Comparison of The Effects of Mannitol After Anesthesia Induction and Skin Incision on Brain Relaxation in Craniotomy: A Randomized Controlled Trial
Abstract
Objective: Effective brain relaxation during craniotomy enhances exposure and minimizes injury. Mannitol reduces intracranial pressure, but the best timing is debated. This study compares 20.0% mannitol administered immediately after anesthesia or at the skin incision on brain relaxation in elective craniotomy patients.
Material and Methods: This randomized controlled trial enrolled 80 patients. Participants received 1.0 g/kg of 20.0% mannitol either immediately after anesthesia induction (Group A, n=40) or at the time of skin incision (Group B, n=40). The primary outcome was the brain relaxation score (BRS), assessed by a blinded neurosurgeon on a four-point scale at the time of durotomy. Secondary outcomes included hemodynamic parameters, electrolyte levels, urine output, and length of stay in the intensive care unit (ICU) and hospital.
Results: Baseline demographic and surgical characteristics were comparable between the two groups (p-value>0.05). Group A demonstrated significantly better brain relaxation compared to Group B, with a mean BRS of 2.02 (S.D. 0.85) versus 2.50 (S.D. 0.73), respectively (p-value=0.004). “Good grade” relaxation (BRS 1–2) was achieved in 73.0% of Group A versus 48.0% in Group B (p-value=0.009). No significant differences were observed in hemodynamic stability, electrolyte imbalances, intraoperative blood loss, or the duration of ICU and hospital stays.
Conclusion: For patients undergoing elective craniotomy for small-to-medium brain tumors, giving 1.0 g/kg of 20.0% mannitol immediately after anesthesia improves brain relaxation more than at the skin incision. This early use enhances surgical conditions without increasing hemodynamic or electrolyte risks.
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