Abstract

LLORENTE, Gisela  and  NINO DE MEJIA, Maria Claudia. Mannitol versus hypertonic saline solution in neuroanaesthesia. Rev. colomb. anestesiol. [online]. 2015, vol.43, suppl.1, pp.29-39. ISSN 0120-3347.

Background: Hyperosmolar therapy with mannitol or hypertonic saline solution is the main medical strategy for the clinical management of intracranial hypertension (IH) and cerebral oedema. IH and cerebral oedema are usually the result of acute and chronic brain injuries such as severe head trauma, ischaemic stroke, intracerebral haemorrhage, aneurismal subarachnoid haemorrhage, tumours and cerebral infections. Objective: We conducted this research in order to assess the benefits and side effects of osmotherapy and to identify the current trends in the management of IH and cerebral oedema. These two conditions worsen neurological outcomes and are the major cause of mortality in neurological patients. In this article we show the current evidence supporting the use of HTS and mannitol, and examine the question of which of the two agents is considered the best option for the medical treatment of IH. We review the efficacy data for HTS compared with mannitol in terms of clinical considerations. Conclusion: Data availability is limited because of small sample sizes, inconsistent methods and few prospective randomized comparative studies, although both agents are effective and have a reasonable risk profile for the treatment of cerebral oedema and IH. Currently, several trials show that HTS could be more effective in reducing ICP, with longer lasting effects. HTS maintains systemic and cerebral haemodynamics.

Keywords : Osmotherapy; Intracranial hypertension; Cerebral oedema; Mannitol; Hypertonic saline solution; Severe TBI; Osmotic load.

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