Perbandingan Mannitol 20%, NaCl 3% dan Natrium Laktat Hipertonik terhadap Osmolaritas dan Brain Relaxation Score Pasien Tumor Otak yang menjalani Kraniotomi Pengangkatan Tumor

Dear Mohtar Wirawijaya, Ruli Herman Sitanggang, Tatang Bisri

Abstract


Latar Belakang dan Tujuan: Mannitol membuat relaksasi otak, namun memiliki efek samping berkurangnya volume intravaskuler, peningkatan kembali tekanan intrakranial (rebound) dan gagal ginjal. Penggunaan NaCl 3% dan natrium laktat hipertonik dapat memberikan relaksasi otak yang baik. Tujuan penelitian ini untuk mengetahui peningkatan osmolaritas dan brain relaxation score (BRS) pada pasien yang menjalani kraniotomi pengangkatan tumor dengan menggunakan mannitol 20%, NaCl 3%, dan matrium laktat hipertonik.

Subjek dan Metode: Penelitian merupakan uji klinik terkontrol secara acak terhadap 39 pasien tumor otak yang masing-masing mendapatkan 2,5cc/kgBB mannitol 20%, NaCl 3%, dan natrium laktat hipertonik.
Hasil: Tidak ada perbedaan peningkatan osmolaritas yang signifikan antara ketiga kelompok 1 jam setelah pemberian osmoterapi dan saat durameter dibuka (p>0,05). BRS pada ketiga kelompok memiliki nilai median yang sama besar (2,00), artinya tidak ada perbedaan BRS yang bermakna (p>0,05). Terdapat peningkatan diuresis yang signifikan pada pemberian mannitol 20%, peningkatan klorida pada NaCl 3% dan peningkatan glukosa signifikan pada natrium laktat hipertonik.
Simpulan: Mannitol 20%, NaCl 3%, dan natrium laktat hipertonik memberikan relaksasi otak yang sama dan tidak mengakibatkan perbedaan osmolaritas yang signifikan.

Comparison Between 20% Mannitol, 3% NaCl and Hypertonic Sodium Lactate on Osmolarity and Brain Relaxation Score Brain Tumor Patient underwent Craniotomy Tumor Removal

Background and Objective: Mannitol produce brain relaxation but associated with several side effects such as reduced intravascular volume, rebound in intracranial pressure and kidney failure. The use of 3% NaCl and hypertonic sodium lactate (HSL) may provide brain relaxation. Aim of this study is to examine increased osmolarity and brain relaxation score (BRS) in patient underwent craniotomy using 20% mannitol, 3% NaCl, and hypertonic sodium lactate. 

Subject and Method: This is a randomized control study of 39 brain tumor patients divided into three groups each obtained 2.5cc/kg 20% mannitol, 3% NaCl, and HSL.
Result: there is no significant difference of osmolarity between the three groups 1 hour after administration of osmotherapy and during the opening of durameter (p>0,05). BRS between the three groups have an equivalent median score (2,00), it means no significant difference in BRS (p>0,05). A significantly increased diuresis in the administration of 20% mannitol, increased chloride to 3% NaCl and significant glucose increase in HSL.
Conclusion: Administration of 20% mannitol, 3% NaCl and HSL produce the same brain relaxation and resulted in insignificant osmolarity differences.


Keywords


Brain relaxation score; kraniotomi; mannitol; NaCl 3%; natrium laktat hipertonik; osmolaritas; Brain relaxation score; craniotomy; hypertonic sodium lactate; 20% mannitol; 3% NaCl; osmolarity

Full Text:

PDF

References


Malik ZA, Mir SA, Naqash IA, Sofi KP, Wani AA. A prospective, randomized, double blind study to compare the effects of equiosmolar solutions of 3% hypertonic saline and 20% mannitol on reduction of brain bulk during elective craniotomy for supratentorial brain tumor resection. Anesth Essays Res. 2014;8(3):388–92.

Sankhyan N, Raju KNV, Sharma S, Gulati S. Management of raised intracranial pressure. Indian J Pediatr. 2010;77:1409–16.

Forster N, Engelhard K. Managing elevated intracranial pressure. Curr Opin Anaesthesiol. 2004;17:371–6.

Bisri T. Pengelolaan hipertensi intrakranial. Seri Buku Literasi Anestesiologi Dasar - Dasar Neuroanestesi. Edisi. Bandung: Saga; 2011; 60.

Bisri T. Pengelolaan hipertensi intrakranial. Penanganan Neuroanestesia dan Critical Care Cedera Otak Traumatik. Edisi. Bandung: Fakultas Kedokteran Universitas Padjadjaran; 2012;187.

Torre-Healy A, Marko NF, Weil RJ. Hyperosmolar therapy for intracranial hypertension. Neurocrit Care. 2012;17:117–30.

Silva JM, Neves EF, Santana TC, Ferreira UP, Marti YN, Silva JMC. The importance of intraoperative hyperchloremia. Rev Bras Anestesiol. 2009;59(3):304–13.

Rozet I, Tontisirin N, Muangman S, Vavilala MS, Souter MJ, Lee LA, dkk. Effect of equiosmolar solutions of mannitol versus hypertonic saline on intraoperative brain relaxation and electrolyte balance. Anesth. 2007;107:697–704.

Raghava A, Bidkar PU, Prakash S, Hemavathy B. Comparison of equiosmolar concentrations of hypertonic saline and mannitol for intraoperative lax brain in patients undergoing craniotomy. Surg Neurol Int. 2015;6:73–9.

Rusa R, Zornow MH. Fluid management during craniotomy. Dalam: Cottrell JE, Young WL, penyunting. Cottrell and Young's Neuroanesthesia. Edisi ke-5. Philadelphia: Mosby Elsevier; 2010; 147–52.

Mortazavi MM, Romeo AK, Deep A, Griessenauer CJ, Shoja MM, Tubbs RS, dkk. Hypertonic saline for treating raised intracranial pressure: literature review with meta-analysis. J Neurosurg. 2012;116:210–21.

Bisri T. Dasar - Dasar Neuroanestesi. Seri Buku Literasi Anestesiologi Dasar - Dasar Neuroanestesi. Edisi. Bandung: Saga; 2011;1–11.

Lu Q, Xu M, Zhou JX. Correlation of measured and calculated serum osmolality during mannitol or hypertonic saline infusion in patients after craniotomy: a study protocol and statistical analysis plan for a randomized controlled trial. BMJ open. 2014;4;e004921.

Matsumoto M, Sakabe T. Intracranial pressure monitoring. Dalam: Cottrell JE, Patel P, penyunting. Cottrell and Patel's Neuroanesthesia. Edisi ke-6: Mosby Elsevier; 2017;74–9.

Sharma RM, Setlur R, Swamy MN. Evaluation of mannitol as an osmotherapeutic agent in traumatic brain injuries by measuring serum osmolality. MJAFI. 2011; 67:230–33.

Ichai C, Armando G, Orban J-C, Berthier F, Rami L, Samat-Long C, dkk. Sodium lactate versus mannitol in the treatment of intracranial hypertensive episodes in severe traumatic brain-injured patients. Intensive Care Med. 2008;35(3):471–9.

Ahmad MR, Hanna. Effect of equiosmolar solutions of hypertonic sodium lactate versus mannitol in craniectomy patients with moderate traumatic brain injury. Med J Indonesian. 2014;23(1):30–6.

Llorente G, Mejia MCNd. Mannitol versus hypertonic saline solution in neuroanaesthesia. Rev Colomb Anestesiol. 2015;43(Suppl 1):29–39.




DOI: https://doi.org/10.24244/jni.vol7i1.15

Refbacks

  • There are currently no refbacks.


                                    

 

JNI is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License