Hypertonic saline or mannitol for brain bulk reduction during intracranial aneurysm surgery?

The aim of this prospective study was to compare the effect of 3.75% HS (GI), 7.5% HS (GII), 20% M (GIII) and placebo (GIV) on lumbar CSF pressure (ICP), brain relaxation (BR), volume of drained CSF (VDCSF), PaCO2, MAP, CPP, diuresis (D), chosen serum and coagulation parameters during intracranial aneurysm clipping under propofol anesthesia. Fifty ASA I-II, Hunt-Hess I-II, Fisher 1-2 patients entered the study. ICP decreased at T15, T30 vs. TO in GII and GI. ICP at T30 was lower in GII vs. GI. BR was greater in GII vs. GIII. VDCSF drained on neurosurgeons request in GII tended to be lower vs. GI, GIII. The data of our study suggest, that HS, especially 7.5% seams to be more effective than M for ICP and BB reduction. HS is safe and more valuable than M for patients after SAH and undergoing operative aneurysms clipping.