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NEUROSURGICAL ANESTHESIA

The Use of Hypertonic Saline for Treating Intracranial Hypertension After Traumatic Brain Injury

Hayden White^*, David Cook, and Bala Venkatesh

*Department of Anesthesiology, QE II Hospital; and Department of Intensive Care, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia

Address correspondence and reprint requests to Hayden White, QE II Hospital, Kessels Rd., Coopers Plains 33, Queensland 4108, Australia. Address e-mail to htw_white{at}yahoo.com.

The past decade has witnessed a resurgence of interest in the use of hypertonic saline for low-volume resuscitation after trauma. Preliminary studies suggested that benefits are limited to a subgroup of trauma patients with brain injury, but a recent study of prehospital administration of hypertonic saline to patients with traumatic brain injury failed to confirm a benefit. Animal and human studies have demonstrated that hypertonic saline has clinically desirable physiological effects on cerebral blood flow, intracranial pressure, and inflammatory responses in models of neurotrauma. There are few clinical studies in traumatic brain injury with patient survival as an end point. In this review, we examined the experimental and clinical knowledge of hypertonic saline as an osmotherapeutic agent in neurotrauma.

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