CC BY-NC-ND 4.0 · J Neuroanaesth Crit Care 2016; 03(04): S35-S40
DOI: 10.4103/2348-0548.174733
Conference Proceeding
Thieme Medical and Scientific Publishers Private Ltd.

Fluid management during neurosurgical procedures

Zulfiqar Ali
Department of Anaesthesiology, Division of Neuroanaesthesiology, SKIMS, Srinagar, Jammu and Kashmir, India
,
Hemanshu Prabhakar
1   Department of Neuroanaesthesiology and Critical Care, AIIMS, New Delhi, India
› Author Affiliations
Further Information

Publication History

Publication Date:
05 May 2018 (online)

INTRODUCTION

The perioperative fluid management of neurosurgical patients presents a special challenge to the neuroanaesthesiologists in the perioperative period. These patients receive diuretics such as mannitol and furosemide in the pre-operative period to reduce the intracranial pressure. During the intraoperative period, they may have vasodilatation due to administration of inhalational anaesthetics and depletion of intravascular volume as a result of severe blood loss. The development of diabetes insipidus (DI) or syndrome of inappropriate antidiuretic hormone secretion may further lead to haemodynamic instability. This review will summarise the physical determinants of water movement across the biological membranes and the practical considerations while administering fluids in various cerebral pathologies.

 
  • REFERENCES

  • 1 Starling EH. In: Schaefer E. editor. Textbook of Physiology. London: Caxton; 1898. p. 285-311
  • 2 Fenstermacher JD, Johnson JA. Filtration and reflection coefficients of the rabbit blood-brain barrier. Am J Physiol 1966; 211: 341-6
  • 3 Tommasino C, Moore S, Todd MM. Cerebral effects of isovolemic hemodilution with crystalloid or colloid solutions. Crit Care Med 1988; 16: 862-8
  • 4 Kaieda R, Todd MM, Cook LN, Warner DS. Acute effects of changing plasma osmolality and colloid oncotic pressure on the formation of brain edema after cryogenic injury. Neurosurgery 1989; 24: 671-8
  • 5 Drummond JC, Patel PM, Cole DJ, Kelly PJ. The effect of the reduction of colloid oncotic pressure, with and without reduction of osmolality, on post-traumatic cerebral edema. Anesthesiology 1998; 88: 993-1002
  • 6 Todd MM, Tommasino C, Moore S. Cerebral effects of isovolemic hemodilution with a hypertonic saline solution. J Neurosurg 1985; 63: 944-8
  • 7 Weed LH, McKibben PS. Pressure changes in the cerebrospinal fluid following intravenous injection of solutions of various concentrations. Am J Physiol 1919; 48: 512-30
  • 8 Prough DS, Johnson JC, Poole Jr. GV, Stullken EH, Johnston Jr. WE, Royster R. Effects on intracranial pressure of resuscitation from hemorrhagic shock with hypertonic saline versus lactated Ringer's solution. Crit Care Med 1985; 13: 407-11
  • 9 Scheller MS, Zornow MH, Seok Y. A comparison of the cerebral and hemodynamic effects of mannitol and hypertonic saline in a rabbit model of acute cryogenic brain injury. J Neurosurg Anesthesiol 1991; 3: 291-6
  • 10 Zornow MH, Scheller MS, Shackford SR. Effect of a hypertonic lactated Ringer's solution on intracranial pressure and cerebral water content in a model of traumatic brain injury. J Trauma 1989; 29: 484-8
  • 11 Jungner M, Grände PO, Mattiasson G, Bentzer P. Effects on brain edema of crystalloid and albumin fluid resuscitation after brain trauma and hemorrhage in the rat. Anesthesiology 2010; 112: 1194-203
  • 12 Li N, Statkevicius S, Asgeirsson B, Schött U. Effects of different colloid infusions on ROTEM and Multiplate during elective brain tumour neurosurgery. Perioper Med 2015; 4: 9
  • 13 Rovlias A, Kotsou S. The influence of hyperglycemia on neurological outcome in patients with severe head injury. Neurosurgery 2000; 46: 335-42
  • 14 Wass CT, Lanier WL. Glucose modulation of ischemic brain injury: Review and clinical recommendations. Mayo Clin Proc 1996; 71: 801-12
  • 15 Magnoni S, Tedesco C, Carbonara M, Pluderi M, Colombo A, Stocchetti N. Relationship between systemic glucose and cerebral glucose is preserved in patients with severe traumatic brain injury, but glucose delivery to the brain may become limited when oxidative metabolism is impaired: Implications for glycemic control. Crit Care Med 2012; 40: 1785-91
  • 16 Connolly Jr. ES, Rabinstein AA, Carhuapoma JR, Derdeyn CP, Dion J, Higashida RT. et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: A guideline for healthcare professionals from the American Heart Association American Stroke Association. Stroke 2012; 43: 1711-37
  • 17 Cinotti R, Ichai C, Orban JC, Kalfon P, Feuillet F, Roquilly A. et al. Effects of tight computerized glucose control on neurological outcome in severely brain injured patients: A multicenter sub-group analysis of the randomized-controlled open-label CGAO-REA study. Crit Care 2014; 18: 498
  • 18 Rudehill A, Lagerkranser M, Lindquist C, Gordon E. Effects of mannitol on blood volume and central hemodynamics in patients undergoing cerebral aneurysm surgery. Anesth Analg 1983; 62: 875-80
  • 19 Ravussin P, Abou-Madi M, Archer D, Chiolero R, Freeman J, Trop D. et al. Changes in CSF pressure after mannitol in patients with and without elevated CSF pressure. J Neurosurg 1988; 69: 869-76
  • 20 Vassar MJ, Fischer RP, O'Brien PE, Bachulis BL, Chambers JA, Hoyt DB. et al. A multicenter trial for resuscitation of injured patients with 7.5% sodium chloride. The effect of added dextran 70. The multicenter group for the study of hypertonic saline in trauma patients. Arch Surg 1993; 128: 1003-11
  • 21 Gunnar W, Jonasson O, Merlotti G, Stone J, Barrett J. Head injury and hemorrhagic shock: Studies of the blood brain barrier and intracranial pressure after resuscitation with normal saline solution, 3% saline solution, and dextran-40. Surgery 1988; 103: 398-407
  • 22 Prabhakar H, Singh GP, Anand V, Kalaivani M. Mannitol versus hypertonic saline for brain relaxation in patients undergoing craniotomy. Cochrane Database Syst Rev 2014; 7: CD010026
  • 23 Härtl R, Ghajar J, Hochleuthner H, Mauritz W. Hypertonic/hyperoncotic saline reliably reduces ICP in severely head-injured patients with intracranial hypertension. Acta Neurochir Suppl 1997; 70: 126-9
  • 24 Schwarz S, Schwab S, Bertram M, Aschoff A, Hacke W. Effects of hypertonic saline hydroxyethyl starch solution and mannitol in patients with increased intracranial pressure after stroke. Stroke 1998; 29: 1550-5
  • 25 Scheingraber S, Rehm M, Sehmisch C, Finsterer U. Rapid saline infusion produces hyperchloremic acidosis in patients undergoing gynecologic surgery. Anesthesiology 1999; 90: 1265-70
  • 26 Trumble ER, Muizelaar JP, Myseros JS, Choi SC, Warren BB. Coagulopathy with the use of hetastarch in the treatment of vasospasm. J Neurosurg 1995; 82: 44-7
  • 27 Strauss RG, Stansfield C, Henriksen RA, Villhauer PJ. Pentastarch may cause fewer effects on coagulation than hetastarch. Transfusion 1988; 28: 257-60
  • 28 Mazzoni MC, Borgström P, Arfors KE, Intaglietta M. Dynamic fluid redistribution in hyperosmotic resuscitation of hypovolemic hemorrhage. Am J Physiol 1988; 255 (3 Pt 2) H629-37
  • 29 Kølsen-Petersen JA. Immune effect of hypertonic saline: Fact or fiction?. Acta Anaesthesiol Scand 2004; 48: 667-78
  • 30 Shackford SR, Bourguignon PR, Wald SL, Rogers FB, Osler TM, Clark DE. Hypertonic saline resuscitation of patients with head injury: A prospective, randomized clinical trial. J Trauma 1998; 44: 50-8
  • 31 Velanovich V. Crystalloid versus colloid fluid resuscitation: A meta-analysis of mortality. Surgery 1989; 105: 65-71
  • 32 Finfer S, Bellomo R, Boyce N, French J, Myburgh J, Norton R. SAFE Study Investigators. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med 2004; 350: 2247-56
  • 33 Ali Z, Hassan N, Syed S. Blood transfusion practices in neuroanaesthesia. Indian J Anaesth 2014; 58: 622-8
  • 34 Harrigan MR. Cerebral salt wasting syndrome: A review. Neurosurgery 1996; 38: 152-60
  • 35 Lennihan L, Mayer SA, Fink ME, Beckford A, Paik MC, Zhang H. et al. Effect of hypervolemic therapy on cerebral blood flow after subarachnoid hemorrhage: A randomized controlled trial. Stroke 2000; 31: 383-91
  • 36 Diringer MN, Bleck TP, Claude Hemphill 3rd J, Menon D, Shutter L, Vespa P. et al. Critical care management of patients following aneurysmal subarachnoid hemorrhage: Recommendations from the Neurocritical Care Society's Multidisciplinary Consensus Conference. Neurocrit Care 2011; 15: 211-40
  • 37 Yang YH, Lin JJ, Hsia SH, Wu CT, Wang HS, Hung PC. et al. Central diabetes insipidus in children with acute brain insult. Pediatr Neurol 2011; 45: 377-80
  • 38 Agha A, Sherlock M, Phillips J, Tormey W, Thompson CJ. The natural history of post-traumatic neurohypophysial dysfunction. Eur J Endocrinol 2005; 152: 371-7