Comparison of 4.54% hypertonic saline and 20% mannitol for brain relaxation during auditory brainstem implantation in pediatric patients: a single-center retrospective observational cohort study.
Auditory brainstem implantation
Brain relaxation
Hypertonic saline
Mannitol
Osmotherapy
Pediatrics
Journal
BMC surgery
ISSN: 1471-2482
Titre abrégé: BMC Surg
Pays: England
ID NLM: 100968567
Informations de publication
Date de publication:
29 Oct 2024
29 Oct 2024
Historique:
received:
13
06
2024
accepted:
16
10
2024
medline:
30
10
2024
pubmed:
30
10
2024
entrez:
30
10
2024
Statut:
epublish
Résumé
Mannitol is frequently utilized to achieve intracranial brain relaxation during the retrosigmoid approach for auditory brainstem implantation (ABI). Hypertonic saline (HS) is an alternative for reducing intracranial pressure; however, its application during ABI surgery remains under-investigated. We aimed to compare the efficacy and safety between HS and mannitol for maintaining brain relaxation. This single-center retrospective cohort study included pediatric patients undergoing ABI surgery from September 2020 to January 2022 who received only 4.54% HS or 20% mannitol for brain relaxation. The analysis involved initial doses, subsequent doses, and dosing intervals of the two hyperosmolar solutions, as well as the time elapsed from meningeal opening to the first ABI electrode placement attempt. Additionally, the analysis encompassed electrolyte testing, hemodynamic variables, urine output, blood transfusion, second surgeries, adverse events, intensive care unit length of stay, and 30-day mortality. We analyzed 68 consecutive pediatric patients; 26 and 42 in the HS and mannitol groups, respectively. The HS group exhibited a reduced rate of supplementary use (7.7% vs. 31%) and lower total urine volume. Perioperative outcomes, mortality, and length of intensive care unit stay did not exhibit significant between-group differences, despite transient increases in blood sodium and chloride observed within 2 h after HS infusion. In pediatric ABI surgery, as an osmotherapy for cerebral relaxation, 4.54% HS demonstrated a lower likelihood of necessitating additional supplementation than 20% mannitol. Furthermore, the diuretic effect of HS was weak and the increase in electrolyte levels during surgery was temporary and slight.
Sections du résumé
BACKGROUND
BACKGROUND
Mannitol is frequently utilized to achieve intracranial brain relaxation during the retrosigmoid approach for auditory brainstem implantation (ABI). Hypertonic saline (HS) is an alternative for reducing intracranial pressure; however, its application during ABI surgery remains under-investigated. We aimed to compare the efficacy and safety between HS and mannitol for maintaining brain relaxation.
METHODS
METHODS
This single-center retrospective cohort study included pediatric patients undergoing ABI surgery from September 2020 to January 2022 who received only 4.54% HS or 20% mannitol for brain relaxation. The analysis involved initial doses, subsequent doses, and dosing intervals of the two hyperosmolar solutions, as well as the time elapsed from meningeal opening to the first ABI electrode placement attempt. Additionally, the analysis encompassed electrolyte testing, hemodynamic variables, urine output, blood transfusion, second surgeries, adverse events, intensive care unit length of stay, and 30-day mortality.
RESULTS
RESULTS
We analyzed 68 consecutive pediatric patients; 26 and 42 in the HS and mannitol groups, respectively. The HS group exhibited a reduced rate of supplementary use (7.7% vs. 31%) and lower total urine volume. Perioperative outcomes, mortality, and length of intensive care unit stay did not exhibit significant between-group differences, despite transient increases in blood sodium and chloride observed within 2 h after HS infusion.
CONCLUSIONS
CONCLUSIONS
In pediatric ABI surgery, as an osmotherapy for cerebral relaxation, 4.54% HS demonstrated a lower likelihood of necessitating additional supplementation than 20% mannitol. Furthermore, the diuretic effect of HS was weak and the increase in electrolyte levels during surgery was temporary and slight.
Identifiants
pubmed: 39472910
doi: 10.1186/s12893-024-02639-1
pii: 10.1186/s12893-024-02639-1
doi:
Substances chimiques
Mannitol
3OWL53L36A
Saline Solution, Hypertonic
0
Types de publication
Journal Article
Observational Study
Comparative Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
340Informations de copyright
© 2024. The Author(s).
Références
World report on. Hearing: executive summary. Geneva: World Health Organization Department of Noncommunicable Diseases; 2021.
Egra-Dagan D, van Beurden I, Barber SR, Carter CL, Cunnane ME, Brown MC, Herrmann BS, Lee DJ. Adult Auditory Brainstem Implant Outcomes and Three-Dimensional Electrode Array Position on Computed Tomography. Ear Hear. 2021;42(6):1741–54.
Teagle HFB, Henderson L, He S, Ewend MG, Buchman CA. Pediatric Auditory Brainstem Implantation: Surgical, Electrophysiologic, and Behavioral Outcomes. Ear Hear. 2018;39(2):326–36.
Sennaroglu L, Colletti V, Manrique M, Laszig R, Offeciers E, Saeed S, et al. Auditory brainstem implantation in children and non-neurofibromatosis type 2 patients: a consensus statement. Otol Neurotol. 2011;32(2):187–91.
Colletti V, Carner M, Miorelli V, Guida M, Colletti L, Fiorino F. Auditory brainstem implant (ABI): new frontiers in adults and children. Otolaryngology–head neck Surgery: Official J Am Acad Otolaryngology-Head Neck Surg. 2005;133(1):126–38.
doi: 10.1016/j.otohns.2005.03.022
Fayad JN, Otto SR, Brackmann DE. Auditory brainstem implants: surgical aspects. Adv Otorhinolaryngol. 2006;64:144–53.
Li J, Gelb AW, Flexman AM, Ji F, Meng L. Definition, evaluation, and management of brain relaxation during craniotomy. Br J Anaesth. 2016;116(6):759–69.
Hans P, Bonhomme V. Why we still use intravenous drugs as the basic regimen for neurosurgical anaesthesia. Curr Opin Anaesthesiol. 2006;19(5):498–503.
Dostal P, Dostalova V, Schreiberova J, Tyll T, Habalova J, Cerny V, et al. A comparison of equivolume, equiosmolar solutions of hypertonic saline and mannitol for brain relaxation in patients undergoing elective intracranial tumor surgery: a randomized clinical trial. J Neurosurg Anesthesiol. 2015;27(1):51–6.
Miller’s basics of anesthesia. 2024;41(2):153–4.
DeHoff G, Lau W. Medical management of cerebral edema in large hemispheric infarcts. Front Neurol. 2022;13:857640.
doi: 10.3389/fneur.2022.857640
pubmed: 36408500
pmcid: 9672377
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.
Kochanek PM, Carney N, Adelson PD, Ashwal S, Bell MJ, Bratton S, et al. American Academy of Pediatrics-Section on Neurological Surgery; American Association of Neurological Surgeons/Congress of Neurological Surgeons; Child Neurology Society; European Society of Pediatric and Neonatal Intensive Care; Neurocritical Care Society; Pediatric Neurocritical Care Research Group; Society of Critical Care Medicine; Paediatric Intensive Care Society UK; Society for Neuroscience in Anesthesiology and Critical Care; World Federation of Pediatric Intensive and Critical Care Societies. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents--second edition. Pediatr Crit Care Med. 2012;13 Suppl 1:S1–82.
Kheirbek T, Pascual JL. Hypertonic saline for the treatment of intracranial hypertension. Curr Neurol Neurosci Rep. 2014;14(9):482.
Susanto M, Riantri I. Optimal Dose and Concentration of Hypertonic Saline in Traumatic Brain Injury: A Systematic Review. Medeni Med J. 2022;37(2):203–11.
Li Q, Chen H, Hao JJ, Yin NN, Xu M, Zhou JX. Agreement of measured and calculated serum osmolality during the infusion of mannitol or hypertonic saline in patients after craniotomy: a prospective, double-blinded, randomised controlled trial. BMC Anesthesiol. 2015;15:138.
Tsaousi GG, Pezikoglou I, Nikopoulou A, Foroglou NG, Poulopoulou A, Vyzantiadis TA, et al. Comparison of Equiosmolar Doses of 7.5% Hypertonic Saline and 20% Mannitol on Cerebral Oxygenation Status and Release of Brain Injury Markers During Supratentorial Craniotomy: A Randomized Controlled Trial. J Neurosurg Anesthesiol. 2023;35(1):56–64.
Shackford SR, Bourguignon PR, Wald SL, Rogers FB, Osler TM, Clark DE. Hypertonic saline resuscitation of patients with head injury: a prospective, randomized clinical trial. J Trauma. 1998;44(1):50–8.
Hernández-Palazón J, Doménech-Asensi P, Fuentes-García D, Burguillos-López S, Piqueras-Pérez C, García-Palenciano C. Comparison of 20% mannitol and 3% hypertonic saline for intraoperative brain relaxation during supratentorial brain tumour craniotomy in patients with a midline shift. Neurocirugia (Astur : Engl Ed). 2023;34(6):273–82.
Fang J, Yang Y, Wang W, Liu Y, An T, Zou M, Cheng G. Comparison of equiosmolar hypertonic saline and mannitol for brain relaxation during craniotomies: A meta-analysis of randomized controlled trials. Neurosurg Rev. 2018;41(4):945–56.
Bhatnagar N, Bhateja S, Jeenger L, Mangal G, Gupta S. Effects of two different doses of 3% hypertonic saline with mannitol during decompressive craniectomy following traumatic brain injury: A prospective, controlled study. J Anaesthesiol Clin Pharmacol. 2021;37(4):523–28.
Abdulhamid AS, Ghaddaf AA, Bokhari AF, Alghamdi YA, Alhakami MF, Alaboud AK, Lary A. Equiosmolar hypertonic saline and mannitol for brain relaxation in patients undergoing supratentorial tumor surgery: A systematic review and meta-analysis. Surg Neurol Int. 2022;13:120.
Noij KS, Kozin ED, Sethi R, Shah PV, Kaplan AB, Herrmann B, Remenschneider A, Lee DJ. Systematic Review of Nontumor Pediatric Auditory Brainstem Implant Outcomes. Otolaryngol Head Neck Surg. 2015;153(5):739–50.
Colletti V, Carner M, Fiorino F, Sacchetto L, Miorelli V, Orsi A, Cilurzo F, Pacini L. Hearing restoration with auditory brainstem implant in three children with cochlear nerve aplasia. Otology Neurotology: Official Publication Am Otological Soc Am Neurotology Soc [and] Eur Acad Otology Neurotology. 2002;23(5):682–93.
doi: 10.1097/00129492-200209000-00014
Colletti V, Shannon RV, Carner M, Veronese S, Colletti L. Complications in auditory brainstem implant surgery in adults and children. Otology Neurotology: Official Publication Am Otological Soc Am Neurotology Soc [and] Eur Acad Otology Neurotology. 2010;31(4):558–64.
doi: 10.1097/MAO.0b013e3181db7055
Colletti L, Zoccante L. Nonverbal cognitive abilities and auditory performance in children fitted with auditory brainstem implants: preliminary report. Laryngoscope. 2008;118(8):1443–8.
doi: 10.1097/MLG.0b013e318173a011
pubmed: 18496153
Tsaousi G, Stazi E, Cinicola M, Bilotta F. Cardiac output changes after osmotic therapy in neurosurgical and neurocritical care patients: a systematic review of the clinical literature. Br J Clin Pharmacol. 2018;84(4):636–48.
doi: 10.1111/bcp.13492
pubmed: 29247499
pmcid: 5867072
Prabhakar H, Singh GP, Anand V, Kalaivani M. Mannitol versus hypertonic saline for brain relaxation in patients undergoing craniotomy. Cochrane Database Syst Rev. 2014;2014(7):Cd010026.
pubmed: 25019296
pmcid: 6464030
Lutters B, Koehler PJ, Wijdicks EF. Worth their salt: one hundred years of Hyperosmolar Therapy. Eur Neurol. 2020;83(5):536–41.
doi: 10.1159/000510183
pubmed: 32866954
Liu S, Li L, Luo Z, Wang M, She H, Yu X, et al. Superior effect of hypertonic saline over mannitol to attenuate cerebral edema in a rabbit bacterial meningitis model. Crit Care Med. 2011;39(6):1467–73.
Rozet I, Tontisirin N, Muangman S, Souter MJ, Lee LA, Kincaid MS, et al. Effect of equiosmolar solutions of mannitol versus hypertonic saline on intraoperative brain relaxation and electrolyte balance. Anesthesiology. 2007(0003-3022 (Print)):107:697–704.
Shi J, Tan L, Ye J, Hu L. Hypertonic saline and mannitol in patients with traumatic brain injury: A systematic and meta-analysis. Medicine (Baltimore). 2020;99(35):e21655.
Adrogué HJ, Madias NE. Hyponatremia. N Engl J Med. 2000;342(21):1581–9.
Kim MY, Park JH, Kang NR, Jang HR, Lee JE, Huh W, Kim YG, Kim DJ, Hong SC, Kim JS, Oh HY. Increased risk of acute kidney injury associated with higher infusion rate of mannitol in patients with intracranial hemorrhage. J Neurosurg. 2014;120(6):1340–8.
doi: 10.3171/2013.12.JNS13888
pubmed: 24484224
Narayan SW, Castelino R, Hammond N, Patanwala AE. Effect of mannitol plus hypertonic saline combination versus hypertonic saline monotherapy on acute kidney injury after traumatic brain injury. J Crit Care. 2020;57:220–4.
doi: 10.1016/j.jcrc.2020.03.006
pubmed: 32220771
Shao L, Hong F, Zou Y, Hao X, Hou H, Tian M. Hypertonic saline for brain relaxation and intracranial pressure in patients undergoing neurosurgical procedures: a meta-analysis of randomized controlled trials. PLoS ONE. 2015;10(1):e0117314.
doi: 10.1371/journal.pone.0117314
pubmed: 25635862
pmcid: 4311961
Shao L, Hong F, Zou Y, Hao X, Hou H, Tian M. Hypertonic saline for brain relaxation and intracranial pressure in patients undergoing neurosurgical procedures: a meta-analysis of randomized controlled trials. PLoS One. 2015;10(1):e0117314.
Kumar AB, Shi Y, Shotwell MS, Richards J, Ehrenfeld JM. Hypernatremia is a significant risk factor for acute kidney injury after subarachnoid hemorrhage: a retrospective analysis. Neurocrit Care. 2015;22(2):184–91.
doi: 10.1007/s12028-014-0067-8
pubmed: 25231531
Visweswaran P, Massin EK, Dubose TD Jr. Mannitol-induced acute renal failure. J Am Soc Nephrol. 1997;8(6):1028–33.
Froelich M, Ni Q, Wess C, Ougorets I, Härtl R. Continuous hypertonic saline therapy and the occurrence of complications in neurocritically ill patients. Crit Care Med. 2009;37(4):1433–41.
Huan J, Ying C, Zhihua Z, Jacobs AK, JingJie L, Yun L, et al. Auditory brainstem implantation in young children with congenital deafness: case report and literature review. J Shanghai Jiao Tong Univ (Medical Science). 2020;40(10):1324–9.