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).
|Published (Last):||10 October 2010|
|PDF File Size:||1.41 Mb|
|ePub File Size:||7.90 Mb|
|Price:||Free* [*Free Regsitration Required]|
Mannitol versus hypertonic saline solution in neuroanaesthesia
Stroke, 29pp. To improve our services and products, we use “cookies” own or third parties authorized to show advertising related to client preferences through the analyses of navigation customer behavior. Fortunately, this devastating condition has been rarely observed in this setting. There are no firm recommendations as to which of the two agents should be used, but mannitol is used more frequently as first-line therapy for TBI-associated IH, followed by HTS as second-line therapy when there is no response to mannitol.
In fact, antihypertensives are often employed to decrease elevated CPP. All of the measurements were recorded at the beginning of the study, before treatment, and 15, 30, 60, and min after treatment. The baseline characteristics between groups were similar.
Pharmacokinetics and effects of mannitol on hemodynamics, blood and cerebrospinal fluid electrolytes and osmolality during intracranial surgery. 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.
Relationship between excitatory amino acid release and outcome after severe human head injury. Saline or albumin for fluid resuscitation in patients with traumatic brain injury.
Hipettonica should be avoided in patients with head trauma isolated or with multiple traumaas it doubles the mortality in this setting. No statistically maniotl difference in either maximum reduction nor in duration of ICP was observed. He concludes by stating that The study included 40 elective patients, the majority ASA-III, taken to surgery for supratentorial tumours, posterior fossa procedures, AVM and aneurisms, with and without subarachnoid haemorrhage.
The authors chose to measure efficacy against cumulative and daily ICP burden as manitl to discrete events. In a meta-analysis of 36 articles carried out inMortazavi found 16 on TBI, including 4 prospective randomized, 1 prospective non-randomized, 7 prospective observational, and 4 retrospective studies.
Gipertonica 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?
The best osmotic agents are those with a reflection coefficient close to 1. Isovolume hypertonic solutes sodium chloride or mannitol in the treatment of refractory posttraumatic intracranial hypertension: Comparison of effects of equiosmolar doses of mannitol and hypertonic saline on cerebral blood flow and metabolism in traumatic brain injury.
The most commonly utilized hyperosmolar agents are mannitol and HTS.
Hypertonic saline resuscitation attenuates neutrophil lung sequestration and transmigration by diminishing leukocyte-endothelial interactions in a two-hit model of hemorrhagic shock and infection. Based on this finding, the authors concluded that the Lund soluccion should not be used to treat severe TBI soluciob additional RCT data is published.
Vasoregulatory and microcirculatory effects HTS increases capillary vessel diameter and plasma volume thus increasing cerebral blood flow counteracting hypoperfusion and vasospasm. One limitation to this study was the osmolar difference between the solutions; the patients in HTS arm received a higher osmolar load than the mannitol arm mOsm vs.
Subscribe to our Newsletter.
Microscopic urinalysis has revealed vacuoles in tubular cells consistent with osmotic nephrosis, which generally does not result in permanent injury and reverts after the drug is removed. While mannitol induces an osmotic diuresis, the initial rapid increase in intravascular volume can paradoxically cause acute hypervolemia which could precipitate heart failure or pulmonary edema in susceptible patients.
High-osmolality saline in neurocritical care systematic review and meta-analysis. In most cases, it is usually mixed. J Neuropathol Exp Neurol.
Although it is not appropriate to extrapolate data obtained in a cell culture models to clinical situations, these data show that HTS may potentially damage hippocampal neurons in vitro. Out of the 17 patients who were randomized in each group, 9 patients received only mannitol, 12 received only sodium lactate, and 13 patients crossed over and received both mannitol and sodium lactate.
The study by Vilas Boas et al. Hypertonic saline in critical care: