The Effect of Mannitol and Hypertonic Sodium Administration on Hemodynamic Parameters Under LiDCO Monitoring in Patients Undergoing Elective Craniotomy

Reza Shariat Moharari; Maryam Hatam; Pardis Emami; Mohamadreza Neishaboury; Seyed Hamidreza Sharifnia; Farhad Etezadi; Mohammad Shirani; Atabak Najafi; Pejman Pourfakhr

doi:10.18502/acta.v61i9.15280

Reza Shariat Moharari Department of Anesthesiology and Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
Maryam Hatam Department of Anesthesiology and Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
Pardis Emami Department of Anesthesiology and Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
Mohamadreza Neishaboury Department of Anesthesiology and Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
Seyed Hamidreza Sharifnia Department of Anesthesiology and Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
Farhad Etezadi Anesthesia, Critical Care and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Iran
Mohammad Shirani Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
Atabak Najafi Department of Anesthesiology and Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
Pejman Pourfakhr Anesthesia, Critical Care and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Iran

DOI: https://doi.org/10.18502/acta.v61i9.15280

Keywords: : Hemodinamic monitoring; Lithium dilution cardiac output (LiDCO); Craniotomy; Mannitol; Hypertonic sodium

Abstract

In craniotomy surgery, it is important to maintain hemodynamics and prevent the increase of intracranial pressure. Using semi-invasive methods such as LiDCO monitoring is a good option in this situation. This study aimed to evaluate the effectiveness of mannitol and hypertonic sodium on hemodynamic parameters in patients undergoing elective craniotomy. This randomized clinical trial was done on 40 patients of both genders. Patients whose ages were between 18-65 years, who had American Society of Anesthesiologists (ASA) score I and II, and who underwent craniotomy surgery were eligible for this study. Participants were divided into two groups receiving hypertonic sodium and mannitol. Hemodynamic parameters were evaluated before surgery, 20 minutes, and 60 minutes after surgery in both groups, under Lithium dilution cardiac output (LiDCO) monitoring. The results showed that there was no difference between groups in terms of the average fluid intake, the duration of the operation, the amount of urinary output, and the primary hemodynamic characteristics. Significant differences were recorded in the evaluation of hemodynamic parameters. The results demonstrated a reduction in systolic, diastolic, and mean arterial blood pressure during 20 to 60 minutes after mannitol injection compared to hypertonic sodium injection. Additionally, the effectiveness of both therapies on maintaining cardiac function was similar, but the use of mannitol led to a greater decrease in arterial and peripheral vascular resistance. It can be concluded that mannitol may be more effective than hypertonic sodium during craniotomy procedures in terms of reducing blood pressure monitored with LiDCO.