- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01048684
Comparison of Two Doses of Mannitol on Brain Relaxation During Supratentorial Craniotomy
Neuroanesthesia for supratentorial surgery involves a thorough understanding of the physiopathology of intracranial pressure, cerebral homeostasis and regulation of cerebral perfusion pressure as well as the effects of anesthesia and surgery on these elements.
The main objective of anesthesia during neurosurgery is to preserve the integrity of the brain by maintaining cerebral homeostasis, and assuring cerebral protection using normovolemia, normotension, normoglycemia, moderate hyperoxia and hypocapnia and hyperosmolality with the administration of mannitol.
During surgery, the use of surgical retractors must be limited to avoid possible ischemia of the brain tissue. Surgical retractors can be replaced by chemical retractors. The concept of chemical retraction involves a reduction of cerebral blood flow, maintaining cerebral perfusion pressure, moderate hyperventilation, drainage of cerebrospinal fluid and osmotherapy.
Mannitol, an osmotic agent, has been widely used to reduce the volume of the brain, the intracranial pressure and to facilitate the surgical approach in reducing the risk of cortical lesions during the opening of the skull.
Mannitol 20% is usually given intravenously in bolus doses of 0.5-1g/kg over 30 minutes. However, over the last few years, the concept of a dose-response relationship has emerged. Some recent studies tend to demonstrate that higher doses of mannitol could reduce intracranial pressure significantly without any important side effects.
The main objective of the present study is to compare two doses of mannitol (0.7 and 1.4 g/kg) on brain relaxation during supratentorial craniotomies.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
80 patients will be divided in two equal groups (Group 1: to receive 20% mannitol 0.7 g/kg or Group 2: 1.4 g/kg).
The anesthetic technique and monitoring will be standardized. The administration of mannitol will start following the induction of general anesthesia. The infusion will be given intravenously over 30 minutes.
Brain relaxation will be assessed by a senior surgeon at the opening of the dura mater on a scale from 1 to 4 (1= perfectly relaxed, 2= satisfactorily relaxed, 3= firm brain, 4=bulging brain)
If needed, in case of significant cerebral edema, a rescue dose of 20% mannitol 0.25 g/kg will be administered.
Hemodynamic variables (MAP, heart rate), temperature, urine output, perioperative fluid balance, blood loss and laboratory values (blood gases, electrolytes, osmolality, hematocrit, glycemia, lactates) will be collected immediately prior to the infusion of mannitol and at 30, 60, 180 minutes following the administration of mannitol.
The type of cerebral lesion, its location and size (in 3 dimensions) will be noted. The presence of a median-line shift will also be assessed.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
Quebec
-
Montreal, Quebec, Canada, H2L 4M1
- Centre Hospitalier de l'Université de Montréal-Hôpital Notre-Dame
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Patients aged 18 or older
- Patients who are to undergo an elective supratentorial craniotomy
- Physical status ASA I to IV inclusive.
Exclusion Criteria:
- Pregnancy
- Severe congestive heart failure
- Severe chronic renal failure
- Recent use (less than 24 hours before surgery)of mannitol or other hypertonic solution
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: 20% Mannitol 0.7 g/kg (low-dose)
Study subjects will be randomized to receive an infusion of 20% mannitol 0.7g/kg over 30 minutes after induction of general anesthesia.
|
Variation of mannitol dose
|
Experimental: 20% Mannitol 1.4 g/kg (high dose)
Study subjects will be randomized to receive an infusion of 20% mannitol 1.4 g/kg over 30 minutes after induction of general anesthesia.
|
Variation of mannitol dose
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Brain relaxation at the opening of the dura mater assessed by a senior surgeon on a scale from 1 to 4 (1= perfectly relaxed, 2= satisfactorily relaxed, 3= firm brain, 4=bulging brain)
Time Frame: At the opening of the dura mater
|
At the opening of the dura mater
|
Secondary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Hemodynamic variables: MAP, heart rate
Time Frame: Immediately prior to the infusion of mannitol and at 30, 60, 180 minutes after the administration of mannitol
|
Immediately prior to the infusion of mannitol and at 30, 60, 180 minutes after the administration of mannitol
|
Temperature
Time Frame: Immediately prior to the infusion of mannitol and at 30, 60, 180 minutes after the administration of mannitol
|
Immediately prior to the infusion of mannitol and at 30, 60, 180 minutes after the administration of mannitol
|
Urine output
Time Frame: Immediately prior to the infusion of mannitol and at 30, 60, 180 minutes after the administration of mannitol
|
Immediately prior to the infusion of mannitol and at 30, 60, 180 minutes after the administration of mannitol
|
Perioperative fluid balance and blood loss
Time Frame: Immediately prior to the infusion of mannitol and at 30, 60, 180 minutes after the administration of mannitol
|
Immediately prior to the infusion of mannitol and at 30, 60, 180 minutes after the administration of mannitol
|
Laboratory data: blood gases, electrolytes, osmolality, hematocrit, glycemia, lactates
Time Frame: Immediately prior to the infusion of mannitol and at 30, 60, 180 minutes after the administration of mannitol
|
Immediately prior to the infusion of mannitol and at 30, 60, 180 minutes after the administration of mannitol
|
Collaborators and Investigators
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- FG2010-003
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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