BACKGROUND: Hyperosmolar solutions have been used in neurosurgery to reduce brain volume and facilitate surgical exposure. The purpose of this study was to compare the effects of equivolume, equiosmolar solutions of @entity2656 and @entity4372 saline (HS) on brain relaxation, intensive care unit (ICU) and hospital stay, postoperative outcomes and incidence of side-effects in @entity1 undergoing elective supratentorial craniotomy. METHODS: In a randomised, prospective, double-blind study, 60 @entity1 undergoing elective supratentorial craniotomy were randomised 1:1 to receive 3   ml/kg of either 20% @entity2656 or 3% HS. The primary outcome was the surgical condition of the brain assessed by the neurosurgeon using a 4-point scale after opening the dura (1   =   relaxed, 2   =   satisfactory, 3   =   firm and 4   =   bulging). Secondary outcomes were electrolytes, blood gases, plasma osmolality and haemodynamic variables measured at 0 min, 30 min, 2 h and 6 h after infusion. Also, predefined @entity260 , length of ICU and hospital stay were recorded. Appropriate statistical tests were used for comparison; p   <   0.05 was considered significant. RESULTS: There was no difference in brain relaxation [ @entity2656 , 1(1-3) versus HS, 1(1.4) points; p   =   0.55]. @entity1 with brain midline shift showed a worse response to hyperosmolar solutions than those without midline shift: 37% versus 8%, respectively; OR   =   6.6 (95% CI, 1.54-28.83); p   =   0.006. Plasma osmolality increased during the study period (6 h) in both the groups (p   <   0.05 compared with baseline). No significant @entity260 or length of ICU and hospital stay were observed between the groups. CONCLUSIONS: Single doses of 3   ml/kg of 20% @entity2656 and 3% HS are safe and effective for intraoperative brain debulking during elective supratentorial craniotomy, but less effective in @entity1 with pre-existing mass effect and midline shift.

A comparison of equivolume, equiosmolar solutions of @entity4372 saline and XXXX for brain relaxation during elective supratentorial craniotomy.

@entity2656 :: ('MESH:D008353', 'Chemical') :: ['mannitol'] @entity1 :: ('9606', 'Species') :: ['Patients', 'patients'] @entity4372 :: ('MESH:D009122', 'Disease') :: ['hypertonic'] @entity260 :: ('MESH:D011183', 'Disease') :: ['differences in postoperative complications', 'postoperative complications']
@entity2656 :: (MESH:D008353,Chemical) :: ['mannitol']
