Made Visvayoni Wisescistiati, Gde Candra Yogiswara, I Wayan Suranadi

Effectiveness of hypertonic saline compared to mannitol in craniotomy patients with elevated intracranial pressure under general anesthesia: a systematic review and meta-analysis

Introduction

Effectiveness of hypertonic saline compared to mannitol in craniotomy patients with elevated intracranial pressure under general anesthesia: a systematic review and meta-analysis. Meta-analysis shows hypertonic saline (HS) significantly reduces intracranial pressure and improves brain relaxation in craniotomy patients with elevated ICP, outperforming mannitol.

Abstract

Introduction: Elevated intracranial pressure (ICP) is linked to decreased survival rates, increased death, and poor neurologic outcomes. Mannitol has long been considered the gold standard for managing high intracranial pressure, but its adverse effects are still debated. Hypertonic saline can be used as a rescue treatment for elevated ICP. However, the scope of these studies is limited, and the findings have been inconsistent. The purpose of this study was to examine the efficacy of hypertonic saline (HS) and mannitol in craniotomy patients with high intracranial pressure while under general anaesthesia. Methods: This study was conducted using the PRISMA methodology. PubMed, ScienceDirect, Google Scholar, Cochrane Library, SpringerLink, and Ebsco were all used to conduct literature searches. The Review Manager 5.4 software was used to analyse ICP reduction, brain relaxation score, Mean Arterial Pressure (MAP), Cerebral Perfusion Pressure (CPP), sodium level, and length of stay after quality assessment using the Newcastle-Ottawa Scale (NOS) and Cochrane Risk-of-bias, as well as data extraction. Results: A total of 423 patients from 8 studies were included in our meta-analysis. This meta-analysis indicated that ICP reduction in patients receiving HS was significantly better than in patients receiving mannitol (mean difference: 1.38, 95%CI: 0.31-2.45, p=0.001). In terms of brain relaxation score, HS showed significantly better than mannitol (OR: 2.22, 95%CI: 1.13-4.35, p=0.02). There was no difference in the MAP (mean difference: 3.47, 95%CI: -0.18-7.11, p=0.06), CPP (mean difference: 2.41, 95%CI: -1.75-6.58, p=0.26), natrium (mean difference -3.36, 95%CI: -9.26-2.53, p=0.26), and length of stay (mean difference: -0.12, 95%CI: -0.55-0.32, p=0.60) between groups. Conclusion: HS showed significantly better results in the ICP reduction and brain relaxation score than mannitol. However, HS and mannitol had similar effects in MAP, CPP, natrium, and length of stay.

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