Effect of equiosmolar solutions of hypertonic sodium lactate versus mannitol in craniectomy patients with moderate traumatic brain injury

  • Muhammad R. Ahmad Department of Anesthesiology, Intensive Care and Pain Management, Faculty of Medicine Hasanuddin University, Makassar
  • Hanna Hanna Department of Anesthesiology, Intensive Care and Pain Management, Faculty of Medicine Hasanuddin University, Makassar
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Abstract

Background: Brain relaxation and prevention from cerebral edema are essential in craniectomy. Osmotherapy with 20% mannitol are generally used to withdraw fluid from the brain parenchyma, however may cause hemodynamic fluctuation, due to increase diuresis. On the other hand 0.5 M hypertonic sodium lactate (HSL) appeared as an alternative of osmotherapy. This study  aimed to observe the effect of hypertonic sodium lactate (HSL) on brain relaxation, blood glucose level and hemodynamic variables in craniectomy due to moderate brain injury.

Methods: A randomized controlled study of 42 cases with moderate brain injury, aged 18 - 65 years, ASA 1 - 3, between September-November 2012, was carried out. The patients were divided into group M (n = 21) that received 2.5 mL/kg 20% mannitol and group HSL that received 2.5 mL/kg 0.5M HSL. Mean arterial pressures (MAP), central venous pressures (CVP) and urine output were measured after induction, and at 15, 30, 45, 60 min after infusion. Brain relaxation was assessed at a four-point scale after opening the duramater. Blood glucose levels were measured before induction and at 60 min after the infusion. Appropriate statistical tests were used for comparison. Unpaired t-test was used to compare hemodynamic and blood glucose level, and chi-square was used to compare brain relaxation.

Results: MAP at 60 minute was significantly higher in HSL group than M group (81.66 ± 7.85 vs 74.33 ± 6.18 mmHg; p = 0.002). There was no difference in brain relaxation (p = 0.988). A significant increase in blood glucose level was observed in group HSL (17.95 ± 11.46 mg/dL; p = 0.001).

Conclusion: Half-molar HSL was as effective as 20% mannitol in producing brain relaxation, with better hemodynamic stability and gave significant increase in blood glucose level.

Keywords: brain relaxation, hemodynamic, hypertonic sodium lactate, mannitol, traumatic brain injury

References

  1. Morgan GE, Mikhail MS, Murray MJ. Anesthesia for neurosurgery. In:Clinical anesthesiology. 4th ed. New York: Lange Medical Books/McGraw-Hill Companies; 2006. p. 631-46.

  2. Tenenbein P, Kincaid S, Lam AM. Head trauma – anesthetic consideration and management. In: Smith CH, editor. Trauma anesthesia. Cambridge: Cambridge University Press; 2008. p. 172-82.

  3. Cottrell JE, Newfield P. Anesthesia for Traumatic Brain injury. In : Textbook of neuroanesthesia. 4th ed. New York: Lippincott Williams and Wilkins; 2007. p. 317-27.

  4. Bratton SL, Chestnut RM, Ghajar J, McConnell Hammond FF, Harris OA, Hartl R, et al. Hyperosmolar therapy. J Neurotrauma. 2007;24(Suppl 1):S14-20.

  5. Haddad SH, Arabi YM. Critical care management of severe traumatic brain injury in adults. Scand J Trauma Resusc Emerg Med. 2012;20:2. http://dx.doi.org/10.1186/1757-7241-20-12

  6. Roberts I, Schierhout G, Wakai A. Mannitol for acute traumatic brain injury. Cochrane Database Syst Rev 2003:CD001049. http://dx.doi.org/10.1002/14651858.CD001049

  7. Rozet I, Tontisirin N, Muangman S, Vavilala MS, Souter MJ, Lee LA, et al. Effect of equiosmolar solutions of mannitol versus hypertonic saline on intraoperative brain relaxation and electrolyte balance. Anesthesiology. 2007;107(5):697-704. http://dx.doi.org/10.1097/01.anes.0000286980.92759.94

  8. Wu CT, Chen LC, Kuo CP. Ju DT, Borel CO, Cherng CH, et al. A comparison of 3% hypertonic saline and mannitol for brain relaxation during elective supratentorial brain tumor surgery. Anesthe Analg. 2010;110(3):903-7. http://dx.doi.org/10.1213/ANE.0b013e3181cb3f8b

  9. Mustafa I, Leverve X. Metabolic and hemodynamic effects of hypertonic solutions: sodium-lactate versus sodium chloride infusion in postoperative patients. Shock. 2002;18(4):306-10. http://dx.doi.org/10.1097/00024382-200210000-00003

  10. Leverve X, Mustafa I. Lactate: a key metabolite in the intercellular metabolic interplay. Crit Care. 2002;6(4):284-5. http://dx.doi.org/10.1186/cc1509

  11. Rice CA, Zsoldon R, Chen T, Wilson MS, Ales Sandri B, Hamm RJ, et al. Lactate administration attenuates cognitive deficits following traumatic brain injury. Brain Res. 2002;928(1-2):156-9. http://dx.doi.org/10.1016/S0006-8993(01)03299-1

  12. Cater HL, Chandratheva A, Benham CD, Morrison B, Sundstorm LE. Lactate and glucose as energy substrates during, and after, oxygen deprivation in rat hippocampal acute and cultured slices. J Neurochem. 2003;87:1381-90. http://dx.doi.org/10.1046/j.1471-4159.2003.02100.x

  13. Ichai C, Armando G, Orban JC, Berthier F, Sama-long C, et al. Sodium lactate versus mannitol in the treatment of intracranial hypertensive episodes in severe traumatic brain-injured patients. Intensive Care Med. 2009;35(3):471-9. http://dx.doi.org/10.1007/s00134-008-1283-5

  14. Lam AM, Winn HR, Cullen B, Sundling N. Hyperglycemia and neurological outcome in patients with head injury. J Neurosurg. 1991;75(4):545-51. http://dx.doi.org/10.3171/jns.1991.75.4.0545

  15. Rovlias A, Kotsou S. The influence of hyperglycemia on neurological outcome in patients with severe head injury. Neurosurgery 2000.46(2);335-42.

  16. Gladden LB. Lactate metabolism: a new paradigm for the third millenium. J Physiol. 2004;558(1): 5-30. http://dx.doi.org/10.1113/jphysiol.2003.058701

  17. Tyagi R, Donaldson K, Loftus CM, Jallo J. Hypertonic saline: a clinical review. Neurosurg Rev. 2007;30(4):277-90. http://dx.doi.org/10.1007/s10143-007-0091-7

  18. Gemma M, Cozzi S, Tommasino C, Mungo M, Calvi MR, Cipriani A, et al. 7.5% hypertonic saline versus 20% mannitol during elective neurosurgical supratentorial procedures. J Neurosurg Anesth. 1997;9(4):329-34. http://dx.doi.org/10.1097/00008506-199710000-00007

  19. Patki A, Shelgaonkar VC. Effect of 6% hydroxyethyl starch-450 and low molecular weight dextran on blood sugar levels during surgery under subarachnoid block: A prospective randomised study. Indian J Anaesth. 2010;54(5):448-52. http://dx.doi.org/10.4103/0019-5049.71045

  20. Rehncrona S, Rosen I, Siesjo BK. Brain lactic acidosis and ischemic cell damage: biochemistry and neurophysiology. J Cereb Blood Flow Metab. 1981;1(3):297-311. http://dx.doi.org/10.1038/jcbfm.1981.34

  21. Schurr A, Payne RS. Hyperglycemia and neuronal damage in cerebral ischemia and beyond. Crit Care & Shock. 2003;6(4):184-90.

  22. Sakellaridis N, Pavlou E, Karatzas S, Chroni D, Vlachos K, Chatzopoulos K, et al. Comparison of mannitol and hypertonic saline in the treatment of severe brain injuries. J Neurosurg. 2011;114(2):545-8. http://dx.doi.org/10.3171/2010.5.JNS091685

Published
2014-03-11
How to Cite
1.
Ahmad MR, Hanna H. Effect of equiosmolar solutions of hypertonic sodium lactate versus mannitol in craniectomy patients with moderate traumatic brain injury. Med J Indones [Internet]. 2014Mar.11 [cited 2019Sep.17];23(1):30-5. Available from: http://mji.ui.ac.id/journal/index.php/mji/article/view/686
Section
Clinical Research