PubMed:23354336 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PubMed/sourceid/23354336","sourcedb":"PubMed","sourceid":"23354336","source_url":"http://www.ncbi.nlm.nih.gov/pubmed/23354336","text":"A comparison of two doses of mannitol on brain relaxation during supratentorial brain tumor craniotomy: a randomized trial.\nBACKGROUND: Twenty percent mannitol is widely used to reduce brain bulk and facilitate the surgical approach in intracranial surgery. However, a dose-response relationship has not yet been established. In this study, we compared the effects of 0.7 and 1.4 g·kg(-1) mannitol on brain relaxation during elective supratentorial brain tumor surgery.\nMETHODS: In this prospective, randomized, double-blind study, we enrolled 80 patients undergoing supratentorial craniotomy for tumor resection. Patients were assigned to receive 0.7 g·kg(-1) (group L) or 1.4 g·kg(-1) (group H) of 20% mannitol at surgical incision. Brain relaxation was assessed immediately after opening of the dura on a scale ranging from 1 to 4 (1 = perfectly relaxed, 2 = satisfactorily relaxed, 3 = firm brain, 4 = bulging brain).\nRESULTS: There was no significant difference between the 2 groups regarding age, sex, body mass index, and brain tumor localization or size. In group L 52.5% of patients and in group H 77.5% of patients presented a midline shift (P = 0.03). The median scores of brain relaxation (interquantile range) were 2.0 (1.75-3) and 2.0 (1-3) (P = 0.16 for patients in group L and H, respectively). We then used a proportional odds model to adjust for this unbalanced distribution and to assess the group effect (low-dose versus high-dose mannitol) on brain relaxation scores. When adjusted for the presence of midline shift, the use of a higher dose of mannitol resulted in an odds ratio of 2.5 (P = 0.03). This indicates that, considering the effect of a midline shift, the odds of having a 1-level improvement in relaxation score in patients who received a higher dose of mannitol (group H) was 2.5 times as large as the odds for the low-dose group. The odds ratio of 0.29 (P = 0.007) for the midline shift indicates that its occurrence was associated with a higher probability of a lower relaxation score, on average.\nCONCLUSION: In this study, we show that 1.4 g·kg(-1) of 20% mannitol results in equivalent brain relaxation scores as 0.7 g·kg(-1) in patients undergoing craniotomy for supratentorial brain tumor. When corrected for the presence of midline shift, this study reveals that patients in the high-dose group had significantly more chances of obtaining a better relaxation score compared with the lower-dose group.","tracks":[{"project":"PubmedHPO","denotations":[{"id":"T1","span":{"begin":455,"end":460},"obj":"HP_0002664"}],"attributes":[{"subj":"T1","pred":"source","obj":"PubmedHPO"}]},{"project":"Linmchun_800_3","denotations":[{"id":"T1","span":{"begin":29,"end":37},"obj":"CI"},{"id":"T2","span":{"begin":151,"end":159},"obj":"CI"},{"id":"T3","span":{"begin":389,"end":397},"obj":"CI"},{"id":"T4","span":{"begin":704,"end":712},"obj":"CI"},{"id":"T5","span":{"begin":1566,"end":1574},"obj":"CI"},{"id":"T6","span":{"begin":1787,"end":1795},"obj":"CI"},{"id":"T7","span":{"begin":2094,"end":2102},"obj":"CI"},{"id":"T8","span":{"begin":1451,"end":1459},"obj":"CI"},{"id":"T9","span":{"begin":80,"end":91},"obj":"DP"},{"id":"T10","span":{"begin":449,"end":460},"obj":"DP"},{"id":"T11","span":{"begin":1029,"end":1040},"obj":"DP"},{"id":"T12","span":{"begin":2218,"end":2229},"obj":"DP"}],"attributes":[{"subj":"T1","pred":"source","obj":"Linmchun_800_3"},{"subj":"T2","pred":"source","obj":"Linmchun_800_3"},{"subj":"T3","pred":"source","obj":"Linmchun_800_3"},{"subj":"T4","pred":"source","obj":"Linmchun_800_3"},{"subj":"T5","pred":"source","obj":"Linmchun_800_3"},{"subj":"T6","pred":"source","obj":"Linmchun_800_3"},{"subj":"T7","pred":"source","obj":"Linmchun_800_3"},{"subj":"T8","pred":"source","obj":"Linmchun_800_3"},{"subj":"T9","pred":"source","obj":"Linmchun_800_3"},{"subj":"T10","pred":"source","obj":"Linmchun_800_3"},{"subj":"T11","pred":"source","obj":"Linmchun_800_3"},{"subj":"T12","pred":"source","obj":"Linmchun_800_3"}]},{"project":"luoyt2021_800_3","denotations":[{"id":"T1","span":{"begin":29,"end":37},"obj":"CI"},{"id":"T2","span":{"begin":2094,"end":2102},"obj":"CI"},{"id":"T3","span":{"begin":1787,"end":1795},"obj":"CI"},{"id":"T4","span":{"begin":1566,"end":1574},"obj":"CI"},{"id":"T5","span":{"begin":1451,"end":1459},"obj":"CI"},{"id":"T6","span":{"begin":704,"end":712},"obj":"CI"},{"id":"T7","span":{"begin":389,"end":397},"obj":"CI"},{"id":"T8","span":{"begin":151,"end":159},"obj":"CI"},{"id":"T9","span":{"begin":2218,"end":2229},"obj":"DP"},{"id":"T10","span":{"begin":1029,"end":1040},"obj":"DP"},{"id":"T11","span":{"begin":449,"end":460},"obj":"DP"},{"id":"T12","span":{"begin":80,"end":91},"obj":"DP"}],"attributes":[{"subj":"T1","pred":"source","obj":"luoyt2021_800_3"},{"subj":"T2","pred":"source","obj":"luoyt2021_800_3"},{"subj":"T3","pred":"source","obj":"luoyt2021_800_3"},{"subj":"T4","pred":"source","obj":"luoyt2021_800_3"},{"subj":"T5","pred":"source","obj":"luoyt2021_800_3"},{"subj":"T6","pred":"source","obj":"luoyt2021_800_3"},{"subj":"T7","pred":"source","obj":"luoyt2021_800_3"},{"subj":"T8","pred":"source","obj":"luoyt2021_800_3"},{"subj":"T9","pred":"source","obj":"luoyt2021_800_3"},{"subj":"T10","pred":"source","obj":"luoyt2021_800_3"},{"subj":"T11","pred":"source","obj":"luoyt2021_800_3"},{"subj":"T12","pred":"source","obj":"luoyt2021_800_3"}]}],"config":{"attribute types":[{"pred":"source","value type":"selection","values":[{"id":"PubmedHPO","color":"#d293ec","default":true},{"id":"Linmchun_800_3","color":"#93ecb8"},{"id":"luoyt2021_800_3","color":"#ec9e93"}]}]}}