Equilíbrio Hidroeletrolítico e relaxamento cerebral com salina isoncótica hipertônica versus manitol (20%) durante neuroanestesia eletiva

Walkíria Wingester Vilas Boas; Mirna Bastos Marques; Atos Alves

doi:10.1590/S0034-70942011000400007

Artigo Científico

Equilíbrio Hidroeletrolítico e relaxamento cerebral com salina isoncótica hipertônica versus manitol (20%) durante neuroanestesia eletiva

Hydroelectrolytic balance and cerebral relaxation with hypertonic isoncotic saline versus mannitol (20%) during elective neuroanesthesia

Walkíria Wingester Vilas Boas; Mirna Bastos Marques; Atos Alves

http://dx.doi.org/10.1590/S0034-70942011000400007 Braz J Anesthesiol, vol.61, n4, p.462-468, 2011

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Resumo

JUSTIFICATIVA E OBJETIVOS: É necessário proceder a relaxamento cerebral durante cirurgia intracraniana e a terapia hiperosmolar é uma das medidas para sua produção. Com frequência, pacientes neurocirúrgicos apresentam distúrbios de sódio. O objetivo deste trabalho foi quantificar e determinar o relaxamento cerebral e a duração das alterações hidroeletrólíticas decorrentes do uso do manitol versus solução isoncótica hipertônica (SIH) durante neurocirurgia. MÉTODO: Foram avaliados relaxamento cerebral e alterações hidroeletrolíticas de 29 pacientes adultos antes, 30 e 120 minutos após o término da infusão de carga aproximadamente equiosmolar de manitol 20% (250 mL) ou SIH (120 mL). Registraram-se volume de líquidos intravenosos infundidos e diurese. Considerou-se p < 0,05 como significativo. RESULTADOS: Não houve diferença estatística significativa entre os dois grupos quanto ao relaxamento cerebral. Embora várias diferenças nos eletrólitos e no equilíbrio ácido-básico com o uso de manitol ou SIH tenham alcançado significância estatística, apenas a redução do sódio plasmático, 30 minutos após o uso do manitol, em média de 6,42 ± 0,40 mEq.L-1 e a elevação do cloro em média 5,41 ± 0,96 mEq.L-1 e 5,45 ± 1,45 mEq.L-1, 30 e 120 minutos, respectivamente, após a SIH deslocaram transitoriamente os níveis séricos desses íons da faixa de normalidade laboratorial. O grupo do manitol (20%) apresentou diurese significativamente maior nos dois tempos estudados em comparação com o grupo da SIH. CONCLUSÕES: Solução salina isoncótica hipertônica [NaCl 7,2%/HES (200/0,5) 6%] e manitol (20%), em dose única com cargas osmolares equivalentes, foram efetivos e seguros em produzir relaxamento cerebral durante os procedimentos neurocirúrgicos eletivos sob anestesia geral.

Palavras-chave

CIRURGIA, DROGAS, DROGAS, METABOLISMO

Abstract

BACKGROUND AND OBJECTIVE: Cerebral relaxation during intracranial surgery is necessary, and hiperosmolar therapy is one of the measures used to this end. Frequently, neurosurgical patients have sodium imbalances. The objective of the present study was to quantify and determine cerebral relaxation and duration of hydroelectrolytic changes secondary to the use of mannitol versus hypertonic isoncotic solution (HIS) during neurosurgery. METHODS: Cerebral relaxation and hydroelectrolytic changes were evaluated in 29 adult patients before de beginning of infusion, and 30 and 120 minutes after the infusion of equiosmolar loads of approximately 20% mannitol (250 mL) or HIS (120 mL). The volume of intravenous fluids infused and diuresis were recorded. A p < 0.05 was considered significant. RESULTS: A statistically significant difference in cerebral relaxation between both groups was not observed. Although several changes in electrolyte levels and acid-base balance with mannitol or HIS reached statistical significance only the reduction in plasma sodium 30 minutes after infusion of mannitol, mean of 6.42 ± 0.40 mEq.L-1, and the increase in chloride, mean of 5.41 ± 0.96 mEq.L-1 and 5.45 ± 1.45 mEq.L-1 30 and 120 minutes after infusion of HIS, caused a transitory dislocation of serum ion levels from normal range. The mannitol (20%) group had a significantly greater diuresis at both times studied compared with HIS group. CONCLUSIONS: A single dose of hypertonic isoncotic saline solution [7.2% NaCl/6% HES (200/0.5)] and mannitol (20%) with equivalent osmolar loads were effective and safe in producing cerebral relaxation during elective neurosurgical procedures under general anesthesia.

Keywords

Saline Solution, Hypertonic, Mannitol, Water-Electrolyte Imbalance, Neurosurgery

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Equilíbrio Hidroeletrolítico e relaxamento cerebral com salina isoncótica hipertônica versus manitol (20%) durante neuroanestesia eletiva

Hydroelectrolytic balance and cerebral relaxation with hypertonic isoncotic saline versus mannitol (20%) during elective neuroanesthesia

Walkíria Wingester Vilas Boas; Mirna Bastos Marques; Atos Alves

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