ABSTRACT
Hyperosmolar therapy remains the keystone in the management of brain edema and raised intracranial pressure (ICP). It is practiced both in the operation theater and in intensive care units. This chapter focuses on the use of two popular hyperosmolar agents, mannitol and hypertonic saline. For achieving brain relaxation in the intraoperative period, hypertonic fluids such as mannitol and hypertonic saline are frequently used. It is by their virtue that water is drawn from intracellular and interstitial compartments into the intravascular compartment, resulting in relaxation of the brain and increased compliance. It is essential that the blood–brain barrier remain intact for the hypertonic fluids to produce their effect on the brain. In a recent review comparing mannitol and hypertonic saline for brain relaxation in patients undergoing craniotomy, hypertonic saline was found to provide better brain relaxation during craniotomy. However, there is lack of evidence on whether hypertonic saline compared to mannitol affects long-term outcomes and mortality.
