The Effect of Intravenous Therapy with Hypertonic Saline 5% (HTS) in Patients with High Intracranial Pressure, 24 and 48 Hours after the Surgery

Document Type : Original Article (s)

Authors

1 Associate Professor, Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Student of Medicine, School of Medicine AND Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Increased intracranial pressure (ICP) can be life-threatening and is associated with poor prognosis. In these patients, mortality rate and life expectancy would increase by reducing the intracranial pressure. Finding appropriate way to reduce pressure without specific changes in blood electrolytes and blood pressure is essential. This study aimed to evaluate the effect of rehydration with hypertonic saline 5% on intraoperative complications and prognosis in patients with high intracranial pressure.Methods: This study was performed on 90 patients with high intracranial pressure undergone surgery. After skin incision, hypertonic saline 5% was injected intravenously. Electrolytes and vital signs of patients at baseline and at 24 and 48 hours after the surgery were compared. The data were analyzed using ANOVA with repeated measures test.Findings: 54 patients (60%) were men and 36 (40%) were women, with the mean age of 48.1 ± 9.8 years. Administration of hypertonic saline significantly increased sodium level (137.5 to 144.9 mmol/l), potassium level (3.8 to 4.96 mmol/l), the amount of output (1.43 to 3.94 l), systolic blood pressure (104.6 to 127.32 mmHg), diastolic blood pressure (61.58 to 85.13 mmHg) and anion gap (9.34 to 18.8) (P < 0.001 for all).Conclusion: This study showed that the use of hypertonic saline 5% serum in patients with high intracranial pressure who need surgery, improve the electrolyte and vital signs, especially blood pressure, which increases the quality of treatment and consequently reduces mortality rate of the patients.

Keywords


  1. Diringer MN, Zazulia AR. Osmotic therapy: fact and fiction. Neurocrit Care 2004; 1(2): 219-33.
  2. Forsyth LL, Liu-DeRyke X, Parker D, Jr., Rhoney DH. Role of hypertonic saline for the management of intracranial hypertension after stroke and traumatic brain injury. Pharmacotherapy 2008; 28(4): 469-84.
  3. Kerwin AJ, Schinco MA, Tepas JJ, III, Renfro WH, Vitarbo EA, Muehlberger M. The use of 23.4% hypertonic saline for the management of elevated intracranial pressure in patients with severe traumatic brain injury: a pilot study. J Trauma 2009; 67(2): 277-82.
  4. Mortazavi MM, Romeo AK, Deep A, Griessenauer CJ, Shoja MM, Tubbs RS, et al. Hypertonic saline for treating raised intracranial pressure: literature review with meta-analysis. J Neurosurg 2012; 116(1): 210-21.
  5. Paredes-Andrade E, Solid CA, Rockswold SB, Odland RM, Rockswold GL. Hypertonic saline reduces intracranial hypertension in the presence of high serum and cerebrospinal fluid osmolalities. Neurocrit Care 2012; 17(2): 204-10.
  6. Bullock R, Chesnut RM, Clifton G, Ghajar J, Marion DW, Narayan RK, et al. Guidelines for the management of severe head injury. Brain Trauma Foundation. Eur J Emerg Med 1996; 3(2): 109-27.
  7. Qureshi AI, Suarez JI. Use of hypertonic saline solutions in treatment of cerebral edema and intracranial hypertension. Crit Care Med 2000; 28(9): 3301-13.
  8. Torre-Healy A, Marko NF, Weil RJ. Hyperosmolar therapy for intracranial hypertension. Neurocrit Care 2012; 17(1): 117-30.
  9. Tyagi R, Donaldson K, Loftus CM, Jallo J. Hypertonic saline: a clinical review. Neurosurg Rev 2007; 30(4): 277-89.
  10. Valentino AK, Nau KM, Miller DA, Hanel RA, Freeman W. Repeated dosing of 23.4% hypertonic saline for refractory intracranial hypertension. A case report. J Vasc Interv Neurol 2008; 1(4): 113-7.
  11. Ware ML, Nemani VM, Meeker M, Lee C, Morabito DJ, Manley GT. Effects of 23.4% sodium chloride solution in reducing intracranial pressure in patients with traumatic brain injury: a preliminary study. Neurosurgery 2005; 57(4): 727-36.
  12. White H, Cook D, Venkatesh B. The use of hypertonic saline for treating intracranial hypertension after traumatic brain injury. Anesth Analg 2006; 102(6): 1836-46.
  13. Miller RD. Miller's anesthesia. 6th ed. London, UK: Churchill Livingstone; 2005.
  14. Rosner MJ, Rosner SD, Johnson AH. Cerebral perfusion pressure: management protocol and clinical results. J Neurosurg 1995; 83(6): 949-62.
  15. Fortune JB, Feustel PJ, Graca L, Hasselbarth J, Kuehler DH. Effect of hyperventilation, mannitol, and ventriculostomy drainage on cerebral blood flow after head injury. J Trauma 1995; 39(6): 1091-7.
  16. Turner CR, Losasso TJ, Muzzi DA, Weglinski MR. Brain relaxation and cerebrospinal fluid pressure during craniotomy for resection of supratentorial mass lesions. J Neurosurg Anesthesiol 1996; 8(2): 126-32.
  17. Mazdeh MD, Mazaheri SH, Mani Kashani KH. Efficacy of 20% mannitol versus 5% hypertonic saline in clinical improvement of patients afflicated with Stroke (double blind clinical trial). Daneshvar Med 2009; 16(78): 57-62. ]In Persian[.
  18. 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. Anesth Analg 2010; 110(3): 903-7.
  19. 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.
  20. 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 Anesthesiol 1997; 9(4): 329-34.