Efeitos de soluÃÃo salina hipertÃnica e manitol em coelhos com hipertensÃo intracraniana aguda

AUTOR(ES)

Joacil Carlos da Silva JÃnior

DATA DE PUBLICAÇÃO

2006

RESUMO

Medical management of brain edema and elevated intracranial pressure (ICP) is a crucial challenge in neurosurgical practice. The control of ICP and cerebral perfusion pressure (CPP) is determinant of patient outcomes whatever the involved physiopathological mecanisms. Depending on the cause, the treatments for brain edema fall into three categories: stabilization of the blood brain barrier, depletion of brain water, and surgical decompression. Althoug mannitol is the mainstay of hyperosmolar therapy, there are doubts about the mechanisms of action, ideal doses and administration method. Hypertonic saline (HS) is emerging as an effective alternative to traditional osmotic agents. Experimental elevated ICP (50 mmHg) was induced in rabbits using an intracranial balloon. The effects of mannitol and hypertonic saline (NaCl 10%) was compared in this specific physiopathological model. Twelve animals were divided in three groups (control, HS and mannitol) according to intravenous administration of NaCl 0,9%, NaCl 10% or mannitol 20% five minutes after the elevation of ICP. The doses of NaCl 10% and mannitol 20% were iso-osmolar. During 90 minutes continuous recording of ICP, mean arterial pressure (MAP) and CPP was realized. The control group had a median survive of only 53 minutes, significantly lower than the treated groups (p=0,0002). There was statical difference between mannitol and HS, the NaCl 10% group had lower values of ICP (p=0,0116) and higher values of MAP (p<0,0001) and CPP (p<0,0001). The findings demonstrate higher efficacy of the treatment with NaCl 10% in this comparison with mannitol 20%. The choice of the ideal osmotic agent depends on future clinical studies using iso-osmotic doses of mannitol and HS in specific situations of intracranial hypertension

ASSUNTO(S)

pressÃo intracraniana hypertonic saline ciÃncias da saÃde salina hipertÃnica manitol mannitol intracranial pressure

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