Effect of 3% Hypertonic Saline and Mannitol on Brain Relaxation during Supratentorial Brain Tumor Surgery

Introduction: Patients with brain tumor usually have increased intracranial pressure due to swelling of the brain tissue. To ease surgical tumor removal, measures are taken to reduce brain swelling, often referred to as brain relaxation. Administration of osmotherapy is one of the interventions used to produce cerebral relaxation in elective neurosurgeries. The objective of the present study is to compare brain relaxation after the administration of hypertonic saline (3%) and mannitol (20%) in patients undergoing supratentorial brain tumor surgery. Materials and Methods: A prospective, case-control study included total 60 patients of ASA I and II between age 18 and 70 years were scheduled for supratentorial brain tumor surgery. Two groups were formed; Group HS received 3% hypertonic saline (3 ml/kg), and Group M received 20% mannitol (0.75 g/kg) via peripheral intravenous line over 30 min before dural opening. Outcome measurements were brain relaxation, fluid input, urine output, and blood loss. Result: Brain relaxation in Group HS was better than those in Group M (P < 0.0017). The mean intraoperative urine output in Group HS was lower 881.0 +/- 112.1 ml as compared to the Group M 1155.0 +/- 145.2 ml (P < 0.05). There were no significant differences in fluid input and blood loss in between the two groups. Conclusion: We conclude that the use of 3% hypertonic saline provides better brain relaxation as compared to 20% mannitol.