Brain-Relaxing Effect of Different Diuretic Regimens in Supratentorial Tumor Surgery: A Comparative Study Guided by Optic Nerve Sheath Diameter

Overview

Journal Anesth Essays Res

Specialty Anesthesiology

Date 2021 Jun 7

PMID 34092871

Citations 1

Authors

Mohamed Adel Aboelela

Alrefaey Kandeel Alrefaey

Affiliations

Soon will be listed here.

Abstract

Background: Hyperosmolar therapy is a well-established method to approach brain relaxation during craniotomy. Mannitol is used with a wide range of dosing regimens, combination with loop diuretics exerts a synergistic effect resulting in both reduction of the dose and its complications. Ultrasound measurement of optic nerve sheath diameter (ONSD) gives reliable information about intracranial pressure (ICP) and avoids overdosing and complications of osmotherapy.

Aims And Objectives: In this study, we compare the ordinary dose of mannitol with the low dose combined with furosemide and detect the effect on ICP by ONSD.

Setting And Design: This is a prospective, randomized, double-blind study involving 60 patients undergoing supratentorial brain tumor surgery.

Materials And Methods: Sixty patients were enrolled in this study, divided into two equal groups: Group M received mannitol 1 g.kg: while Group F received mannitol 0.25 g.kg and furosemide 0.5 mg.kg. Reduction in ONSD measurement was the primary objective, while brain-relaxation score (BRS), hemodynamic changes, urine output, serum lactate, and changes in serum electrolyte were the secondary objectives.

Statistical Analysis: Data collected were analyzed using SPSS software, IBM, USA, version 22. value was considered significant if <0.05.

Results: ONSD and BRS showed no statistically significant difference between the studied groups. After diuresis, Group M showed significant reduction in heart rate and mean arterial blood pressure, serum sodium, potassium, and lactate ( = 0.02, = 0.02, = 0.001, = 0.001, = 0.001, = 0.001 respectively), with increased urine output (UOP) and fluids replacement ( = 0.00, = 0.01, respectively).

Conclusion: Compared to high dose, adding loop diuretics to low-dose mannitol during supratentorial brain tumor surgeries resulted in comparable BRSs with a lower incidence of hemodynamic and metabolic disturbances.

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References

Tavakoli S, Peitz G, Ares W, Hafeez S, Grandhi R . Complications of invasive intracranial pressure monitoring devices in neurocritical care. Neurosurg Focus. 2017; 43(5):E6. DOI: 10.3171/2017.8.FOCUS17450. View

Lee S, Kim H, Yun S . Optic nerve sheath diameter measurement for predicting raised intracranial pressure in adult patients with severe traumatic brain injury: A meta-analysis. J Crit Care. 2020; 56:182-187. DOI: 10.1016/j.jcrc.2020.01.006. View

Ali M, Hashmi M, Shamim S, Salam B, Siraj S, Salim B . Correlation of Optic Nerve Sheath Diameter with Direct Measurement of Intracranial Pressure through an External Ventricular Drain. Cureus. 2019; 11(9):e5777. PMC: 6825501. DOI: 10.7759/cureus.5777. View

Wang L, Chen H, Tong L, Chen L, Dong Y, Xing Y . Ultrasonographic optic nerve sheath diameter monitoring of elevated intracranial pressure: two case reports. Ann Transl Med. 2020; 8(1):20. PMC: 6995732. DOI: 10.21037/atm.2019.12.16. View

Hanafi M, Verki M, Parei S . Ultrasonic Assessment of Optic Nerve Sheath to Detect Increased Intracranial Pressure. J Med Ultrasound. 2019; 27(2):69-74. PMC: 6607883. DOI: 10.4103/JMU.JMU_54_18. View

Shah S, Bhargava A, Choudhury I . Noninvasive intracranial pressure monitoring via optic nerve sheath diameter for robotic surgery in steep Trendelenburg position. Saudi J Anaesth. 2015; 9(3):239-46. PMC: 4478813. DOI: 10.4103/1658-354X.154693. View

Seo H, Kim E, Jung H, Lim Y, Kim J, Park C . A prospective randomized trial of the optimal dose of mannitol for intraoperative brain relaxation in patients undergoing craniotomy for supratentorial brain tumor resection. J Neurosurg. 2016; 126(6):1839-1846. DOI: 10.3171/2016.6.JNS16537. View

Randell T, Niskanen M . Management of physiological variables in neuroanaesthesia: maintaining homeostasis during intracranial surgery. Curr Opin Anaesthesiol. 2006; 19(5):492-7. DOI: 10.1097/01.aco.0000245273.92163.8e. View

Li J, Gelb A, Flexman A, Ji F, Meng L . Definition, evaluation, and management of brain relaxation during craniotomy. Br J Anaesth. 2016; 116(6):759-69. DOI: 10.1093/bja/aew096. View

10.

Dimitriou J, Levivier M, Gugliotta M . Comparison of Complications in Patients Receiving Different Types of Intracranial Pressure Monitoring: A Retrospective Study in a Single Center in Switzerland. World Neurosurg. 2015; 89:641-6. DOI: 10.1016/j.wneu.2015.11.037. View

11.

Quentin C, Charbonneau S, Moumdjian R, Lallo A, Bouthilier A, Fournier-Gosselin M . A comparison of two doses of mannitol on brain relaxation during supratentorial brain tumor craniotomy: a randomized trial. Anesth Analg. 2013; 116(4):862-8. DOI: 10.1213/ANE.0b013e318282dc70. View

12.

Miller C, Tummala R . Risk factors for hemorrhage associated with external ventricular drain placement and removal. J Neurosurg. 2016; 126(1):289-297. DOI: 10.3171/2015.12.JNS152341. View

13.

Thenuwara K, Todd M, Brian Jr J . Effect of mannitol and furosemide on plasma osmolality and brain water. Anesthesiology. 2002; 96(2):416-21. DOI: 10.1097/00000542-200202000-00029. View

14.

Sussman E, Kellner C, Nelson E, McDowell M, Bruce S, Bruce R . Hemorrhagic complications of ventriculostomy: incidence and predictors in patients with intracerebral hemorrhage. J Neurosurg. 2014; 120(4):931-6. DOI: 10.3171/2013.12.JNS131685. View

15.

Poblete R, Zheng L, Raghavan R, Cen S, Amar A, Sanossian N . Trends in Ventriculostomy-Associated Infections and Mortality in Aneurysmal Subarachnoid Hemorrhage: Data From the Nationwide Inpatient Sample. World Neurosurg. 2016; 99:599-604. DOI: 10.1016/j.wneu.2016.12.073. View

16.

Jun I, Kim M, Lee J, Park S, Hwang J, Hong J . Effect of Mannitol on Ultrasonographically Measured Optic Nerve Sheath Diameter as a Surrogate for Intracranial Pressure During Robot-Assisted Laparoscopic Prostatectomy with Pneumoperitoneum and the Trendelenburg Position. J Endourol. 2018; 32(7):608-613. DOI: 10.1089/end.2017.0828. View

17.

Akcil E, Dilmen O, Karabulut E, Koksal S, Altindas F, Tunali Y . Effective and safe mannitol administration in patients undergoing supratentorial tumor surgery: A prospective, randomized and double blind study. Clin Neurol Neurosurg. 2017; 159:55-61. DOI: 10.1016/j.clineuro.2017.05.018. View

18.

Fang J, Yang Y, Wang W, Liu Y, An T, Zou M . Comparison of equiosmolar hypertonic saline and mannitol for brain relaxation during craniotomies: A meta-analysis of randomized controlled trials. Neurosurg Rev. 2017; 41(4):945-956. DOI: 10.1007/s10143-017-0838-8. View

19.

Gardner P, Engh J, Atteberry D, Moossy J . Hemorrhage rates after external ventricular drain placement. J Neurosurg. 2009; 110(5):1021-5. DOI: 10.3171/2008.9.JNS17661. View

20.

Raghava A, Bidkar P, Satya Prakash M, Hemavathy B . Comparison of equiosmolar concentrations of hypertonic saline and mannitol for intraoperative lax brain in patients undergoing craniotomy. Surg Neurol Int. 2015; 6:73. PMC: 4429334. DOI: 10.4103/2152-7806.156771. View