Abstract:

To explore the effect of hypertonic saline/hetastarch solution on intracranial pressure in patients undergoing surgery for intracranial tumours. MethodsTwentysix ASA Ⅰ or Ⅱ patients, aged 2871 years and 5089?kg in weight undergoing intracranial tumor removal were randomly divided into two groups (13 in each ):groupⅠwith hypertonic saline/hetastarch solution(HSS40) and group Ⅱ with 20% mannitol (M). All patients were intramuscularly premedicated with 0.1g phenobarbital and 0.5?mg atropine. Under local anesthesia, an epidural catheter (17?G) was inserted into the subarachnoid space at the L34 interspace for measurement of cerebral spinal fluid (CSF) pressure. Anesthesia was induced with 3?μg/kg fentanyl, 4?mg midazolam, 0.3?mg/kg etomidate and 0.1?mg/kg vecuronium. Then patients were mechanically ventilated (VT=10?mL/kg,RR=12?bpm,I∶E=1∶2,FiO2=100%). PETCO2 was maintained 3035?mmHg by adjusting the tidal volume and respiratory rate. Anesthesia was maintained with inhalation of 1.5% isoflurane. The left radial artery was cannulated for BP monitoring and blood sampling. The right internal jugular vein was cannulated for CVP monitoring. HSS40 200?mL or 20% mannitol 250?mL was intravenously given over 15?min when the hemodynamics were stable. MAP,HR,CVP and urine output were measured and recorded before HSS40 or mannitol infusion(T0), immediately after infusion(T1) and 15，　30，　60 and 120?min after infusion(T25).　Also CSFP was measured and CPP was calculated. ResultsThere were no significant differences in MAP and HR at all time points between the two groups. As compared with their baseline values at T0, CSFP was significantly decreased at T25 in the HSS40 group and at T35 in the mannitol group, and CVP was significantly increased at T24 in the HSS40 group but decreased at T45 in the M group.CSFP was significantly decreased at T3 and CVP increased at T45 in the HSS40 group as compared with the M group. Urine output was significantly higher after infusion(T25) in the mannitol group than in the HSS40 group. ConclusionHSS40 is more effective than 20% mannitol in reducing CSFP and improving hemodynamics during intracranial tumor removal.

Key words: Saline solution,hypertonic, Hetastarch, Intracranial pressure, Brain neoplasms