Comparison of mannitol alone versus different doses of mannitol in combination with furosemide on brain relaxation in supratentorial mass resection surgery
Eren Fatma Akçıl1, Özlem Korkmaz Dilmen1, Yusuf Tunalı1, Esra Sultan Karabulut1, Serdar Selçuk Köksal2, Fatiş Altındaş1
1Department of Anesthesiology and Intensive Care, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
2Department of Public Health, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
INTRODUCTION: Although the safe and effective dose of mannitol, its use in combination with loop diuretics are still matters of debate, a common treatment approach to increased ICP is osmotic diuresis with mannitol. PURPOSE: This study aimed to compare the effects of the mannitol alone and in combination with furosemide in different doses, on the brain relaxation, electrolyte, lactate levels, peroperative fluid balance and the volume of the urine in supratentorial mass resection surgeries. METHODS: The study included 51 patients who had intracranial shift and who were scheduled for supratentorial mass resection. During surgery, after head fixation, patients were administered with mannitol and the study drug, furosemide or placebo. The brain relaxation score (BRS) was evaluated by the surgeon using a 4 point scale at dura opening, and 30 minutes after the administration of the study drug. Blood sodium, potassium, chlorine, lactate levels, osmolarity and urine output were recorded. RESULTS: BRS decreased significantly in within group comparison, no significant difference was observed in between group comparisons. DISCUSSION: It is reported that using mannitol >2 g.kg-1 will not ensure an uniform decrease in ICP, will cause intravascular and cardiac loading, electrolyte/acid-base disorders and renal failure. It is also claimed that in high dosages a rebound increase in the ICP occur. In a study conducted to compare the effects of low and high dosages on brain relaxation, similar results were obtained in two groups; however, it was also reported that in patients with mid-line shift, high dosage BRS was better. In our study, we compared the 0.5 g.kg-1 and 1 g.kg-1 dosages. There were mid-line shift in all cases;however, the results were similar in terms of BRS. CONCLUSIONS: Osmotic diuresis with 0.5 g.kg-1 mannitol is considered as being sufficient for brain relaxation in neurosurgeries. Adding loop diuretic does not have a contribution.
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