• Cattleya Thongrong, Nicolas Kong, Barani Govindarajan, Duane Allen, Ehud Mendel, and Sergio D Bergese.
• 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.
• World Neurosurg. 2014 Dec 1;82(6):1307-18.

ObjectiveTo review and summarize controversies and current concepts regarding the use of hypertonic saline during the perioperative period in neurosurgery.MethodsRelevant literature was searched on PubMed and Scopus electronic databases to identify all studies that have investigated the use of hypertonic saline in neurosurgery.ResultsFluid 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.ConclusionsWe 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.Copyright © 2014 Elsevier Inc. All rights reserved.

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