Mannitol dose requirements in brain-injured patients

View More View Less
  • 1 Department of Surgery, Division of Neurological Surgery, Department of Anesthesiology, University of California, San Diego, and Veterans Administration Hospital, La Jolla, San Diego, California
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

✓ There is little information as to the optimal use of mannitol. To determine the dose-response relationship, the osmotic gradient required, and the time course of intracranial pressure (ICP) reduction produced by mannitol, eight patients with acute head injury were studied in whom ICP was monitored with a ventriculostomy and found to be elevated. Ventilation was controlled to a pCO2 of 25 ± 3 mm Hg and all were paralyzed with Pavulon. None had received barbiturates. Before mannitol administration the intracranial volume-pressure response was determined. Mannitol was administered as a bolus of 0.25 gm/kg, 0.5 gm/kg, and in six patients, 1 gm/kg, separated by at least 8 hours.

In all patients the ICP reduction with 0.25 gm/kg (41.3 ± 10.2 mm Hg→16.4 ± 5.6, p < 0.01) was equivalent to that achieved with the larger doses. Serum osmolality rises of 10 mOsm or more were associated with a reduction in ICP. Much smaller doses than those previously recommended were effective in reducing the ICP acutely, although at 5 hours there was a trend toward persistent reduction when the larger dose is used. This trend was small and indicates that smaller and more frequent doses are as effective in reducing the ICP while avoiding the risk of osmotic disequilibrium and severe dehydration.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address reprint requests to: Lawrence F. Marshall, M.D., University Hospital, University of California Medical Center, San Diego, P.O. Box 3548, 225 West Dickinson Street, San Diego, California 92103.
  • 1.

    Kühner A, , Roquefeuil B, & Viguie E, et al: The influence of high and low dosages of mannitol 25% in the therapy of cerebral edema, in Schürmann K, , Brock M, & Reulen H-J, et al (eds): Advances in Neurosurgery 1. Brain Edema. Berlin/Heidelberg/New York: Springer-Verlag, 1973, pp 8191 Kühner A, Roquefeuil B, Viguie E, et al: The influence of high and low dosages of mannitol 25% in the therapy of cerebral edema, in Schürmann K, Brock M, Reulen H-J, et al (eds): Advances in Neurosurgery 1. Brain Edema. Berlin/Heidelberg/New York: Springer-Verlag, 1973, pp 81–91

    • Search Google Scholar
    • Export Citation
  • 2.

    Miller JD, & Leech P: Effects of mannitol and steroid therapy on intracranial volume-pressure relationships in patients. J Neurosurg 42:274281, 1975 Burton AC: Physiology and Biophysics of the Circulation: An Introductory Text, ed 2. Chicago: Year Book Medical Publishers, 1972, pp 40

    • Search Google Scholar
    • Export Citation
  • 3.

    Shenkin HA, , Goluboff B, & Haft H: The use of mannitol for the reduction of intracranial pressure in intracranial surgery. J Neurosurg 19:897901, 1962 Shenkin HA, Goluboff B, Haft H: The use of mannitol for the reduction of intracranial pressure in intracranial surgery. J Neurosurg 19:897–901, 1962

    • Search Google Scholar
    • Export Citation
  • 4.

    Stuart FP, , Torres E, & Fletcher R, et al: Effects of single, repeated and massive mannitol infusion in the dog: structural and functional changes in kidney and brain. Ann Surg 172:190204, 1970 Stuart FP, Torres E, Fletcher R, et al: Effects of single, repeated and massive mannitol infusion in the dog: structural and functional changes in kidney and brain. Ann Surg 172:190–204, 1970

    • Search Google Scholar
    • Export Citation
  • 5.

    Wise BL, & Chater N: The value of hypertonic mannitol solution in decreasing brain mass and lowering cerebrospinal-fluid pressure. J Neurosurg 19:10381043, 1962 Wise BL, Chater N: The value of hypertonic mannitol solution in decreasing brain mass and lowering cerebrospinal-fluid pressure. J Neurosurg 19:1038–1043, 1962

    • Search Google Scholar
    • Export Citation
  • 6.

    Wise BL, , Perkins RK, & Stevenson E, et al: Penetration of C14-labelled mannitol from serum into cerebrospinal fluid and brain. Exp Neurol 10:264270, 1964 Wise BL, Perkins RK, Stevenson E, et al: Penetration of C14-labelled mannitol from serum into cerebrospinal fluid and brain. Exp Neurol 10:264–270, 1964

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 1365 620 47
Full Text Views 473 31 1
PDF Downloads 165 7 0
EPUB Downloads 0 0 0