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Anesth Analg 1983; 62:875-880
© 1983 International Anesthesia Research Society
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Effects of Mannitol on Blood Volume and Central Hemodynamics in Patients Undergoing Cerebral Aneurysm Surgery

Anders Rudehill, MD, Michael Lagerkranser, MD, Christer Lindquist, MD, PhD, and Emeric Gordon, MD, PhD

Received from the Departments of Anesthesiology and Neurosurgery, Karolinska Hospital, Stockholm, Sweden.

Abstract

The effects on hemodynamics and blood volume of 500 ml of 20% mannitol administered intravenously in 15 min at the beginning of cerebral aneurysm surgery have been studied in 10 patients. Measurements were made before the infusion of mannitol (control) and at 15-min intervals for 1 hr. Control measurements showed normal hemodynamic data, while blood volume was lower than normal (P < 0.001). Immediately after the mannitol infusion cardiac index (25%; P < 0.01), pulmonary capillary wedge pressure (48%; P < 0.001), and blood volume (43%; P < 0.001) increased. Thirty minutes after the mannitol infusion, blood volume had returned to control levels, while the cardiac index and pulmonary capillary wedge pressure decreased 21% (P < 0.01 and P < 0.05, respectively) below control levels. Forty-five minutes after the mannitol infusion, serum osmolality and urine volume remained high. Our data confirm the presence of hypovolemia in patients with subarachnoid hemorrhage and a transient increase in blood volume associated with the infusion of mannitol. The data emphasize, however, that the hemodynamic response is biphasic, with an initial increase in pulmonary capillary wedge pressure and cardiac index, followed by a hypokinetic circulatory pattern with pulmonary capillary wedge pressure and cardiac index below control levels. The hypokinetic state occurred in spite of return of blood volume to control levels, suggesting that redistribution of blood from central to peripheral circulatory compartments had occurred.

Key Words: KIDNEY Diuretics: mannitol • ANESTHESIA Neurosurgical • HEART, Myocardial function: mannitol • BLOOD Volume: mannitol




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H.-J. Priebe
Aneurysmal subarachnoid haemorrhage and the anaesthetist
Br. J. Anaesth., July 1, 2007; 99(1): 102 - 118.
[Abstract] [Full Text] [PDF]


Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 1983 by the International Anesthesia Research Society.