అనస్థీషియా & క్లినికల్ రీసెర్చ్
అందరికి ప్రవేశం

నైరూప్య

Transoperative Management of Cerebral Edema Secondary to Supratentorial Tumors; Hypertonic Saline 3% vs. Mannitol: A Reconstruction of a Cohort

González-Chávez María del Socorro1 , Jiménez-Aguilar Rosalinda2 , Carmona-Suazo José Antonio3 , TorresSalazar Quitzia Libertad4 , Holguín-Gutiérrez Aldo Uriel1 , Ramírez-Aguilar Ricardo1 , García-Elías Omar Saúl1 , Ledezma-González Elena2

Introduction: During a craniotomy, the intracranial pressure value is reduced; however, the opening of the compartment may generate transcalvarial herniation with risk of secondary injury by venous compression over the edge of the craniotomy. Cerebral relaxation has been considered an important neuroprotective measure. Historically, cerebral edema has been managed with mannitol; nevertheless, the use of 3% Hypertonic Saline (HS) as first choice therapy is increasing.

Material and methods: Cohort, observational, retrospective, analytical, longitudinal study with a control group. Thirty ASA II-III patient files were included, aged 18 to 60 years, with a diagnosis of supratentorial brain tumor, serum sodium between 135 and 155 mEq/L and clinical intracranial hypertension. The groups were constituted considering the management used and were related by binary logistic regression analysis.

Results: Female gender was the most frequent in both groups; the most prevalent diagnosis in the HS 3% group was meningioma (40%) while in the mannitol group the majority was distributed between meningioma (20%), glioblastoma (20%) and frontal tumors (20%). There was a 1.37-fold advantage of HS 3% over mannitol in improving edema management; however, this advantage was not statistically significant (RR 1.37, 95%CI 0.286-6.6).

Conclusion: Hypertonic saline solutions may be an effective alternative to other conventional osmotic agents, especially in patients with supratentorial brain tumors. Further evidence needs to be generated with controlled clinical studies and an adequate sample size.