reducing its viscosity, lowering the haematocrit, and increasing CBF and O2 supply.

Mannitol or hypertonic saline in the setting of traumatic brain injury: What have we learned?

The majority of the data reviewed suggest that HTS offers more favourable results in the control of ICP and all types of IH, regardless of concentration.

A hundred years of hard-earned lessons. So this raises the question of looking at each component of a traditional ICP algorithm to determine the relative benefit.

J Pediatr Rio J ; 79 Suppl 2: Since the cranium is a fixed vault, expansion of one of its components – the brain, intravascular blood, or CSF — must be at the expense of a reduction in another component. Twenty-nine patients were enrolled and had episodes of intracranial hypertension.

He determined that Hypertonic saline, intracranial pressure, mannitol, traumatic brain injury. After reviewing potential articles, the reviewers were unable to find any RCTs that met their inclusion criteria.

We review the efficacy data for HTS compared with mannitol in terms of clinical considerations. The value of hypertonic mannitol solution in decreasing brain mass and lowering cerebro-spinal-fluid pressure. Hypertonic saline-dextran solutions for the prehospital management of traumatic hypotension.

Mannitol or hypertonic saline in the setting of traumatic brain injury: What have we learned?

However, HTS is increasingly used in this setting. The Lund hipertoniica specifically avoids the use of hyperosmolar agents to decrease ICP. This search strategy yielded seven articles for inclusion that were analyzed from the full manuscript. They found hipertpnica degrees of increased CBF in the contralateral hemisphere of patients with ischaemic stroke after osmotic therapy, apparently mediated by blood pressure.


The following medical subject headings were used: Trials should also test equiosmolar agents infused over the same time period as to mitigate the effects of molarity and infusion time. The authors chose to measure efficacy against cumulative and daily ICP burden as opposed to discrete events.

Osmole gap in neurologic-neurosurgical intensive care unit: The net effect is improved cerebral blood flow and oxygen delivery. He concludes by stating that Hypertonic saline in patients with poor-grade subarachnoid hemorrhage improves cerebral blood flow, brain tissue oxygen, and pH.

Increasing sedation, manitll administration or initiating vasoactive medications, and hyperventilation. Ann Fr Anesth Reanim.


Comparison of mannitol and hypertonic saline in the treatment of severe brain injuries. Author information Article notes Copyright and License information Disclaimer. Fortunately, this devastating condition has been hlpertonica observed in this setting. The American Association of Neurological Surgeons.

This study was conducted with different neurosurgical procedures and non-equiosmolar doses of HTS and mannitol. Guidelines for the management of severe traumatic brain injury. InRozet et al.