• Pavel Dostal, Vlasta Dostalova, Jitka Schreiberova, Tomas Tyll, Jirina Habalova, Vladimir Cerny, Svatopluk Rehak, and Tomas Cesak.
• Departments of *Anesthesia and Intensive Care ‡Neurosurgery, Faculty of Medicine Hradec Kralove, Charles University in Prague, University Hospital Hradec Kralove, Hradec Kralove †Department of Anesthesia and Intensive Care, 1st Faculty of Medicine Prague, Charles University in Prague, Military University Hospital, Prague, Czech Republic.
• J Neurosurg Anesthesiol. 2015 Jan 1;27(1):51-6.

BackgroundHyperosmolar solutions have been used in neurosurgery to modify brain bulk and prevent neurological deterioration. The purpose of the study was to compare the effects of equivolume, equiosmolar solutions of mannitol and hypertonic saline (HTS) on brain relaxation and postoperative complications in patients undergoing elective intracranial tumor surgery.MethodsIn this prospective, randomized study, patients with American Society of Anesthesiologists physical status I to III scheduled to undergo a craniotomy for intracranial tumors were enrolled. Patients received a 3.75 mL/kg intravenous infusion of either 3.2% HTS (group HTS, n=36) or 20% mannitol (group M, n=38). The surgeon assessed the condition of the brain using a 4-point scale after opening the dura. Recorded measures included duration of surgery, blood loss, urine output, volume and type of infused fluids, hemodynamic variables, electrolytes, glucose, creatinine, predefined postoperative complications, and length of intensive care unit and hospital stays.ResultsBrain relaxation conditions in group HTS (score 1/2/3/4, n=10/17/2/7) were better than those in group M (score 1/2/3/4, n=3/18/3/14, P=0.0281). Patients in group M had higher urine output, received more crystalloids during surgery, and displayed lower central venous pressure and lower natremia at the end of surgery than did patients in group HTS. No significant differences in postoperative complications or lengths of intensive care unit and hospital stays were observed between the groups.ConclusionsOur results suggest that HTS provides better brain relaxation than mannitol during elective intracranial tumor surgery.

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