Cattleya Thongrong1, Nicolas Kong2, Barani Govindarajan2, Duane Allen2, Ehud Mendel3, Sergio D Bergese4. 1. Department of Anesthesiology, Ohio State University Wexner Medical Center and Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio, USA; Department of Anesthesiology, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. Electronic address: jupiters66@gmail.com. 2. Department of Anesthesiology, Ohio State University Wexner Medical Center and Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio, USA. 3. Department of Neurological Surgery, Ohio State University Wexner Medical Center and Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio, USA. 4. Department of Anesthesiology, Ohio State University Wexner Medical Center and Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio, USA; Department of Neurological Surgery, Ohio State University Wexner Medical Center and Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio, USA.
Abstract
OBJECTIVE: To review and summarize controversies and current concepts regarding the use of hypertonic saline during the perioperative period in neurosurgery. METHODS: Relevant literature was searched on PubMed and Scopus electronic databases to identify all studies that have investigated the use of hypertonic saline in neurosurgery. RESULTS: Fluid management during the course of neurosurgical practice has been debated at length, especially strategies to control intracranial pressure and small volume resuscitation. The goal of fluid therapy includes minimizing cerebral edema, preserving intravascular volume, and maintaining cerebral perfusion pressure. Mannitol is widely recognized as the gold standard for treating intracranial hypertension but can result in systemic hypotension. Thus, hypertonic saline provides volume expansion and may improve cerebral and systemic hemodynamics. Recently published prospective data, however, regarding the use of osmotic agents fails to establish clear guidelines in neurosurgical patients. CONCLUSIONS: We suggest that hypertonic saline will emerge as an alternative to mannitol, especially for a long-term use or multiple doses are needed and lead to a great opportunity for collaborative research.
OBJECTIVE: To review and summarize controversies and current concepts regarding the use of hypertonicsaline during the perioperative period in neurosurgery. METHODS: Relevant literature was searched on PubMed and Scopus electronic databases to identify all studies that have investigated the use of hypertonicsaline in neurosurgery. RESULTS: Fluid management during the course of neurosurgical practice has been debated at length, especially strategies to control intracranial pressure and small volume resuscitation. The goal of fluid therapy includes minimizing cerebral edema, preserving intravascular volume, and maintaining cerebral perfusion pressure. Mannitol is widely recognized as the gold standard for treating intracranial hypertension but can result in systemic hypotension. Thus, hypertonicsaline provides volume expansion and may improve cerebral and systemic hemodynamics. Recently published prospective data, however, regarding the use of osmotic agents fails to establish clear guidelines in neurosurgical patients. CONCLUSIONS: We suggest that hypertonicsaline will emerge as an alternative to mannitol, especially for a long-term use or multiple doses are needed and lead to a great opportunity for collaborative research.
Authors: Leonardo M Sousa; Almir F de Andrade; Alessandro R Belon; Matheus S Soares; Robson Luis Amorim; Jose Pinhata Otochi; Manoel J Teixeira; Wellingson S Paiva Journal: Med Sci Monit Basic Res Date: 2016-10-25